Blood clot! What to do?

When a patient develops a “clot’ in an artery or a vein, that is a medical emergency. An example of this is shown in figure 1 where you see the dark image of the contrast coming to an abrupt halt. The patients left foot was ice cold and painful. There were no pulses felt in the foot. The foot was dusky and purple.

Blood clot blocking flow to a patients leg.

After using a clot busting medication the artery and adjacent graft that is supplying flow to that leg is now open (figure 2).

Graft with excellent blood flow.
Open blood flow through the graft connecting to the popliteal artery at the knee joint.

However, at the origin of the graft there is a residual clot and blockage either from scar tissue or plaque. (Figure 3).

Residual blood clot and adjacent blockage seen. Arrow depicts the blockage.

At this time the decision was made to take the patient to the operating room to “clean” up the rest of the artery. The plan was to manually remove the clot and then “cut” out (endarterectomy) the plaque that was narrowing the artery.  (figure 3 and 4).

Long large “red” clot seen in the artery during surgery.
Large plaque excised from the artery to completely re-establish flow.

After this combined and collaborative approach to the treatment of a very complex patient, the patients foot was warm to the touch, had normal pulses re-established, and the foot was once again PINK! Advances in treatments for patients with blood clots has allowed physicians the tools to change the outcomes for this emergent medical condition.