Simultaneous Treatment of Acute Pulmonary Embolism and Deep Venous Thrombosis. A Preliminary Multicentre Experience

Abstract

Introduction: Venous thromboembolism, which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a global disease burden. New mechanical thrombus removal devices could represent a safe and effective treatment for acute PE, especially in patients with absolute contraindication to thrombolysis, resulting in high technical and clinical success of this procedure[i] . Moreover coexisting DVT could be treated with thrombus removal devices avoiding caval filter deployment. Aim of this study is to assess the feasibility of aspiration mechanical thrombectomy of massive or submassive PE and DVT, in a single session, in patients with contraindications to thrombolysis. Methods: In two centers, from April 2017 to April 2018, we prospectively enrolled all patients with contraindications to thrombolysis, suffering from DVT and massive or submassive PE according to ESC and AHA guidelines, undergone simultaneous mechanical thrombectomy of both pulmonary arteries and deep peripheral veins. All procedures were approved by our institutional review board and a written informed consent was obtained from all patients when possible. Exclusion criteria were: low risk PE and eligibility for first-line thrombolytic treatment. All patients included in the study were proved to have acute PE based on clinical and radiological findings, according to the presence of proximal arterial PE at computed tomography angiography (CTA) and DVT based on ultrasound and CTA. RV/LV ratio was measured from CTA using a four-chamber views on a dedicated workstation, before trombectomy, postoperatively and at 12 months follow-up. SpO2, Heart Rate (HR), and ultrasound venous examination were recorded at 12 months follow-up. Technical success was defined as pulmonary arterial systolic pressure reduction at 50% from the initial value for PE treatment and direct visualisation of thrombus significant reduction (> 70%) in peripheral DVT. Results: Six patients (2 male) were enrolled in our study. Mean age was 76 (55-91). All patients required before treatment high volume O2 therapy, with mean SpO2 of 85.8 (82-90), mean heart rate of 72.5 (42-100) and mean RV/LV of 1.37 (1.2-1.8). Contraindications for first-line thrombolytic treatment were: recent stroke in 4 cases, known bleeding risk in 1 case and brain metastasis in 1 case. Two patients presented popliteal residual DVT, 3 patients femoral DVT and 1 patient iliac DVT. No procedural or periprocedural complications were observed. PE technical success was achieved in all patients, peripheral venous revascularisation was effective in 4 patients, in two patients mechanical aspiration was unable to solve the subacute thrombosis and no further treatment was attempt. At 12 months follow up only 1 patient required 1L O2 therapy with mean SpO2 of 91.8 mmHg (90-94), mean heart rate of 68,3 (63-73) and mean RV/LV ratio of 0,90 (0,85-0,95). Vein ultrasound examination revealed that 4 patients still had patent veins, while in uneffective peripheral veins aspiration a chronic DVT was evident. Conclusion: In our preliminary series simultaneous treatment of DVT and PE is safe and effective. Low rate of complications encourage extensive use of this technique in selected patients, however larger prospective studies are needed to assess the feasibility of this treatment. Disclosure: Nothing ti disclose