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ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 81-87

Catheter-based management of pulmonary embolism


1 Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India
2 Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Correspondence Address:
Dr. Bishav Mohan
Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_36_18

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Background: Pulmonary embolism (PE) is a major cause of mortality and morbidity. Forty-four percent of patients would not have gotten intravenous (IV) thrombolysis due to contraindications or delay. Catheter-directed thrombolysis with fragmentation has been shown to improve short-term and long-term outcomes in acute high-risk patients of pulmonary embolism. Methodology: Patients presented de nova with massive pulmonary embolism or with subacute pulmonary embolism. Some presented with failed thrombolysis from other centers. Results: Our experience from these patients shows that a policy of mechanical thrombus breakdown with a 5F multipurpose or pigtail catheter followed by a urokinase infusion can achieve satisfactory results. Fifty patients with acute were treated with thrombolysis with or without mechanical breakdown. There was 96% event-free survival. With subacute PE, using a mechanical breakdown plus IV thrombolysis, there was fall in pulmonary arterial pressures (PAPs) with 100% 6-month event-free survival. In seven patients with failed thrombolysis, this strategy leads to fall in PAPs and 100% survival at 2 years. Conclusions: Various catheter-based techniques are available which can be used in combination with thrombolysis to achieve good results. Surgery should be considered if the catheter-based techniques fail.


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