Author + information
- Luis Enrique Berumen Dominguez Sr.,
- Hugo Gutierrez Leonard,
- Anton Meneses Bonilla and
- Ricardo Aguilar-oliva
Our aimwas to establish this new technique as one of the main procedures and to demonstrate that this technique is feasible, cheap and very useful resulting in patency of the pulmonary arteries.
Methods and Results
From November 2010 to February 2016 a total of 96 patients, 50 female and 46 male, between the ages of 28 and 64 were studied. We found bilateral obstruction in 62 patients, and over 80% main branch obstruction. We use a 8 Fr by 80 cm long metal sheath and 8 Fr Judkins right guiding catheter with a 20 ml syringe to make diagnostic angiographies and therapeutic thrombectomies. The PE diagnosis was suspected clinically, guided by laboratories, and confirmed by pulmonary angiotomography and echocardiography. Initially, we decided to treat patients with hemodynamic compromise; by now we are treating patients with proximal embolism who could develop pulmonary hypertension. We punctured the femoral vein and placed a metal sheath of 8 Fr by 80 cm in length into the trunk of the pulmonary artery. Through this a 8 Fr Judkins right guiding catheter was advanced to the site of the thrombosis and with a 20 ml syringe we used suction to aspirate the largest amount of thrombi. We repeat this maneuver was repeated several times and finally catheter angiography was used to confirm the patency of the pulmonary branches. In all cases it was possible to obtain permeability of the main pulmonary branches, and blood pressure and saturation were restored in the next few hours. Of the 96 patients, nine died during the procedure and only one patient had haemoptysis. The procedure had a mortality rate of 5.3% and a morbidity rate of 2.63%.
This is an effective technique for the treatment of acute high-risk pulmonary embolism re-establishing blood pressure, oxygen saturation and right ventricular function. Treating the high-risk pulmonary embolism as soon as possible diminished the cardiovascular complications.