First Ultrasound-Assisted Thrombolysis for Pulmonary Embolism after Lung Surgery

Abstract

Background Experience with early postoperative catheter-directed ultrasound-assisted thrombolysis (USAT) in high-risk pulmonary embolism (PE) is limited. A first case of USAT directly after pulmonary surgery is presented. Case Description A 60-year-old female patient with two malignancies (triple negative breast cancer and pulmonary squamous cell carcinoma) underwent video-assisted lobectomy. The second postoperative day, she developed PE with hemodynamic deterioration. Note that 24 mg of alteplase was applied by USAT. After 3 days she was successfully weaned from ventilation and vasopressors. Conclusion USAT for acute PE is possible after major pulmonary resections and seems promising if reperfusion is needed.

How to Treat Today? Oral and Facial Cancer-Associated Venous Thromboembolism

“…IVC filter placement [ 41 ] and catheter-directed local thrombolysis [ 42 ] can be considered to prevent pulmonary embolism or treat DVT in CA-VTE patients who cannot receive pharmacological anticoagulation or do not respond optimally to anticoagulation. Catheter-directed (or catheter-derived ultrasound-facilitated) local thrombolysis [ 43 ] or embolectomy [ 44 ] can be considered non-pharmacological treatment in high-risk pulmonary embolism CA-VTE patients with a low risk of bleeding [ 27 ]. Brailovsky et al [ 42 ] in their observational study analyzed 31,124 patients with cancer-associated proximal DVT, of whom 1290 (4%) received catheter-directed thrombolysis.…”

“…These studies were not dedicated to patients with OFC and did not report results in this specific sub-population. Although there is no study examining the use of catheter-directed thrombolysis/embolectomy in patients with OFC and high-risk pulmonary embolism, there are several cases of its successful use in patients with other types of malignancies and high-risk cancer-associated pulmonary embolism [ 43 , 44 ].…”