Catheter technique for pulmonary embolectomy or thrombofragmentation

The management of acute massive pulmonary embolism (PE) constitutes a major clinical problem because of the associated derangement of hemodynamic and respiratory functions from obstruction to pulmonary blood flow. Despite advances in management with thrombolytic therapy or open embolectomy, the mortality rate remains high. To improve the chance of survival, catheter techniques that are capable of removing or fragmenting the clot have been developed. These include catheter pulmonary embolectomy and thrombofragmentation. The former involves the introduction of a suction catheter from a femoral or jugular venotomy through the right heart into the appropriate pulmonary artery under fluoroscopic guidance. The technique for the latter involves the percutaneous introduction of a fragmentation catheter from a femoral vein through a guiding catheter into the appropriate pulmonary artery. The success of the catheter technique in removing pulmonary emboli varies with different devices. The overall success rate is approximately 76%, with a mortality rate of 25%. Transvenous pulmonary embolectomy and thrombofragmentation are safe and effective techniques for treating patients with massive PE. The success of each of the techniques depends on a thorough understanding of the mechanism of action of each of the devices used and a facile catheterization technique.