Background Information:

What are the other Names for the Procedure?

• Thrombolysis using Catheter

What is Catheter-Directed Thrombolysis radiology procedure? (General Explanation)

• Catheter-Directed Thrombolysis is a minimally-invasive procedure to remove or dissolve blood clots, for improving blood flow to a vital organ
• A thrombosis or embolization (blood clot) can be life-threatening; it may even lead to the loss of an organ

What part of the Body does the Procedure involve?

A Catheter-Directed Thrombolysis procedure involves most areas of the body; it is based on the target area that needs to be examined.

Why is the Catheter-Directed Thrombolysis radiology procedure Performed?

The Catheter-Directed Thrombolysis procedure is performed to remove blood clots, which arises from:

• Pulmonary embolism
• Thrombosis of mesenteric veins or portal veins
• Narrowing of arteries, due to atherosclerosis
• Deep vein thrombosis, where the clot is formed in a main vein
• Thrombolysis of dialysis fistulas or grafts

What is the Equipment used? (Description of Equipment)

The equipment used for a Catheter-Directed Thrombolysis procedure consists of the following:

• A catheter - a long, thin, hollow plastic tube
• Various embolic agents
• An X-ray camera
• An examination table
• An X-ray tube
• A computer monitor to view the images
• Fluoroscopy is used to convert X-ray images into video images

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Catheter-Directed Thrombolysis procedure.

What is the Cost of performing the Catheter-Directed Thrombolysis radiology procedure?

The cost of the Catheter-Directed Thrombolysis procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Catheter-Directed Thrombolysis procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=thrombo (accessed on 08/02/2014)

Prior to Catheter-Directed Thrombolysis radiology procedure:

How does the Catheter-Directed Thrombolysis radiology procedure work?

The Catheter-Directed Thrombolysis procedure works in the following manner:

• Contrast material and an X-ray machine are used to visualize the blood vessels
• A catheter is inserted into the blood vessel and sent to the site of treatment
• Once the catheter reaches the site of thrombosis, medication is injected into the site of abnormality, which helps in dissolving the clot

How is the Catheter-Directed Thrombolysis radiology procedure Performed?

The Catheter-Directed Thrombolysis procedure is performed in the following manner:

• The patient is positioned on the examination table
• The area of the catheter’s site is cleaned and sterilized and an intravenous (IV) line is inserted into the patient’s arm to give sedative medication, during the procedure
• A catheter is inserted into the clean area and sent to the treatment site
• A contrast material is injected through the catheter and the x-ray machine is used to visualize the site of the clot
• After the clot is visualized, the clot is removed by a mechanical device, or by delivering suitable medication to dissolve the clot
• Both the catheter and IV lines are removed at the end of the procedure; no stitches are required

Where is the Procedure Performed?

The Catheter-Directed Thrombolysis procedure is performed as an inpatient procedure, at a hospital.

Who Performs the Procedure?

The Catheter-Directed Thrombolysis procedure is usually performed by a radiologist or a vascular surgeon.

How long will the Procedure take?

A Catheter-Directed Thrombolysis Procedure will take about 1-2 hours to complete.

Who interprets the Result?

An interventional radiologist interprets the result of the Catheter-Directed Thrombolysis procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Catheter-Directed Thrombolysis:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the procedure
• It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
• The patient must avoid eating or drinking at least 8 hours prior to the procedure, depending on when the procedure is arranged
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, before the preparation sessions
• The patient may be asked to stop taking certain medications, such as aspirin or other blood thinning medicines, the midnight before the procedure
• The patients are required to be admitted to the hospital; they may have to stay for several days at the hospital

What is the Consent Process before the Procedure?

