Local Thrombolysis for Acute Massive Pulmonary Embolism using a Pulse-Infusion-Thrombolysis Catheter

Acute massive pulmonary embolism (PE) is a common life-threatening condition requiring emergent and suitable treatment. The aim of this study is to assess the efficacy and safety of local thrombolysis with a pulse-infusion-thrombolysis (PIT) catheter in the management of acute massive PE. Thirty-nine patients with PE were treated with catheter directed intervention (CDI). CDI involves suction embolectomy and local thrombolysis with a PIT catheter. Procedural success was achieved in all patients (100%). After the CDI, a significant increase of mean systemic blood pressure was observed (93.8 ± 22.0 mmHg versus 100.8 ± 22.9 mmHg, P = 0.02), and pulmonary perfusion on the basis of Miller score was improved (19.6 ± 7.6 versus 16.3 ± 7.1, P = 0.04). Clinical success was achieved in 36 of 39 patients (92.3%). Two patients died of PE after CDI despite a successful recanalization, and 1 patient died of disseminated intravascular coagulation after the CDI. No major complication occurred in the remaining 36 patients and minor complications developed in 3 patients (7.7%). Local thrombolysis using a PIT catheter for massive PE is safe and effective treatment with minimal complication

Compressed Amplatzer Vascular Plug II Embolization of the Left Subclavian Artery for Thoracic Endovascular Aortic Repair is Efficient and Safety Method Comparable to Conventional Coil Embolization

[Background] Left subclavian artery (LSA) embolization is occasionally required to prevent type II endoleak in the thoracic endovascular aortic repair (TEVAR) procedure. This is a retrospective study comparing compressed Amplatzer Vascular Plug II embolization (CAE) and conventional coil embolization (CCE) in preventing retrograde flow into the aneurysmal sac through the LSA after TEVAR. [Methods] We retrospectively reviewed the records of patients who underwent CAE or CCE of the LSA during TEVAR from June 2013 to March 2016 in our hospital. The efficacy, safety and cost of each method were compared between two groups. [Results] Thirty patients underwent LSA embolization during TEVAR. Six CCEs in 6 patients were performed from June 2013 to November 2013, while twenty-four CAEs in 24 patients were performed from December 2013 to March 2016. Technical success was achieved in all patients in both groups. No embolization-related complications or type II endoleaks from LSA were recorded during the follow-up period in all patients. In both groups, all embolic materials were detected in the proximal portion of the LSA from the LSA orifice to the vertebral artery origin and no vertebral artery occlusions were detected. The mean compression ratio of AVP II was 58 ± 5.9% of predicted length of standard procedure. In the CAE group, one AVP II was sufficient to achieve complete LSA occlusion in all patients. On the other hand, multiple coils (10.2 ± 2.7) were used in the CCE group (P < .01), resulting in a significantly lower cost incurred in the CAE group (CAE: 129,000 JPY vs. CCE: 639,600 ± 140,060 JPY; P < .01). [Conclusion] The CAE is a useful and cost-effective procedure for TEVAR-related LSA embolization