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Background: Ultrasound-assisted catheter-directed thrombolysis (USAT) aims to improve morbidity and mortality in patients with acute pulmonary embolism while reducing hemorrhagic complications in comparison to systemic fibrinolysis. To date, no study has investigated access site as a contributor to bleeding complications and outcomes in USAT. Acceptable sites for USAT include the internal jugular vein (IJV) or common femoral vein (CFV).
Methods: From January 2012 to February 2016, 72 patients treated with USAT using the EkoSonic Endovascular System (EKOS, Bothell, WA, USA) for submassive or massive pulmonary embolism were identified. Data was collected on access site location, bleeding complications, total thrombolytic dose, and additional clinical outcomes. The primary outcome was any bleeding event during their hospitalization following USAT. Bleeding events were defined by any episode fulfilling either Global Use of Strategies to Open Occluded Arteries (GUSTO) or Non-CABG Thrombosis in Myocardial Infarction (TIMI) bleeding definitions.
Results: A majority of patients (48/72; 67%) were treated via the CFV in contrast to 33% (24/72) utilizing the IJV. A total of 17 TIMI (6 Major, 8 Minor, 3 Minimal) or 16 GUSTO (3 Severe or Life-threatening, 4 Moderate, 9 Mild) bleeding events occurred and the incidence was similar between the IJV (5/24; 21%) and CFV (13/48; 27%) groups. There were 10 access site-related complications (IJV 3/24; 12.5% and CFV 7/48; 14.6%) that included hematoma, vascular injury, and pseudoaneurysm. Two patients had gastrointestinal bleeding, 1 had hemoptysis, and 3 had a drop in hemoglobin without overt evidence of bleeding. One intracranial hemorrhage occurred in the IJV group and there was 1 death in the CFV group as a result of hemodynamic collapse from a massive pulmonary embolism. There was no association between thrombolytic dose and a complication.
Conclusions: In patients treated with USAT for acute pulmonary embolism, there was no difference in bleeding events when comparing an IJV versus CVF approach. This study further illustrates the heterogeneity with currently employed bleeding definitions that may undermine adjudicating the safety of USAT.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-120
- 2017 American College of Cardiology Foundation