Specialist performs minimally invasive thoracic surgery at Mediclinic Heart

Dr Sidney Malefahlo, a cardiothoracic surgeon at Mediclinic Heart, performs groundbreaking minimally invasive thoracic procedures, including EkoSonic Endovascular System (EKOS) catheter-directed thrombectomy/thrombolysis.

Which patients benefit from an EKOS procedure?  

Dr Malefahlo explains this procedure is suitable for people who have a deep vein thrombosis (DVT) or pulmonary embolism (PE). A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow. Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs.

“These patients often have a history of blood clots or are at risk of developing them due to factors such as surgery, immobility, or underlying medical conditions,” he says. “The procedure is also used in select cases of acute limb ischemia. Patients may vary in age, but they all share a need to address clot-related health issues.”

What are the benefits of this technique for treating pulmonary embolisms?

 “This new EKOS technique enables us to go into the groin, through the venous system and into the lungs, where we deploy catheters to break down and dissolve the thrombus.”  

The procedure is minimally invasive compared to traditional surgical methods, reducing the risk of complications and speeding up recovery. EKOS technology also enables precise targeting of the clot, potentially reducing damage to surrounding tissues. This procedure often has high success rates in clot resolution, improving blood flow, and relieving symptoms. In addition, patients may experience shorter hospitalisations, leading to cost savings and improved patient comfort. Successfully treating DVT or PE can enhance patients' overall well-being, reducing the risk of complications and improving mobility. This procedure is in general cheaper than an open surgery procedure with a reduced length of stay, reduced theatre time, and other consumables.

What makes the EKOS procedure for pulmonary embolisms unique?

The use of EKOS technology, which combines ultrasound with thrombolytic medication delivery, is a unique feature. This technology enhances the effectiveness of the procedure by breaking down clots more efficiently and with fewer side effects.
EKOS catheter-directed thrombectomy/thrombolysis has shown a lower risk of bleeding complications compared to traditional systemic thrombolysis and the procedure can be tailored to the specific needs of each patient, making it highly personalised and potentially more effective. Its minimally invasive nature is a distinctive feature, reducing the risks and recovery time associated with open surgery.

Is there a growing need for the EKOS procedure?

“In the last few years we’ve seen a rise in the number of pulmonary embolisms, mainly in  patients who have previously had COVID 19, patients who are on contraceptives, and those whose lifestyles aren’t optimal,” says Dr Malefahlo

“People are spending more time working from home and that loss of mobility is what puts a lot of patients at risk. This EKOS surgical technique comes at the time when it is much needed, as the burden of disease is higher. The cherry on top is the fact we can perform the surgery without cutting open the chest or the pulmonary vessels and without the need to stop blood flow to the brain.”

How were deep vein thrombosis (DVT) or pulmonary embolism (PE) treated in the past?

Anti-clotting medication would be injected into the fat tissue under the skin to help to prevent further clots from forming. That buy the body time to make its own mechanisms to break down the clot that's already there. The second mechanism was the catheter-based techniques, where you would go into a pulmonary artery and try to extract the thrombus.

The challenge with this approach is that it can put more strain on the right heart, which is already under a lot of strain.

The third approach for patients who presented with pulmonary embolisms was an open surgical procedure or sternotomy. “This is invasive surgery where you have to cut open the sternum to get to the pulmonary vessels. You would then have to stop flow of blood to the brain in order to work on the blood vessel, extracting the thrombus from the blood vessel,” says Dr Malefahlo. The new minimally invasive EKOS technique is therefore preferable.