Catheter-directed thrombolysis is a procedure to remove a blood clot (thrombus) from inside a blood vessel. A blood clot inside a blood vessel can block blood flow or break away and travel to another area of the body, which can cause severe problems such as heart attack or stroke. You may have this procedure to treat:

  • A clot blocking the blood flow in your arm or leg (limb ischemia).

  • A clot in a large vein (deep vein thrombosis).

  • A blockage in a dialysis graft.

  • A clot in the blood flow to your lungs (pulmonary embolism).

Tell a health care provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Any problems you or family members have had with anesthetic medicines.

  • Any blood disorders you have.

  • Any surgeries you have had.

  • Any medical conditions you have.

  • Whether you are pregnant or may be pregnant.

  • Whether you are breastfeeding.

  • Any recent injuries, such as a car accident or fall.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Bleeding at the catheter site or other places in the body. Bleeding in the brain is a rare but serious complication.

  • Movement of the clot, requiring more treatment.

  • Allergic reactions to medicines or dyes.

  • Infection.

  • Bruising or swelling.

  • Damage to blood vessels.

  • Damage to the kidneys from the contrast dye.

What happens before the procedure?

Staying hydrated

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Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.

  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.

  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.

  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.

  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.

  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

Tests

You may have:

  • Blood tests to check how well your blood clots.

  • Tests to check your kidney function.

General instructions

  • Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.

  • Plan to have someone take you home from the hospital or clinic.

  • Ask your health care provider what steps will be taken to help prevent infection. These may include washing your skin with a germ-killing soap.

What happens during the procedure?

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  • An IV will be inserted into one of your veins.

  • You will be given one or more of the following:

    • A medicine to help you relax (sedative).

    • A medicine to numb the surgical area (local anesthetic). This is given as an injection near the incision.

    • A medicine to make you fall asleep (general anesthetic).

  • A small incision will be made in your groin area or in your wrist.

  • A catheter will be placed through the incision and into a blood vessel that leads to the clot.

  • The catheter will be moved through the blood vessel toward the clot.

  • A dye, also called contrast dye, will be injected through the catheter as it is moved forward. A type of X-ray (fluoroscopy) will be done to guide the movement of the catheter. The dye makes the catheter easy to see during imaging.

  • When the catheter reaches the clot, your health care provider will break up the clot by doing one of the following:

    • Injecting a clot-dissolving medicine through the catheter.

    • Threading a device through the catheter and using that device to break up the clot.

  • The catheter may be left in place to deliver clot-dissolving medicine during the next 24–72 hours.

  • Your incision may be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • You may need to stay in bed at the hospital to receive clot-dissolving medicine through your catheter.

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.

  • You may continue to receive fluids and medicines through an IV. Your IV will also be used to remove blood for testing.

  • You will be given pain medicine as needed.

  • You may need to wear compression stockings or a compression sleeve on your arm or leg. These garments help to prevent blood clots and reduce swelling.

  • Your catheter and IV will be removed after treatment for the clot is complete.

Summary

  • Catheter-directed thrombolysis is a procedure to remove a blood clot from inside a blood vessel.

  • Before the procedure, follow your health care provider’s instructions about eating and drinking restrictions. You may be asked to stop eating and drinking several hours before the procedure.

  • During this procedure, a catheter is inserted through your skin into a blood vessel that leads to the clot.

  • The clot is either dissolved with medicine or broken up with a device. You may need to stay in the hospital for 24–72 hours while medicine continues to dissolve the clot.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.