In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary ...In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA （TO） and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index （Qanadli index） and compared with Miller index. CTPA, oxygen saturation （SaO2） and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was （55 ± 13）% （range, 40%- 75%）, and Miller index was （62 ± 15）% （range, 45%-85%）. Correlations between them were statistically significant （r = 0.867, P 〈 0.0001）. The Qanadli index showed significant reduction [TO： （55±13）%; TI： （12±10）%; P 〈 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO2 （r = 0.934）, and pulmonary artery pressure （r = 0.813）. The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.展开更多
Background Acute massive pulmonary embolism （PE） is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study wa...Background Acute massive pulmonary embolism （PE） is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE. Methods From January 2003 to June 2007, 28 patients （20 men, 8 women; mean age 64 years） with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation. Results Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from （86.2±4.5）% to （96.1±3.2）% （P 〈0.001） after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from （34.2±4.8） mmHg to （25.2±5.1） mmHg （P 〈0.001）. During clinical follow-up （range, 1-5 years）, no patients had recurrence of PE. Conclusion Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.展开更多
Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death...Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.展开更多
AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy sin...AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto.035' and XL extraction catheter(Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto.035' or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography(CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle(RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients(n = 8), the mean pulmonary pressures declined from a median(range) of 35.5(19-46) to 23(10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE(n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting(n = 2). CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.展开更多
Pulmonary embolism represents a common life-threatening condition.Prompt identification and treatment of this pathological condition are mandatory.In cases of massive pulmonary embolism and hemodynamic instability or ...Pulmonary embolism represents a common life-threatening condition.Prompt identification and treatment of this pathological condition are mandatory.In cases of massive pulmonary embolism and hemodynamic instability or right heart failure,interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment(systemic thrombolysis)and surgical treatment.Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration,which can prove useful in cases of failure or infeasibility of medical and surgical approaches.展开更多
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 challen...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.展开更多
目的：探讨疑难性可回收下腔静脉滤器的回收技巧和策略。方法2010年1月-2013年6月收治采用常规圈套技术无法成功取出的下腔静脉滤器置入术后患者30例，采用导丝成袢法、胃镜活检钳辅助法及猪尾导管搅拌法行下腔静脉滤器取出术。结果成...目的：探讨疑难性可回收下腔静脉滤器的回收技巧和策略。方法2010年1月-2013年6月收治采用常规圈套技术无法成功取出的下腔静脉滤器置入术后患者30例，采用导丝成袢法、胃镜活检钳辅助法及猪尾导管搅拌法行下腔静脉滤器取出术。结果成功回收下腔静脉滤器30例（100％）。导丝成袢法取出8例，胃镜活检钳辅助法取出12例，猪尾导管搅拌法取出10例。回收过程用时20～90 min，中位时间50．5 min 。滤器在体内留置时间为14～60 d，中位数25．6 d。术后3 d 内全部患者顺利出院。结论对于疑难性可回收下腔静脉滤器采用多种辅助性圈套技术可有效提高其回收率，有一定的临床应用价值。展开更多
文摘In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA （TO） and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index （Qanadli index） and compared with Miller index. CTPA, oxygen saturation （SaO2） and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was （55 ± 13）% （range, 40%- 75%）, and Miller index was （62 ± 15）% （range, 45%-85%）. Correlations between them were statistically significant （r = 0.867, P 〈 0.0001）. The Qanadli index showed significant reduction [TO： （55±13）%; TI： （12±10）%; P 〈 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO2 （r = 0.934）, and pulmonary artery pressure （r = 0.813）. The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.
文摘Background Acute massive pulmonary embolism （PE） is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE. Methods From January 2003 to June 2007, 28 patients （20 men, 8 women; mean age 64 years） with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation. Results Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from （86.2±4.5）% to （96.1±3.2）% （P 〈0.001） after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from （34.2±4.8） mmHg to （25.2±5.1） mmHg （P 〈0.001）. During clinical follow-up （range, 1-5 years）, no patients had recurrence of PE. Conclusion Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.
文摘Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.
文摘AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto.035' and XL extraction catheter(Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto.035' or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography(CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle(RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients(n = 8), the mean pulmonary pressures declined from a median(range) of 35.5(19-46) to 23(10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE(n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting(n = 2). CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.
文摘Pulmonary embolism represents a common life-threatening condition.Prompt identification and treatment of this pathological condition are mandatory.In cases of massive pulmonary embolism and hemodynamic instability or right heart failure,interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment(systemic thrombolysis)and surgical treatment.Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration,which can prove useful in cases of failure or infeasibility of medical and surgical approaches.
文摘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.
文摘目的：探讨疑难性可回收下腔静脉滤器的回收技巧和策略。方法2010年1月-2013年6月收治采用常规圈套技术无法成功取出的下腔静脉滤器置入术后患者30例，采用导丝成袢法、胃镜活检钳辅助法及猪尾导管搅拌法行下腔静脉滤器取出术。结果成功回收下腔静脉滤器30例（100％）。导丝成袢法取出8例，胃镜活检钳辅助法取出12例，猪尾导管搅拌法取出10例。回收过程用时20～90 min，中位时间50．5 min 。滤器在体内留置时间为14～60 d，中位数25．6 d。术后3 d 内全部患者顺利出院。结论对于疑难性可回收下腔静脉滤器采用多种辅助性圈套技术可有效提高其回收率，有一定的临床应用价值。
