A. A. Siddiq1, W. Qu1, H. Maldonado1, A. K. Baothman1, M. Osman1, F. Brunicardi1, M. Nazzal1 1University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
Introduction:
Pulmonary embolism (PE) is the third most common cause of cardiovascular-related death in the United States. Endovascular techniques have been suggested as an option to treat submissive and massive PE with lower hemorrhagic complications than systemic thrombolysis. We aim to evaluate the outcomes of different endovascular techniques of in the management of submissive and massive PE.
Methods:
This is a single center retrospective review. All adult (age≥18 years) patients with a diagnosis of acute massive or sub-massive PE during Jan 2012 and Jan 2017 were identified. Medical records were reviewed for demographics, medical history, and treatment modality of PE. The outcomes of PE including ICU stay, mortality, and postoperative complications were analyzed. Statistical analyses were performed using IBM SPSS Statistics, Version 24 (IBM Corp., Armonk, NY) as appropriate.
Results:
There were 36 PE patients enrolled in our study. One third of patients (n=12 were had massive PE, the rest (n=24) were sub massive PE. In 32 (88.9%) patients, PE involved both sides of the pulmonary artery.
The most common symptoms presented were dyspnea (58.3%, n=21), chest pain (25%, n=9), and syncope (16.7%, n=6). The average age was 54.8±12.6 years old. There were 28 Females (58.3%) and 15 males (41.7%). The majority of the patients were Caucasian (88.9%, n=32), 3 (8.3%) of the patients were African Americans. There were no significant differences in demographics between patients with massive PE and those with sub massive PE. Four groups were identified on the basis of the therapy received: Catheter Directed Thrombolysis (CDT) only (n=9), CDT + EkoSonic Endovascular System (EKOS) (n=15), other( which includes; CDT with mechanical thrombectomy or maceration suction) (n=10). One patient had systemic thrombolysis while another one had open embolectomy. No significant differences were identified in outcomes (mortality, complications, and echocardiographic results) between those groups. Patients received EKOS have 30 days mortality rate 0% (P-value = 0.027) compared to those did not receive EKOS intervention (30%). Post-hoc pairwise comparison with Fisher exact test of 30 days mortality showed no significant difference between any pair of the endovascular intervention groups. There is no significantly difference in ICU or hospital length of stay between the different intervention (median 3 and 6 days respectively).
Conclusion:
Massive and sub massive PE can be safely treated with a variety of endovascular techniques. All endovascular techniques had comparable outcomes, although EKOS thrombolysis may have lower mortality.