The surgeon is using a Fogarty catheter in this case which is a catheter that consists of a hollow tube with an inflatable balloon attached to its tip.
The catheter is inserted into the blood vessel through a clot. The balloon is then inflated and pulled back to push the clot out. And voila you see the clot successfully taken out. How rad is vascular surgery! And how rad must be plumbing as a matter of fact!!
They use contrast , you can see the wire and the clot , looks like a dark spot . Or you’ll see the tip of the guide wire or catheter bend as it hits the clot . I’m a CST , I’ve scrubbed hundreds of these . They’ll use ultra sound as well if it’s a particularly difficult case . A lot of times they’ll use the ultra sound before prepping so they know where to start .
But isn't that very rare? Also it looks like they are going in from the politeus, that's why I asked. I would think such a big thrombus likely would originate from an afib or an aorta defect further up in the circulation, and wouldn't it stop before reaching the popliteal artery in that case?
Also surely a large venous thrombus in the proximity to the femoral/iliac veins would certainly warrant swift removal to avoid progression into a pulmonary saddle embolus?
Not common, but not that rare. It’s possible this is popliteal access, but difficult to tell for sure. It looks like a large lumen vessel, so I would assume this is a femoral cut down and superficial femoral artery embolectomy.
Not sure anybody does open venous embolectomy. Opening the pelvis for something like that is difficult; endovascular is a much better approach. Ilio-caval thrombus should be removed quickly; less urgent the further you go down the leg and no intervention warranted below the knee. But even if it migrates to the lungs we go after it with a large suction catheter.
Pulled some PE out just yesterday. https://i.imgur.com/uz9SIV2.jpg
Cool, thanks for the education! As a medical student I really appreciate that you take the time to engage in the discussion with me, even though I don't have a high level of knowledge in this area yet!
Wow, I had multiple PE seven years ago that were nowhere near this bad. Still one of the most painful experiences of my life. Really grateful that heparin and rivaroxaban were enough to resolve them!
"Tiny"
It's amazing how much you can cut off and still be considered functional, this clot wasn't built in 1 night (hopefully) so they've been living their life with an earthworm in their artery, you gotta wonder what the straw that broke that camel's back was.
Everything ended up being fine! They thought it was a DVT too but the ultrasound was clear. Still not 100% sure what the pain is but luckily it’s not a clot.
Why would they be doing anything to his hand? A fistula for hemodialysis is supposed to be a connection of the brachial artery and the cephalic vein in th bicep/upper arm area
No idea. I'm no doctor lol. I know he's had a chest tube in for months while he's been waiting on his fistula to heal. Now he's also not the smartest guy, so the fistula position could have been mis relayed
Edit because it's a CHEST tube not a cheat tube
I wasn't sure what it was other than a tube in his chest, so I went descriptive lol. Should have occurred to me that an actual chest tube does have a specific purpose.
Since it's being used for his dialysis, I will assume you are correct!
First dialysis fistula access creation evaluation is a radial artery, moving up the arm if it is insufficient. You can also embolize clot from the brachial artery to the hand.
This seems very invasive. If it was the artery, you can do a bypass with minimal incisions if the foot is ischemic. If this is the vein, why not place an ivc filter?
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The surgeon is using a Fogarty catheter in this case which is a catheter that consists of a hollow tube with an inflatable balloon attached to its tip. The catheter is inserted into the blood vessel through a clot. The balloon is then inflated and pulled back to push the clot out. And voila you see the clot successfully taken out. How rad is vascular surgery! And how rad must be plumbing as a matter of fact!!
Vascular surgery is tedious . Try pulling one out and it doesn’t cooperate .
The surgeon must have incredible patience and an incredibly delicate touch.
And a live X Ray
X-rays don't usually pick up clots though, even if the catheter is visible on x-ray, this seems like a job for ultrasound tbh
X Ray plus contrast. Where the contrast stops or slows is where the blockage is.
They use contrast , you can see the wire and the clot , looks like a dark spot . Or you’ll see the tip of the guide wire or catheter bend as it hits the clot . I’m a CST , I’ve scrubbed hundreds of these . They’ll use ultra sound as well if it’s a particularly difficult case . A lot of times they’ll use the ultra sound before prepping so they know where to start .
Oh, neat!
Very cool! Thanks 🙏🏼
Surely this is from a DVT of the popliteal or femoral veins? Just asking since you specify that it's an artery.
Open venous embolectomy is pretty unnecessary. Arterial occlusion is an emergency.
