why would clots keep forming after a thrombectomy?
after the third thrombectomy, clots keep forming and doctors don't know why.
Circumstances must be favorable for a thromus to form. Once the thrombus is excised this does not change the underlying tendency for clot formation. After a 2nd thrombectomy and before the 3rd I would expect that the physician would have done an extensive coagulation work-up. There must be an explanation for recurrent thrombosis in the same location (I am assuming that the thrombus forms in the same location). Bear in mind that surgical excision of a thrombus paradoxically increases the risk for thrombus at the surgical site as part of normal would healing. I also assume that you are speaking of an arterial thrombus. These are called 'white' as they are composed mostly of thrombocytes or platelets. After the 1st thrombectomy if arterial the surgeon should have started you on anti-thrombic drugs such as aspirin and / or clopidogrel bisulfate. If these are venous thrombi they would be referred to as 'red' as they are composed mostly of erythrocytes or red blood cells. After the 1st thrombectomy if venous the surgeon should have started you on warfarin sodium. If your physician is not able to question of why you are experiencing recurrent thrombosis then you should seek the opinion of another vascular surgeon. If I may be of further assistance please let me know. I wish you the very best of health and happiness and in all things may God bless. JR (+ info
Why are thrombi removed with an embolectomy catheter?
Is it because it's the best way to remove the plaque without it breaking into pieces?
Yes I know Boopsy. What I'm looking for is an explanation as to why that method is the most popular one as opposed to other methods.
Seediph- I meant to say break the clot away from the vessel wall, not break plaque into pieces. Thanks
First off, I assume you are referencing coronary thrombus and not other circulation. Thrombectomy does break the clot into pieces. The method varies with the extraction device. Plaque is not removed this way, thrombus is. This is done to remove space occupying thrombus and prevent large thrombi from showering distal circulation with emboli,
Advice offered here is not meant to be a replacement for proper evaluation and examination by a qualified medical professional and should not be construed as such. (+ info
Is there any alternate treatment for Essential Thrombocythemia or High Platelets?
Limitation in the intake of vit.k and thrombectomy can be done (+ info
Hello, what does lytics and TPA mean?
the context is:She underwent multiple attempts at lytics with TPA to relieve the occlusion of her left popliteal artery, all of which were unsuccessful.
the full ds just in case is:
Report de-identified (Safe-harbor compliant) by De-ID v.6.22.07.0] **INSTITUTION Transfer Summary Name: **NAME[AAA, BBB] Acct #: **ID-NUM MRN: **ID-NUM Admitted: Discharged: **DATE[Apr 09 2007] Dict: **NAME[XXX, WWW] Attend: **NAME[ZZZ, YYY] ADMITTING DIAGNOSES: 1. Aortic stenosis. 2. Lower extremity arterial embolic disease. ADMITTING SURGEON OF RECORD: Dr. **NAME[VVV]. Ms. **NAME[AAA] is an **AGE[in 80s]-year-old female who originally presented to **INSTITUTION on **DATE[Mar 23 2007], with an acutely ischemic left lower extremity. She underwent angiography at that time which showed an aortic occlusive lesion which was 80% stenotic at the level of the aortic bifurcation and evidence of bilateral lower extremity distal embolization with the left being more acute than the right. She underwent multiple attempts at lytics with TPA to relieve the occlusion of her left popliteal artery, all of which were unsuccessful. Subsequently on **DATE[Mar 29 2007], she was taken to the operating room and underwent a thrombectomy at the level of the popliteal fossa and tibial vessels. Her foot continued to be ischemic. In addition, she had hemodynamic pressures measured above and below her aortic stenosis and she had a significant hemodynamic gradient of 60 mmHg systolic pressure. On **DATE[Mar 31 2007], she was taken to the operating room for a transaortic endarterectomy of her distal aortic occlusive lesion. This procedure was performed without complications. She had a short stay in the ICU over the weekend. At this time it was determined that there was no flow to that left foot and lower extremity and it was starting to turn dark, necrotic, and clearly looked infected. Her white count was also rising, so it was deemed that she would need to have an amputation. It was discussed with her and