Management of acute massive pulmonary thrombosis embolism with interventional techniques

Abstract

To assess the efficacy and safety of interventional techniques in the treatment of deep venous thrombosis (DVT) and its complication of acute massive pulmonary thrombosis embolism (PTE). Twenty massive PTE patients received the examinations of Doppler ultrasonography, computed tomography (CT) and venography. After a definite diagnosis, interventional therapy was used for symptomatic controls. The interventional procedures included catheter fragmentation and suction (n = 11), catheter-directed thrombolysis (n = 7), stent placement (n = 4) and inferior vena cava (IVC) filter placement (n = 11). After the above procedures, low doses of urokinase and heparin were prescribed for 1 week. During a follow-up period of 6 - 24 months, the findings of CT, radiography and ultrasound were re-examined. Interventions were successful. The success rates of fragmentation and suction and iliac vein stenting were both 100%. No major complications occurred. Pulmonary embolism involved main trunks and branches of lungs. Both arterial blood pressure and oxygen saturation were below normal values. After interventions, the clinical symptoms and angiographic results improved obviously. It is safe and effective to apply catheter-directed mechanical fragmentation, suction and thrombolysis in the treatment of DVT and PTE. IVC filter may be useful for the prevention of PTE.