Description
Lysis therapy is a particularly effective form of therapy for treating vascular occlusions. Strong anticoagulant and thrombus-dissolving substances are administered into the blood vessel. A distinction is made between systemic lysis and local lysis. In systemic lysis, the medication is administered by infusion and acts throughout the entire body. In local lysis, the thrombus-dissolving medication is delivered directly to the occluded area of the blood vessel via a thin tube (catheter).
Systemic lysis therapy is administered by continuous infusion with the aid of so-called thrombolytics (clot-dissolving substances, for example urokinase, streptokinase, rtPA). The aim is to dissolve an existing blood clot. It is very rarely used in cases of severe pulmonary embolism. Systemic lysis is associated with a considerable risk of complications such as severe and uncontrollable bleeding, especially cerebral hemorrhage. For this reason, local and catheter-controlled lysis is the preferred treatment option.
In local lysis (catheter-controlled thrombolysis), the blood clot is dissolved directly via a catheter. This has the advantage that the drug acts with a higher concentration directly at the blocked site in the blood vessel and is accompanied by a lower concentration in the rest of the body. This reduces the risk of bleeding.
Procedure
At the beginning of the catheter examination, we numb the injection site in the body with a local anesthetic. We then introduce a so-called airlock, which works like a valve. We can use it to insert metal wires and catheters (special thin tubes through which a contrast medium can be injected) into the artery or vein without the risk of bleeding from the puncture site. We can now visualize the blood clot directly by injecting a contrast agent using X-rays. We then decide whether the thrombus-dissolving drug (thrombolytic) is administered locally once in a certain quantity, or whether the catheter is left in the vessel and a certain concentration of the drug is administered over approximately 15 hours. In the latter case, you will be admitted to our monitoring ward and should comply with the prescribed bed rest. During this time, we will repeatedly determine and monitor your blood values at certain intervals.
Before the catheter is removed, the result of the treatment is checked by a final control X-ray. The catheter is then removed and the puncture site is pressed to stop the bleeding. A pressure bandage is then applied and a sandbag is placed on top. As a rule, you will have to lie on your back for six hours (after arterial intervention) or two hours (after venous intervention) after the procedure. This is necessary so that the puncture site can close securely and does not continue to bleed.
Before discharge, an ultrasound examination is usually performed again to document the openness of the treated vessel and the success of the treatment. The success of therapy varies greatly and depends on the age of the thrombosis.
Preparation
Before we perform this procedure on you, we will inform you in detail about the treatment and its risks, as well as about the alternative treatment options and their risks. You will receive a written declaration of consent for this purpose. We can only plan the next steps once you have read through and signed these at your leisure.
Before the procedure, we need a list of the medication you are currently taking. We also need all information about previous illnesses, hospital stays and allergies. We also need your current laboratory values, which we will have determined before the procedure.
Aftercare
Blood thinning of varying duration is always necessary after lysis therapy. You will be informed in detail about the duration of the blood thinning.
At our clinic, it is important to us not only to provide our patients with successful treatment, but also to see them again in the following months for outpatient follow-up checks. You will always receive a written request from us for the check-up appointments. If you develop symptoms prematurely, you can be seen and treated by us at any time.