Editing Vascular techniques (section)

== Thrombectomy and thromboembolectomy ==

** Arteriotomy
*** Arteriotomy can be placed either proximal or distal to the clot
*** Site selection depends on ease of exposure, anticipated location of thrombus, and ease of closure
*** Acute lower extremity ischaemia - CFA
*** Transverse arteriotomy - easier to close (interrupted sutures), generally preferred for dealing with emboli
*** Longitudinal - atherosclerotic/thrombotic process, significant plaque (allows incorporation into an anastomosis in case a bypass is required)
**** Patch needed to close
** Thrombectomy catheter choice
*** Size 2F to 7F 
*** All use saline to inflate except 2F which requires air
*** Standard balloons are made of latex, but are also available latex-free
*** Also come in sizes that can be introduced over guidewires for size 3-7
*** Special corkscrew catheters for adherent clot are available
***

{| class="wikitable"
|Size
|Diameter of fully inflated balloon
|Use
|-
|2
|4mm
|Very small pedal or hand arteries
|-
|3
|5mm
|Tibial vessels
|-
|4
|9mm
|SFA/popliteal arteries
|-
|5
|11mm
|External or common iliac
|-
|6
|13mm
|Aortic or saddle PE
|-
|7
|14mm
|Aortic or saddle PE
|}

*

* Thrombectomy procedure
** Test balloon, and only have enough saline in the syringe to inflate the balloon correctly
** Establish inflow: pass catheter proximally, inflate, withdraw through arteriotomy. Allow brief but unrestricted bleeding to flush debris.
** Pass it gently - don't advance forcefully, can pass into subintimal plane
** Fluoroscopic procedure - essentially the same. Can be quite tricky to get the balloon to the right spot. Can either bend the tip, or put another balloon distally at a junction to prevent it going down that path.
* Complications
** Vascular injury
*** Excessive inflation of balloon - can result in significant shearing, even leading to rupture or pseudoaneurysm
*** During insertion, advancement, or withdrawal