Thrombectomy and thrombolysis: the interventional radiology approach

Objective– To present interventional therapeutic options for patients with thrombosis. Etiology– Thrombosis in small animals results from an unbalance in the normal hemostatic mechanisms leading to vessel occlusion. In veterinary medicine, thrombosis is recognized as a common complication of many acquired diseases, including cardiac, endocrine, immunological, inflammatory, and neoplastic disorders. Diagnosis– Clinical signs are variable depending on the location of the thrombus and various laboratory and imaging modalities can aid in its identification and localization. Therapy– Once identified, a decision must be made to whether or not intervene and which method is most appropriate. A number of minimally invasive approaches for dealing with thrombosis are available and offer veterinarians a choice of therapeutic options when dealing with a thrombotic patient. In the presence of thrombosis, a combined approach of vessel balloon dilatation, catheter‐directed thrombolysis and stenting may be most appropriate. Percutaneous mechanical thrombectomy, if available, may also be appropriate. Embolic trapping devices can be used with vena cava thrombosis to help prevent pulmonary embolism. Anticoagulant therapy may be indicated in the postoperative period to prevent further thrombus formation while the patient's fibrinolytic system breaks the clot down. Prognosis– Outcome is variable depending on the site of the thrombus formation. Arterial thrombosis can be life‐threatening while venous thrombosis tends to be less life‐threatening but may lead to pulmonary embolism.