Percutaneous Pulmonary Embolism Thrombectomy and Thrombolysis: Technical Tips and Tricks

Overview

Journal Semin Intervent Radiol

Specialty Radiology

Date 2018 Jun 7

PMID 29872249

Citations 6

Authors

Zlatko Devcic

William T Kuo

Affiliations

Soon will be listed here.

Abstract

Catheter-directed therapy (CDT) is now acknowledged as a treatment option for select patients with acute massive or submassive pulmonary embolism (PE), and more patients are being considered for CDT if there is available expertise. Therefore, interventionalists should be aware of the variety of catheter-based treatment options, specific pitfalls to avoid during therapy, and the appropriate treatment endpoints. This article reviews currently available techniques and protocols for treating acute massive and submassive PE, with tips to safely and successfully perform percutaneous PE interventions.

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References

Piazza G, Hohlfelder B, Jaff M, Ouriel K, Engelhardt T, Sterling K . A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv. 2015; 8(10):1382-1392. DOI: 10.1016/j.jcin.2015.04.020. View

Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky R, Sardar P . Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014; 311(23):2414-21. DOI: 10.1001/jama.2014.5990. View

Kabrhel C, Jaff M, Channick R, Baker J, Rosenfield K . A multidisciplinary pulmonary embolism response team. Chest. 2013; 144(5):1738-1739. DOI: 10.1378/chest.13-1562. View

Resnick S, OBrien D, Strain D, Malaisrie C, Schimmel D, Salem R . Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi. J Vasc Interv Radiol. 2016; 27(5):723-729.e1. DOI: 10.1016/j.jvir.2016.02.009. View

Kuo W, Sista A, Faintuch S, Dariushnia S, Baerlocher M, Lookstein R . Society of Interventional Radiology Position Statement on Catheter-Directed Therapy for Acute Pulmonary Embolism. J Vasc Interv Radiol. 2018; 29(3):293-297. DOI: 10.1016/j.jvir.2017.10.024. View

Nakazawa K, Tajima H, Murata S, Kumita S, Yamamoto T, Tanaka K . Catheter fragmentation of acute massive pulmonary thromboembolism: distal embolisation and pulmonary arterial pressure elevation. Br J Radiol. 2008; 81(971):848-54. DOI: 10.1259/bjr/93840362. View

Fiumara K, Kucher N, Fanikos J, Goldhaber S . Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol. 2005; 97(1):127-9. DOI: 10.1016/j.amjcard.2005.07.117. View

Al-Hakim R, Park J, Bansal A, Genshaft S, Moriarty J . Early Experience with AngioVac Aspiration in the Pulmonary Arteries. J Vasc Interv Radiol. 2016; 27(5):730-4. DOI: 10.1016/j.jvir.2016.01.012. View

Semba C, Weck S, Patapoff T . Alteplase: stability and bioactivity after dilution in normal saline solution. J Vasc Interv Radiol. 2003; 14(1):99-102. DOI: 10.1097/01.rvi.0000052297.26939.05. View

10.

Hofmann L, Lee D, Gupta A, Arepally A, Sood S, Girgis R . Safety and hemodynamic effects of pulmonary angiography in patients with pulmonary hypertension: 10-year single-center experience. AJR Am J Roentgenol. 2004; 183(3):779-86. DOI: 10.2214/ajr.183.3.1830779. View

11.

Kuo W, Banerjee A, Kim P, DeMarco Jr F, Levy J, Facchini F . Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results From a Prospective Multicenter Registry. Chest. 2015; 148(3):667-673. DOI: 10.1378/chest.15-0119. View

12.

Schmitz-Rode T, Kilbinger M, Gunther R . Simulated flow pattern in massive pulmonary embolism: significance for selective intrapulmonary thrombolysis. Cardiovasc Intervent Radiol. 1998; 21(3):199-204. DOI: 10.1007/s002709900244. View

13.

Engelberger R, Spirk D, Willenberg T, Alatri A, Do D, Baumgartner I . Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Circ Cardiovasc Interv. 2015; 8(1). DOI: 10.1161/CIRCINTERVENTIONS.114.002027. View

14.

Kucher N, Boekstegers P, Muller O, Kupatt C, Beyer-Westendorf J, Heitzer T . Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation. 2013; 129(4):479-86. DOI: 10.1161/CIRCULATIONAHA.113.005544. View

15.

Kuo W . Endovascular therapy for acute pulmonary embolism. J Vasc Interv Radiol. 2011; 23(2):167-79.e4. DOI: 10.1016/j.jvir.2011.10.012. View

16.

Kuo W, Gould M, Louie J, Rosenberg J, Sze D, Hofmann L . Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol. 2009; 20(11):1431-40. DOI: 10.1016/j.jvir.2009.08.002. View

17.

Baker R, Samuels S, Benenati J, Powell A, Uthoff H . Ultrasound-accelerated vs standard catheter-directed thrombolysis--a comparative study in patients with iliofemoral deep vein thrombosis. J Vasc Interv Radiol. 2012; 23(11):1460-6. DOI: 10.1016/j.jvir.2012.08.008. View

18.

Mills S, Jackson D, Older R, Heaston D, MOORE A . The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology. 1980; 136(2):295-9. DOI: 10.1148/radiology.136.2.7403500. View