How is a thrombolysis procedure performed?
A thorough history and physical examination of the patient are performed. Particular attention should be given to any prior surgeries described in the history. Understanding the patient’s vascular anatomy is of paramount importance for planning access and intervention. Prior arteriograms, if available, should be reviewed. These may also help in the planning of the access site and in determining an appropriate end point for the procedure. Comparison to a baseline physical examination is essential for monitoring the patient’s progress or deterioration during the procedure. After laboratory findings are reviewed and patient informed consent has been obtained, a thorough diagnostic arteriogram is performed. The patient is given heparin, and a sheath is placed. The thrombosed segment is crossed with a wire, and an infusion catheter is placed across the clot. Lytic agents are infused continuously through the catheter, and the patient is sent to the intensive care unit for monitoring. Every 12 to 24 hours, the patient is brought back to the interventional suite for a follow-up arteriogram. Sometimes, mechanical thrombolysis devices are also used to help remove the clot. When the clot has resolved, the underlying lesion is treated.
