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Endovascular techniques (ET) for recanalization of complete and partial occlusions of the pulmonary trunk or major pulmonary arteries:
ET are the method of choice or in fact a life-saving procedure by a certain group of patients with massive or submassive pulmonary embolism. They may be used as an alternative to thrombolysis when there are contraindications or in hospitals, where emergency surgical thrombectomy is unavailable or contraindicated. ET can be performed when systemic thrombolysis has failed to improve hemodynamics in the acute phase of PE. The hybrid technique that involves catheter-based defragmentation and local thrombolysis is a new advanced strategy for effective treatment of patients with PE, assessed as high and intermediate risk. This technique is more widely used in endovascular centers with extensive experience in treatment of various vascular pathology.
The objectives of catheter-based therapy include:
• Rapid reduction of pulmonary artery pressure,
• Reduction in pulmonary vascular resistance (PVR);
• Increasing systemic perfusion;
• Facilitate recovery of RV.
• Reduction of the amount of the fibrinolytic agent (based upon supraselective catheter fibrinolysis applies 1/3 to 1/2 of the total systemic dose of fibrinolytic)
Our aim is to show the effectiveness of the endovascular treatment of acute pulmonary embolism and pulmonary hypertension in patients with a chronic pulmonary embolism.
We present the data for 62 patients, treated for the period 10.2013-06.2015: 34 men (55%) and 28 women (45%) with massive and submassive pulmonary embolism, with an average age - 61 years (24-82).
During the procedure in 28 patients (43%) pulmonary pressure decreased over 10%. After the procedure 52 patients (81%) showed clinical improvement (reduced shortness of breath, hemodynamic stability), echocardiography data showed - lower pulmonary pressure and improved right to left ventricle ratio - lifesaving procedure.
In 9 patients (14%) with some comorbidity, age, a presence of cancer, coronary and cerebral vascular disease, there was a longer recovery period and persistence of respiratory failure within hospitalization. No complications or bleeding were observed in these 62 patients. All patients underwent parenteral and oral anticoagulation.
The endovascular techniques for treating both acute and chronic PE are a cheap and very effective option for treatment. They are becoming the first line of treatment for acute PE in the centers with experienced endovascular teams. The advantages are very low doses of adjunctive thrombolytic therapy, low risk of bleeding and the expectation of rapid hemodynamic improvement in patients with an acute thrombotic event/lifesaving procedure.