Combined thrombolysis and inferior vena caval interruption as a therapeutic approach to massive and submassive pulmonary embolism

Massive and a submassive pulmonary embolism (PE) is a life-threatening emergency. This condition is usually treated urgently with measures to attain hemodynamic stability and anticoagulation. In selected subjects, thrombolysis, inferior vena caval interruption and embolectomy have been used. We report a consecutive case series of subjects with massive and submassive pulmonary embolism treated with both inferior vena caval interruption and thrombolysis.

Chart review of consecutive cases of massive and submassive pulmonary embolism treated with both inferior vena cava filter placement and thrombolysis. Hospital course was reviewed and subjects were followed up six months after the acute event. Complications as a result of therapy were documented.

Sixteen subjects were identified. Ten (62.5%) subjects were categorized as submassive and six subjects (37.5%) were categorized as massive. There was no attributable mortality to PE or its treatment. Minor bleeding was seen in the majority of subjects (75 %) but major bleeding was seen in only one (6.25%) subject. Other complications were not encountered. No recurrent thromboembolic events were clinically evident during a six-month follow-up period.

The combination of inferior vena caval interruption and thrombolysis seems safe and effective for the treatment of PE. This modality was not associated with mortality in any of our patients. The only complication encountered was bleeding primarily at the sites of vascular access. We conclude that combined vena caval interruption and thrombolysis is a safe means of treating potentially life-threatening pulmonary embolism.