Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism.
Objective The hemodynamic benefits of catheter-directed thrombolysis for acute pulmonary embolism have not been clearly defined beyond the periprocedural period. The objective of this study is to report midterm outcomes of catheter-directed thrombolysis for treatment of acute pulmonary embolism. Methods Records of all patients undergoing catheter-directed thrombolysis for high- or intermediate-risk pulmonary embolism were retrospectively reviewed. Endpoints were clinical success, procedure-related complications, mortality, and longitudinal echocardiographic parameter improvement. Results A total of 69 patients underwent catheter-directed thrombolysis (mean age 59 ± 15 y, 56% male). Eleven had high-risk and 58 intermediate-risk pulmonary embolism. Baseline characteristics did not differ by pulmonary embolism subtype. Fifty-two percent of patients underwent ultrasound-assisted thrombolysis, 39% standard catheter-directed thrombolysis, and 9% other interventional therapy; 89.9% had bilateral treatment. Average treatment time was 17.7 ± 11.3 h with average t-Pa dose of 28.5 ± 19.6 mg. The rate of clinical success was 88%. There were two major (3%) and six minor (9%) periprocedural bleeding complications with no strokes. All echocardiographic parameters demonstrated significant improvement at one-year follow-up. Pulmonary embolism-related in-hospital mortality was 3.3%, and estimated survival was 81.2% at one year. Conclusions Catheter-directed thrombolysis is safe and effective for treatment of acute pulmonary embolism, with sustained hemodynamic improvement at one year. Further prospective large-scale studies are needed to determine comparative effectiveness of interventions for acute pulmonary embolism.
1 Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Nathan L
NL
Liang
1 Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Rabih A
RA
Chaer
2 Division of Vascular Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Luke K
LK
Marone
1 Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Michael J
MJ
Singh
1 Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Michel S
MS
Makaroun
1 Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Efthymios D
ED
Avgerinos
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Pulmonary embolism; deep venous thrombosis; endovascular therapy; thrombolysis