Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Ineffective fragmentation

17 Jul
2014

Systolic and diastolic pulmonary artery pressure decreased significantly prefragmentation to postfragmentation (p = 0.03 and 0.01). Within the 48-h follow-up, significant decrease continued (p = 0.02 and 0.01). However, the decrease of the average mean arterial pulmonary pressure prefragmentation to postfragmentation was insignificant (p = 0.14), whereas it was highly significant within the 48-h follow-up (p < 0.001). Development of the blood gases (Pao2 and Paco2) showed no significance at all.
The catheter approach used was three times the right jugular vein and five times the right femoral vein (Table 3). In one case, the left femoral vein was chosen in a patient with right deep vein thrombosis who was wearing a stiff-neck bandage. In another patient with an obliterated right jugular vein, the left one was cannulated. The different approaches did not impair placement and handling of the fragmentation catheter.
Mean total procedure time was 41 min, with a range of 8 to 70 min (Table 3) newmycanadianpharmacy.com canadian pharmacy. Mean real fragmentation time was 17 min, with a range of 4 to 35 min. In 6 of 10 cases, there were no technical problems with catheter handling and fragmentation function. In three cases, there was an obvious mismatch between the fragmentation pigtail with a diameter of 8 mm and a large embolus (diameter, 28 to 33 mm) in a dilated main artery (Fig 3). Fragmentation achieved only marginal improvement in these cases (Table 3, No. 3,6,10). According to observation under fluoroscopy, the rotating pigtail tended to displace to the circumference of the large emboli without reaching out to the center. Small improvements were due to recanalization at the margin of the emboli and of obstructed lobar arteries, where the pigtail size was adequate.
In one case the catheter was wedged in the sheath, which made catheter advancement impossible. Exchange with a new catheter set allowed fragmentation as planned.

Figure 3. Ineffective fragmentation in a 53-year-old male patient with traumatic lumbar spine fractures. There is an obvious mismatch in size between the small pigtail and the enlarged pulmonary artery containing a large, high consistent embolus. In this patient with proven heparin-induced thrombocytopenia, a thrombolysis with 60 mg ol plasminogen activator already had been performed the day before without any recanalization effect. Left: pigtail rotation catheter in the right main artery via jugular access (same scale as the right panel). Right: postcatheter treatment, only marginal improvement of perfusion: there is still a large embolus (arrowheads) in an enlarged right main pulmonary artery, with narrow bands of circumferential flow.

Figure 3. Ineffective fragmentation in a 53-year-old male patient with traumatic lumbar spine fractures. There is an obvious mismatch in size between the small pigtail and the enlarged pulmonary artery containing a large, high consistent embolus. In this patient with proven heparin-induced thrombocytopenia, a thrombolysis with 60 mg ol plasminogen activator already had been performed the day before without any recanalization effect. Left: pigtail rotation catheter in the right main artery via jugular access (same scale as the right panel). Right: postcatheter treatment, only marginal improvement of perfusion: there is still a large embolus (arrowheads) in an enlarged right main pulmonary artery, with narrow bands of circumferential flow.

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