Current Endovascular Treatment Options in Acute Pulmonary Embolism

Abstract

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

Mechanical thrombectomy is associated with shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis

“…Similarly, PE is associated with decreased aerobic functional capacity in half the patients 1 year after their PE diagnosis and has a negative impact on quality of life (6,17). Current guidelines regarding the management of acute submassive PE recommend anticoagulation therapy with observation and/or the escalation of care based on hemodynamic instability (18). In addition to conservative therapy with anticoagulation, catheter-based thrombolysis has been shown to be efficacious but is associated with an increased risk of bleeding (7,9,10).…”

Tromboembolismo Pulmonar Agudo - revisão sistemática sobre o manejo da doença e novas perspectivas na intervenção cirúrgica em pacientes graves

“…O mecanismo fisiopatológico envolve a oclusão arterial pulmonar por êmbolos, os quais se originam, principalmente, a partir TVP. Nesse sentido, dentre as possíveis complicações clínicas da tromboembolia venosa, a embolia pulmonar (EP) aguda é a mais grave, sendo categorizada como uma causa comum de morte súbita em todo o mundo (MORRONE;MORRONE, 2018;PALM et al, 2019;MOORE et al, 2021).…”

“…Nesses casos, a mortalidade em 30 dias ultrapassa 50%. Já o TEP considerado submaciço, ou de risco intermediário, é marcado por estabilidade hemodinâmica em pacientes que apresentam disfunção cardíaca direita, evidenciada através de um ecocardiograma, tomografia computadorizada e/ou através de sinais de necrose miocárdica -avaliada pela dosagem de marcadores séricos de isquemia e pelo eletrocardiograma (IACCARINO et al, 2018;MOORE et al, 2021;ZUO et al, 2021).…”

“…No entanto, caso pontue 1 ou mais, mas sem alterações nos exames complementares, será classificado como Intermediário-baixo risco. Por fim, caso o paciente não tenha hipotensão, sinais de disfunção cardíaca ou de necrose miocárdica, este será de baixo risco, com mortalidade a curto prazo <1% e bom prognóstico (HOWARD, 2019;MOORE et al, 2021;ZUO et al, 2021).…”

Pulmonary embolism management in the emergency department: part 2

“…The incidence of major bleeding was 6.7% 48. There is insufficient evidence to recommend catheter-directed therapies over systemic thrombolysis at present 49. Surgical embolectomy may be considered in patients with haemodynamic instability despite anticoagulation treatment, as an alternative to ‘rescue thrombolysis’ 1.…”