Pulmonary Embolism in Pregnancy: UltrasoundAssisted Catheter-Directed Thrombolytic Therapy for the Treatment of a Pulmonary Embolus—A Case Report

In the United States,pulmonary embolism(PE)accounts for approximately 10%of all pregnancy related deaths.The standard treatment for a patient with high-risk PE is systemic thrombolysis.Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications,including spontaneous abortion,preterm delivery,and fetal bleeding.Currently,there is limited evidence for a standardized approach for the treatment and management of intermediate-and high-risk PEs in pregnancy.A 36-year-old gravida 3 para 2002 woman at 31+1weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath.A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches.A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function.The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis.She subsequently delivered a healthy male infant at term.Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited.Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy.Catheterdirected thrombolysis can be efficacious in treating intermediate-and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.

Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success.?The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting.?In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic thrombolysis.This literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.