A physician will request your consent for a Catheter-Directed Thrombolysis procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Catheter-Directed Thrombolysis procedure:

• Thrombolysis with a catheter is safe and less-invasive procedure than an open surgery
• It requires significantly lesser hospital stay; also complications are much lesser, than those occurring with other methods
• It is very effective in removing clots, re-establishing blood flow and in eliminating the related symptoms

Following are the risks of the Catheter-Directed Thrombolysis procedure:

• The catheter used in the procedure may sometimes damage the blood vessel(s)
• By using a thrombolytic agent, there is a risk of bleeding in the body. If bleeding occurs in the head, it may cause some major problems
• Sometimes, a clot may move to other sites in the vascular system. This may require surgery, if it cannot be removed using thrombolysis
• The contrast material used in the procedure may cause allergic reactions in some patients. Contrast material may also damage the kidney, especially in diabetic patients, or in patients with kidney disease
• Any procedure, where the skin is penetrated carries a risk of infection. Although, the probability of an infection requiring antibiotic treatment, is less than 1 per 1,000 procedures

What are the Limitations of the Catheter-Directed Thrombolysis radiology procedure?

The success of the Catheter-Directed Thrombolysis radiology procedure depends on a number of factors, such as:

• Closeness of the catheter tip to blood clot
• The strength of the blood clot
• Whether the clot breaking medication is able to reach the blood clot
• The size of the blood clot

Further, the blood clot may already cause tissue damage, which may not be able to be reversed.

Breaking down the clot using the Catheter-Directed Thrombolysis radiology procedure will not cure the underlying condition that cause the blood clot formation. Treatment of the underlying cause of the clot formation is necessary.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is the Catheter-Directed Thrombolysis procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the biopsy procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Catheter-Directed Thrombolysis radiology procedure:

What is to be expected during the Catheter-Directed Thrombolysis radiology procedure?

The following may be expected during the Catheter-Directed Thrombolysis procedure:

• The patient may feel some pain, due to needle insertion into the skin
• Slight pressure may be experienced, when the catheter is inserted
• A heart rate monitor and blood pressure cuff will be attached to the patient’s body
• A warm feeling may be experienced, when contrast material is injected
• Side effects of thrombolysis are painful, but can be controlled through medications

What kind of Anesthesia is given, during the Procedure?

Usually, local anesthesia will be injected to numb the path of the needle, during the Catheter-Directed Thrombolysis procedure. In some cases, general anesthesia may be needed.

How much Blood will you lose, during the Procedure?

There is only a minimal loss of blood during the Catheter-Directed Thrombolysis procedure.

What are the possible Risks and Complications during the Catheter-Directed Thrombolysis radiology procedure?

Following are the possible risks of the Catheter-Directed Thrombolysis procedure:

• The catheter used in the procedure may sometimes damage the blood vessels
• By using a thrombolytic agent, there is a risk of bleeding in the body. If bleeding occurs in the head, it could cause some severe complications
• Sometimes, a clot may move to the other sites, within the vascular system. These may have to be removed by surgery, if it cannot be removed by the thrombolysis procedure
• The contrast material used in the procedure may cause allergic reactions in some patients. The contrast material may also damage the kidney, especially in diabetics, or in those with kidney disease
• During the procedure, there is a slight risk of infection, since the skin is penetrated by a needle. However, this risk is very low; it is less than 1 in 1000 procedures

What Post-Operative Care is needed at the Healthcare Facility after the Catheter-Directed Thrombolysis radiology procedure?

There is no postoperative care necessary after the Catheter-Directed Thrombolysis procedure, at the healthcare facility.

After the Catheter-Directed Thrombolysis radiology procedure:

What is to be expected after the Catheter-Directed Thrombolysis radiology procedure?

The patient may feel sore in the area of the procedure for a few days, after a Catheter-Directed Thrombolysis.

When do you need to call your Physician?

If the patient experiences any infection at the needle site; then, do contact the physician.

What Post-Operative Care is needed at Home after the Catheter-Directed Thrombolysis radiology procedure?

There is no postoperative care necessary after the Catheter-Directed Thrombolysis procedure.

How long does it normally take to fully recover, from the Procedure?

Individuals may resume their normal activities the day after the Catheter-Directed Thrombolysis radiology procedure is performed.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue clot is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The clot tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Radiologist or vascular surgeon, performing the procedure
• A pathologist
• Healthcare providers, physicians, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Catheter-Directed Thrombolysis procedure is performed.