title: [Successful catheter-guided local thrombolysis in acute pulmonary embolism in the early postoperative period after pancreatic head resection].
abstract: Pulmonary embolism in the early postoperative period is characterized by high morbidity and mortality. Systemic application of thrombolytic agents during this time is contraindicated; operative thrombectomy also has a high mortality rate. We report a case of successful local lysis in combination with catheter fragmentation of a massive two-sided pulmonary embolism diagnosed on the 4th postoperative day after pylorus-preserving duodenopancreatectomy for distal carcinoma of the common bile duct. Thrombolysis was performed in three sessions by a combination of catheter-supported interventional fragmentation of the thrombus with local rt-PA lysis. There were no bleeding complications or disturbances of anastomotic healing. The patient was discharged from the hospital on the 23rd postoperative day after changing anticoagulation to a vitamin K antagonist. The case presented demonstrates the possibility of local lysis in combination with interventional methods as a therapeutic option for pulmonary embolism in the early postoperative period as an alternative to surgical strategies.
authors.affiliation: Abteilung für Allgemein- und Viszeralchirurgie, Chirurgische Universitätsklinik, Albert-Ludwigs-Universität Freiburg, Germany. robert.obermaier@web.de
authors.forename: R
authors.initials: R
authors.lastname: Obermaier
authors.forename: J C
authors.initials: JC
authors.lastname: Kröger
authors.forename: S
authors.initials: S
authors.lastname: Benz
authors.forename: F
authors.initials: F
authors.lastname: Makowiec
authors.forename: W
authors.initials: W
authors.lastname: Schareck
authors.forename: U
authors.initials: U
authors.lastname: Adam
authors.forename: U T
authors.initials: UT
authors.lastname: Hopt
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000792:Angiography; D017130:Angioplasty / Q000295:instrumentation*; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D017128:Embolectomy / Q000295:instrumentation*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D010959:Tissue Plasminogen Activator