Rheolytic thrombectomy in patients with massive and submassive acute pulmonary embolism

Abstract

In experienced hands AngioJet RT can be operated safely and effectively in most patients with acute PE, either massive or submassive, and substantial involvement of pulmonary vascular bed.

Angiojet Rheolytic Thrombectomy in Massive Pulmonary Embolism: Locally Efficacious but Systemically Deleterious?

“…The excellent efficacy of ART in the case of massive PE was also observed by the significant improvement of the Miller index in the series by Chechi et al (3) and by the angiographic observations made in our series (Figure). As opposed to other vascular territories (eg, coronary arteries or lower extremities) where a maximal thrombus fragmentation and aspiration should be attempted, in massive PE, endovascular therapy should be aimed at improving hemodynamic status and not at obtaining an optimal angiographic result.…”

“…In our experience and in other published series, periprocedural deaths despite a satisfactory final angiographic result have been observed (3). The fact that ART itself produces hypotension confounds the efficacy of thrombus aspiration on hemodynamics, potentially leading the operator to continue thrombus aspiration unnecessarily.…”

Pulmonary Embolism in Children

“…Rheolytic embolectomy (the most common type being the AngioJet) injects pressurized saline into the embolus while aspirating macerated thrombus through the catheter port. Early adult data show promising results for patients with PE (47,48). A major disadvantage of this procedure is that mandatory venotomy is required for insertion, which increases the bleeding risk.…”

Catheter-Assisted Pulmonary Embolectomy

“…The largest series included 50 patients with combined catheter-directed thrombolysis used in 30% of treated patients. 20 Primary outcome measures have varied from series to series, with mortality ranging from 12% to 25% in a heterogeneous patient population. Its wide application in coronary and peripheral arterial and venous interventions fueled its popularity in PE interventions.…”