Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Study Design and Selection of Patients

11 Jul

Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Study Design and Selection of PatientsDepending on the patient’s condition, written or verbally informed consent was obtained. The ethics committee was notified about the inclusion of any mechanically ventilated and sedated patient and consent was obtained as soon as possible in the clinical course.
Ten patients (4 female, 6 male, age 53.8 ± 9.5 years) from three centers were included in the study. Levitra Link The demographic and clinical data are given in Table 1.
Inclusion criteria were angiographically confirmed acute massive pulmonary embolism with hemodynamic impairment (pulmonary arterial occlusion > 50%, mean pulmonary artery pressure > 25 mm Hg, shock index = heart rate/systolic systemic BP > 1) and involvement of the central (main and/or lobar) pulmonary arteries. Hemodynamically stable patients and patients with exclusive involvement of peripheral (segmental/subsegmental) pulmonary arteries were excluded.
All examinations, including pulmonary angiography and the fragmentation procedure, were carried out in an ICU. Patients who showed a rapid deterioration of their cardiopulmonary condition were intubated, sedated, and put on respiratory therapy with oxygen supplementation. Positive inotropic and vasoactive support with catecholamines was supplemented according to the patient’s hemodynamic condition. Prior to pulmonary angiography, bedside transthoracic or transesophageal echocardiography was performed to confirm the suspicion of pulmonary embolism and to exclude right atrial or ventricular floating thrombi. In case of thrombi-in-transit, right heart catheterization was waived. For catheter access, the protocol allowed jugular or femoral puncture, according to the preference of the examiner. However, transfemoral access was considered contraindicated in case of iliocaval or ipsilat-eral femoral venous thrombosis, as documented by vascular ultrasound and subsequent iliocavography. To avoid inadvertent arterial puncture, jugular cannulation was usually performed by ultrasound guidance.
Table 1—Demographic and Clinical Data

Patient No./ Sex/Age, yr Height,cm Weight,kgHistory/Primary DiagnosisCPR Duration, minMechanical Ventilation (V), Inotropic Support (I)
l/M/47185110Repeated syncopes last 2 wk, recurrent pulmonary embolism, pulmonary hypertension, DVT left legV, I
2/M/6617472Perforated appendix, appendectomy, gastrectomy, DVT right leg
3/M/5319-5100Trauma: lumbar vertebral body fractures, internal fixationV. I
4/M/3617872Trauma: fractures right leg, cervical spine, DVT right legI
5/M/5817580Recurrent pulmonary embolism
6/F/7016075Hip endoprothesisUnknownV, I
7/F/5316684Meningioma, cranial surgery10V, I
8/F/5616982Cranial trauma, endogenous depressionV, I
9/F/5517293Transsphenoidal hypophysectomy repeated resuscitations30V, I
10/M/4418794Cerebral stroke, left hemiparesisV, I