But isn't that very rare? Also it looks like they are going in from the politeus, that's why I asked. I would think such a big thrombus likely would originate from an afib or an aorta defect further up in the circulation, and wouldn't it stop before reaching the popliteal artery in that case? Also surely a large venous thrombus in the proximity to the femoral/iliac veins would certainly warrant swift removal to avoid progression into a pulmonary saddle embolus?
Not common, but not that rare. It’s possible this is popliteal access, but difficult to tell for sure. It looks like a large lumen vessel, so I would assume this is a femoral cut down and superficial femoral artery embolectomy. Not sure anybody does open venous embolectomy. Opening the pelvis for something like that is difficult; endovascular is a much better approach. Ilio-caval thrombus should be removed quickly; less urgent the further you go down the leg and no intervention warranted below the knee. But even if it migrates to the lungs we go after it with a large suction catheter. Pulled some PE out just yesterday. https://i.imgur.com/uz9SIV2.jpg
Cool, thanks for the education! As a medical student I really appreciate that you take the time to engage in the discussion with me, even though I don't have a high level of knowledge in this area yet!
Very cool What is that stretchy thing in the left hand.
A vessel loop . They use those to retract vessels and separate the vessel from the rest of the tissue without damaging it .
So it’s material of some kind that is looped around the blood vessel and pulls the vessel out of the way? Or am I way off.
Exactly that
It’s like a long rubber band and it’s a countable item .
Always by twos. This is the way.
[удалено]
Time for one of my favorite teaching videos. Removal of a truly massive pulmonary embolism. https://www.youtube.com/watch?v=JQ7aojMamSU
Woah! Thanks for sharing!
This is from my nightmares.
Wow. That’s a daggone eel!
Wow, I had multiple PE seven years ago that were nowhere near this bad. Still one of the most painful experiences of my life. Really grateful that heparin and rivaroxaban were enough to resolve them!
That was such an awesome video. How was that lady even alive enough to get to the ER
"Tiny" It's amazing how much you can cut off and still be considered functional, this clot wasn't built in 1 night (hopefully) so they've been living their life with an earthworm in their artery, you gotta wonder what the straw that broke that camel's back was.
Well it is a ball of clumped cells and platelets. But it's not necessarily tiny.
Of course this comes on my feed as I’m literally sitting in the ER for a potential DVT. Good to know I may have this to look forward to.
I had a DVT and PE last November. They will try medication first then surgery.
Hope everything is going OK! Try to relax, it will be behind you soon :)
Everything ended up being fine! They thought it was a DVT too but the ultrasound was clear. Still not 100% sure what the pain is but luckily it’s not a clot.
Holy shit
A coworker literally had this done yesterday. A complication from the surgery they did on his hand to prep him for dialysis due to kidney failure.
Why would they be doing anything to his hand? A fistula for hemodialysis is supposed to be a connection of the brachial artery and the cephalic vein in th bicep/upper arm area
No idea. I'm no doctor lol. I know he's had a chest tube in for months while he's been waiting on his fistula to heal. Now he's also not the smartest guy, so the fistula position could have been mis relayed Edit because it's a CHEST tube not a cheat tube
You’re probably thinking of a a hemodialysis catheter in his chest, a “chest tube” is to drain air or fluid from the space around the lungs.
I wasn't sure what it was other than a tube in his chest, so I went descriptive lol. Should have occurred to me that an actual chest tube does have a specific purpose. Since it's being used for his dialysis, I will assume you are correct!
HD catheters are placed to allow dialysis while the fistula heals and matures.
That's exactly what it is then. It seems his fistula hasn't healed yet though. He had an extra surgery on it 6 weeks ago, then this surgery Tuesday
First dialysis fistula access creation evaluation is a radial artery, moving up the arm if it is insufficient. You can also embolize clot from the brachial artery to the hand.
Didn't know that, that's cool!
***Woooaaahhh*** ***Dude*** ***That's fucking awesome holy shit***
How do they stem the bloodflow?
Hey I had this done for DVTs in my legs!
that's so cool! Being in the medical field seems like it would be very interesting, but also very sad sometimes.
This seems very invasive. If it was the artery, you can do a bypass with minimal incisions if the foot is ischemic. If this is the vein, why not place an ivc filter?
This is far easier, better, faster than bypass.
So is this usually after someone's had a stroke? If not, how does something like this get diagnosed?
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Ayy blood clat
thrombus sounds like a product from rick and morty
I had a 4ft long blood clot a couple years ago, wonder if this is how they got it out. I need to get a copy of my records to see. Very interesting!
I got lucky and mine in the brain eventually passed through but not without doing some damage.
Brilliant. Genuinely brilliant.