Interventional radiology treatment for pulmonary embolism

Abstract

Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.

Keywords: Catheter directed therapy; Interventional radiology; Massive pulmonary embolism; Pulmonary embolism; Pulmonary embolism treatment; Submassive pulmonary embolism; Venous thromboembolism.

Figure 1

Schematic representation of thrombus fragmentation by a mechanical thrombolysis resulting a distal embolization of smaller thrombi, creating a larger surface area of the clot improving the efficacy of the thrombolytic agent therapy.

Figure 2

The great advantage of these devices although of dubious effectiveness, is that they are simple to use and available at a low price. A, B: Pulmonary angiography and CT angiography, of a 37-year-old male patient diagnosed with a massive pulmonary embolism; C: Catheter drug therapy, and mechanical thrombolysis; D, E: Schematic representation of mechanical thrombolysis and the infusion of fibrinolytic agents through the pigtail catheter; F: Pulmonary angiography after 24 h of perfusion with 100000.00 UI/h of urokinase, showing no residual occlusion.

Figure 3

Aspirex^®S by Straub Endovascular System. Mechanism of thrombectomy in which haves a screw that rotates inside the catheter lumen, and this spiral movement is generated by an active motor that produces a thrombus aspiration.

Figure 4

The Indigo mechanical aspiration system (Penumbra Alameda, United States) is an aspiration thrombectomy catheter system. A, B: Pulmonary angiography and CT angiography, of a 37-year-old male patient diagnosed with a massive pulmonary embolism, 24-year-old female patient diagnosed with massive pulmonary embolism; C-F: Treated with CAT8 and SEP8 Indigo System^® by PENUMBRA and catheter directed therapy with Pig-tail catheter with an infusion of 1200000.00 UI urokinase administered in 12 h. CT: Computed tomography.

Figure 5

EKOsonic Endovascular System by BTG. Specialized catheter that lodges in its interior a sophisticated mechanism that haves an ultrasonic core to effectively target an entire clot producing thrombolysis effect, and also helps the infusion of the fibrinolytic agent work faster and more efficient.