her son at length, and although neither of them were excited about the prospect of amputation, they both realized that it was really their only option and without it the foot would eventually die and could cause systemic sepsis. On **DATE[Apr 5 2007], she underwent a left below-knee amputation. This was performed without complications. Postoperatively, she did well from a surgical standpoint. Her dressing was left on for approximately 3 days. She was maintained on Zosyn and Keflex for this duration. The dressing was removed postoperative day 3 and the staple line was intact with mild edge necrosis. There was no erythema, swelling, drainage, or warmth at the site of the incision. Following this, medically she was stable and otherwise tolerating a regular diet. However, the patient was taking very little p.o. as she was indicating that she was depressed and continually and routinely said that she wanted to die and that she could not live like this. Psychiatry was consulted and the patient was started on Lexapro 10 mg p.o. q. day. The patient was deemed stable at that time for transfer to rehab and on **DATE[Apr 9 2007], she was transferred to rehab. She was given instructions to follow up with Dr. **NAME[ZZZ] in approximately 2 weeks and was given a phone number to call to make that appointment. MEDICATIONS: 1. Tylenol 650 p.o. p.r.n. q.4 hours. 2. Vicodin 5/500 one to two p.o. q.6 hours p.r.n. pain. 3. Colace 100 mg p.o. b.i.d. 4. Lexapro 10 mg p.o. q. a.m. 5. Protonix 40 mg p.o. q. day. 6. K-Dur 20 mEq p.o. b.i.d. 7. Aspirin 81 mg p.o. q. day. ACTIVITY: She should be out of bed as tolerated, nonweightbearing left lower extremity. She should have routine Foley care. DIET: Resume a regular diet. WOUND CARE: She should have 4 x 4's to her left lower extremity staple line to prevent contact abrasions with the brace. Otherwise, it should be kept clean and dry. The brace to her left lower extremity should be on for 4 hours, then off for 4 hours, and rotated as such, etc. LAB WORK: She should have a CBC checked in 3 days. She should be monitored for any signs of infection at the site of her BKA such as fever greater than 100.4, any redness, swelling, tenderness, or drainage and we should be notified. She should have physical and occupational therapy evaluation and treatment as recommended. ______________________________ **NAME[WWW XXX] HS Job # 383114 / 37383 / SHY # **ID-NUM D: **DATE[Apr 09 2007] 10:29 T: **DATE[Apr 09 2007] 10:50 **CARBON-COPY
No way I'm gonna read the whole thing!
"Lytics" is short for thrombolytics which are a type of medication which is used to break down blood clots. tPA is a type of thrombolytic. (+ info
Help, I think I may have a blood clot in my leg!?
Okay so I am on the birth control pill, a low-dose of estradiol. I also have a family history of blood clotting problems and varicose veins-- my mom and grandmother have/had them, and my grandmother had to have a thrombectomy when I was a little girl.
I am having a consistent, but sort of dull, pain in my mid-thigh that is especially noticeable at night. I am 19 though, and a blood clot seems almost like an impossibility to me. But at the same time, it is very frightening and I do have family history as well as I am taking birth control pills. My grandma died of a stroke, likely a complication of deep vein thrombosis. I feel I'm way too young for this and I am terrified. Please help!
Cardiology Stuck on an exam please help if you are willing?
3. What does the abbreviation EP mean as it relates to cardiovascular services?
A. Elective procedure
D. Electric pathology
4. A patient has the following procedure performed: selective catheter placement in the first-order brachiocephalic artery, with angiography, including contrast done at the clinical catheterization laboratory. Assign the correct CPT codes.
A. 36215, 75705, 99070
B. 36200, 75705, 99070
C. 36216, 75710, 99070
D. 36215-RT, 75710, 99070
6. A patient with a pacemaker is seen by the physician within the 90-day follow-up (global) period for implantation. However, he presents today for a problem not related to the implantation. Which of the following statements is false?
A. Append the E/M service code with modifier -25.
B. Documentation in the medical record must support the statement that the service is unrelated to the implantation.
C. Service for the new problem can be billed.
D. Append the E/M service code with modifier -24.
8. Which of the following is the correct code for an in-person electronic evaluation of a dual-chamber pacemaker system with reprogramming?
