Percutaneous Mechanical Thrombectomy of Submassive Pulmonary Embolism and Extensive Deep Venous Thrombosis for Early Thrombus Removal

Abstract

Traditional treatment with anticoagulation in nonfatal submassive pulmonary embolism can result in serious sequelae of chronic thromboembolic pulmonary hypertension or poor exercise tolerance, and functional impairment. To prevent long-term complications in previously healthy young patients, other treatment options to actively resolve existing thrombi should be considered. Despite recommendations for use in only severe clinical presentations, endovascular interventional techniques could serve as suitable treatment options for such patients. Here we report the case of a previously healthy 23-year-old female with submassive pulmonary embolism and extensive deep vein thrombosis in the inferior vena cava down to the right popliteal vein. The patient was initially treated with catheter-directed thrombolysis. However, she continued to show extensive venous thrombosis and pulmonary embolism. Percutaneous thrombectomy and aspiration using an AngioJet successfully removed the main pulmonary artery embolism and venous thrombus. The patient's recovery was uneventful, and 3-month follow-up showed no signs of recurrence or discomfort.

Keywords: Deep vein thrombosis; Mechanical thrombolysis; Pulmonary embolism; Thrombolytic therapy.

Fig. 1

Initial computed tomography angiography showed right main pulmonary artery thromboembolism (A), left lower lobe segmental artery pulmonary thromboembolism (B), inferior vena cava thrombus (C), and extensive deep vein thrombosis in right common iliac to popliteal vein (D).

Fig. 2

In prone position, pharmacomechanical thrombectomy with AngioJet was performed via popliteal vein puncture, followed by balloon angioplasty with Mustang 10 mm×60 mm to right common iliac vein stenosis.

Fig. 3

Arteriography was initially undertaken through a 7-Fr sheath and a pigtail catheter was placed up to the main pulmonary vein. A large thrombus at the right main pulmonary artery (RPA) was checked and an 8Fr shuttle for aspiration thrombectomy was attempted followed by AngioJet Zealante for mechanical thrombectomy. Repeated aspiration and mechanical thrombectomy were undertaken and completion pulmonary arteriography showed that the RPA thrombus disappeared without distal embolism.