Catheter directed thrombolytic therapy and percutaneous thrombectomy

Abstract

Abstract 40% of DVTs occur in the femoral and iliac veins and have a high risk of pulmonary thromboembolism and Post Thrombotic Syndrome (PTS), which can be avoided by timely interventional management. Catheter Directed Thrombolytic Therapy (CDTT) and Pharmacomechanical Catheter-Directed Thrombolysis (PCDT), (combination of CDTT with percutaneous mechanical thrombectomy) techniques enhance the efficiency and rate of thrombus removal. It also uncovers the May Thurner syndrome in many cases. Massive Pulmonary Embolism (PE) is associated with high morbidity and mortality due to thrombotic occlusion of main pulmonary artery and/or both major pulmonary arteries leading to severe hypoxemia, pulmonary artery hypertension and cardiogenic shock. Till now, open surgical pulmonary endarterectomy was the only option for prompt restoration of flow in major pulmonary arteries but carried a high mortality in hemodynamically unstable patients. Catheter based pulmonary thromboaspiration and intrapulmonary thrombolysis can be used. We present our experience in 45 consecutive patients of massive PE presenting with cardiogenic shock.