11. Reinforcing a collapsed or blocked coronary vessel is done using
A. coronary thrombectomy.
B. intracoronary stent placement.
D. coronary endarterectomy.
12. A patient is in cardiac arrest. A physician provides CPR to the patient. Assign the correct CPT code.
13. If a clinic owns its own x-ray equipment, what modifier would be used when coding for the supervision and interpretation of a cardiac catheterization?
B. No modifier is used.
14. Which kind of pacemaker has leads going to the right atrium and the left ventricle?
15. A patient had a pacemaker inserted three days ago. Today the patient is complaining of feeling very dizzy. The electrocardiogram is showing some abnormalities. The patient is returned to the operating room and the physician discovers that the pacemaker lead is malfunctioning. The pacemaker lead is replaced and the patient recovers uneventfully. Assign the correct CPT code.
16. Which of the following is the correct CPT code for thromboendarterectomy with patch graft, tibial?
17. Which CPT code assignment is correct for a bundle of His recording?
18. The _______ are the electrodes that are placed into the atrium and/or ventricle of the heart when a pacemaker is inserted.
20. A patient undergoes a thrombectomy of the aortoiliac artery, by leg incision. Assign the correct CPT code.
21. The correct CPT code(s) for coronary artery bypass using two arterial grafts is:
C. 33533 x 2
22. For items that aren't bundled into the vascular injection procedure, you report each item separately. Which of the following would not be bundled and would be billed separately?
B. Pre-injection care related to the procedure
C. Injection of contrast media
D. Local anesthesia
If you help Thank you and God Bless
An electrophysiology study (EP test or EP study) is a minimally invasive procedure which tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.
Answer 3 B: Electrophysiology.
Answer: 11 B . intracoronary stent placement.
Answer 14 C: Dual chamber pace maker.
Answer 17 C: 93602
Answer 18 C: Leads.
Answer 20 A: 34201
Answer 21 C: 33533 x 2
Please note that I am not a medical professional. (+ info
I had acl surgery about two weeks back. Developed some calf pain yesterday evening and told my doc. Ultrasound?
revelealed a very small clot in my peroneal vein below the knee. Will I have to take blood thinners? I really want to avoid them. Is this common? I am really scared. Note: I am 28, quit smoking a year back and never had a history of clots.
a clot in a superficial vein is no big deal, usually they prescribe comfort measures like pain meds and moist heat and tell you to take it easy until the clot is reabsorbed, it's called a phlebitis, and while uncomfortable, doesn't require aggressive therapies.
it's the deep vein clots that are a serious threat, and then they would not only put you on blood thinners, they would hospitalize you and likely do a thrombectomy to get it out of there. (+ info
What causes cyanosis (blueness) in feet?
My feet are staying cold and blue all the time, I have a mild form of hypogylcemia but my feet were not staying blue when i was diagnosed with that. I know its poor blood circulation or poor oxygen supply in my blood, but what causes it and what can i do to fix it?
It's caused by inadequate blood flow, for which there are many causes. Peripheral vascular disease, diabetes mellitus, raynaud's phenomenon, Buerger's disease, etc. are all potential causes. You should have a doctor examine your pulses. He/she may order a Doppler ultrasound to evaluate your arteries. If that doesn't help, an MRA or CTA would be the next best step.
Your question implies that this is a long-term, ongoing problem. However, if you ever develop a cold, blue extremity acutely (all of the sudden), that is an emergency and you should go to an emergency room. The earlier you go, you may potentially be cured by an interventional radiologist relatively non-invasively. The alternative is surgery. If you don't get attention in time, you can lose your limb.
If you have something chronic, an interventional radiologist can sometimes do angioplasty (widening up your arteries with a balloon) and/or stenting (putting a wire mesh to hold them open) to improve blood flow to your feet.
If it's acute from a blood clot or thromboembolism, they can do thrombolysis (clot busting medicine), thrombectomy (physically removing the clot), and also angioplasty & stenting. (+ info