Dialysis Thrombolysis

Using image-guided technology and contrast dye (dye inserted to make the clot visible), a catheter is inserted and moved through the vein to the site of the clot. The clot is then either dissolved with medication delivered to the clot itself or through the use of a device that breaks up the clot. In some cases both methods of destroying the clot are used.

When you arrive for your procedure a nurse will greet you and let the team know you’ve arrived. You will be brought into an exam room and asked to change into a gown. Your doctor will greet you, explain the procedure and answer any questions you may have.

You will lie on an exam table for the procedure. The technologist or nurse will connect monitors for your heart rate, blood pressure, and pulse, and an intravenous (IV) line will be inserted into a vein in your hand or arm. This will be used to give you sedatives during the procedure. Some patients receive general anesthesia, but in most cases, this is not necessary.

The technologist will shave, sterilize, and cover the area of your body where a catheter will be inserted with a surgical drape. The area will then be numbed using a local anesthetic. You may feel a tiny pinch when the anesthesia is administered. The radiologist will make a very small nick, and you may feel some pressure as the catheter is inserted, but you won’t feel any serious discomfort. Using X-ray image-guidance and contrast dye to locate the clot, the catheter will be manipulated to the vein.

Once the catheter is in place and the dye has been injected to locate the clot, the clot will be treated either by medication or a mechanical device will be used to break it up. If it is treated by medication the catheter may need to remain in place for several days. If it is treated with a device the procedure may take only an hour. Most patients do not require overnight stay in the hospital.

Once the procedure is complete, the catheter will be removed. Your IV line will be removed as well. Your doctor will apply pressure to stop any bleeding and cover the area with a bandage. You will not need stitches.

If you do not require an overnight stay you will be sent home when you have recovered and feel ready. You may feel some pain following the procedure and this can usually be treated with over-the-counter pain medications. You should discuss this with your physician.

Your doctor will discuss any limitations you may have to your daily activities.

You should call your doctor if you have any bleeding, fever, swelling or drainage at the catheter insertion site.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. For example, you may want to arrange to have someone drop you off on the day of your procedure and pick you up after your hospital stay – usually a few days. You might like to keep a list of questions or — as you’re doing now — educate yourself about the procedure.

Some other things to keep in mind in planning for this procedure include:

• Wear loose, comfortable clothing to the procedure.
• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin or warfarin) for a time before the procedure.
• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a nurse from your doctor’s office will call you. The nurse will give you any additional instructions, and will ask if you have any questions.
• When you arrive, make sure the nurse and radiologist know about any allergies you may have, especially allergies to local anesthetics, such as lidocaine. If there’s any chance you may be pregnant, tell your physician

On the day of your procedure you should:

• Wear comfortable, loose-fitting clothes
• Wear comfortable shoes
• Avoid bringing jewelry or valuables

The benefits of a thrombolysis procedure may include:

• High success rates in removing blood clots in dialysis access sites, allowing for continuation of dialysis treatment
• A safe, non-surgical method for treating clots
• Most patients do not require hospital stays and can resume regular activities quickly

Some risks that you should be aware of include:

• As with any procedure there is a slight risk of infection. This is rare.
• Slight risk of allergic reaction to the contrast dye used during the procedure.
• As with any procedure that involves a catheter placed inside a blood vessel, there is potential for damage to the blood vessel, bruising or bleeding at the puncture site.
• There is a slight risk that bleeding will occur in another part of your body due to the use of anticoagulant medications.
• There is a slight risk that the clot may move elsewhere in your blood vessels. This may be treated with another thrombolysis procedure but sometimes requires surgery to be treated
• There is a risk of kidney damage
• Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.