title: Management of pulmonary embolism with rheolytic thrombectomy.
abstract: BACKGROUND
  Catheter thrombectomy combining thrombus destruction with local thrombolysis has been used in patients with pulmonary embolism (PE) who are unstable or have significant right heart dysfunction, but have contraindications to systemic thrombolytic therapy.
  
  
  OBJECTIVE
  To assess the outcomes of patients who underwent pulmonary embolectomy using a commercially available thrombectomy device.
  
  
  METHODS
  A retrospective chart review of patients who underwent pulmonary embolectomy between March 2007 and August 2009 was performed. Patients were classified as having clinical massive or submassive PE, and moderate or severe right ventricular dysfunction. Data collected included pre- and postprocedure shock index (heart rate divided by systolic blood pressure) and mean pulmonary artery pressure.
  
  
  RESULTS
  Sixteen patients with a mean (± SD) age of 54.4 ± 15.8 years underwent embolectomy. Five had clinical massive PE (two in cardiogenic shock) and three of 11 submassive cases had severe right ventricular dysfunction. All were deemed to have contraindications to systemic lysis. Both shock index (1.02 ± 33 preintervention versus 0.71 ± 0.2 postintervention [P=0.001]) and mean pulmonary artery pressure (34.5 ± 9.9 mmHg preintervention versus 27.1 ± 7.1 postintervention [P=0.01]) improved. In the massive PE group, one patient died and two survivors experienced retroperitoneal bleeding and transient renal failure. At follow-up (17.3 ± 7.8 months), two patients in the massive PE group demonstrated evidence of mild cor pulmonale.
  
  
  CONCLUSIONS
  Rheolytic thrombectomy is an effective strategy in managing massive PE, particularly in patients who have well-defined contraindications to systemic lytic therapy. The effectiveness of rheolytic thrombectomy for submassive PE is not as well defined, but warrants a comparison with systemic lytic therapy.
authors: Southwest Washington Medical Center, Vancouver, WA, USA.
authors: Lisa
authors: L
authors: Ferrigno
authors: Robert
authors: R
authors: Bloch
authors: Judson
authors: J
authors: Threlkeld
authors: Thomas
authors: T
authors: Demlow
authors: Raman
authors: R
authors: Kansal
authors: Riyad
authors: R
authors: Karmy-Jones
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D000075202:Contraindications; D017128:Embolectomy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage; D011300:Preoperative Care / Q000379:methods; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology