Pulmonary Interventional Therapy for Acute Massive and Submassive Pulmonary Embolism in Cases Where Thrombolysis Is Contraindicated.

Abstract

BACKGROUND:

In this study, we sought to analyze the clinical outcomes of pharmacomechanical therapy for massive and submassive acute pulmonary embolism (APE).

METHODS:

We conducted a retrospective investigation of 97 patients who received pharmacomechanical therapy at out center between January 2013 and June 2018 for acute massive and submassive PE because thrombolysis was contraindicated.

RESULTS:

Of the 97 patients, 46 (47%) were men, and the mean age of the patients was 56 ± 14 years (median, 58 years; range, 21-84 years). Fifty patients had massive PE, whereas the remaining had submassive PE. Analysis of the site of embolus revealed that 67 (69%) had bilateral emboli in the pulmonary arteries (PAs); 5 (5%) only in the left PA, and 25 (26%) only in the right PA. Seventy-nine (81%) of the 97 patients underwent intraoperative placement of the inferior vena caval filters, whereas 3 (3%) required use of a noninvasive ventilator. Two (2%) patients died within 30 days of the interventional therapy because of severe right ventricular failure. The amount of blood loss was nonsignificant.

CONCLUSIONS:

Our results indicate that an optimal pharmacomechanical therapy protocol could yield favorable outcomes for rapid clot debulking in cases of massive and submassive APE where thrombolysis is contraindicated. Pending further randomized trials, pharmacomechanical therapy shows promise as an alternative treatment method in cases of acute massive or submassive PE, with minimal risk of major bleeding.

• Authors: Yan Meng, Junbo Zhang, Qiang Ma, Hao Qin, Bo Zhang, Honggang Pang, Qian Yin, Hongyan Tian
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 64 Pg. 169-174 (Apr 2020) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 31634603 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Urokinase-Type Plasminogen Activator

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Contraindications, Drug
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Pulmonary Embolism (diagnostic imaging, mortality, therapy)
• Retrospective Studies
• Risk Factors
• Suction
• Thrombectomy (adverse effects, mortality)
• Thrombolytic Therapy (adverse effects, mortality)
• Treatment Outcome
• Urokinase-Type Plasminogen Activator (administration & dosage, adverse effects)
• Young Adult