Balloon catheter pulmonary embolectomy under direct visual control using a choledochoscope

Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. To salvage critically ill patients, complete clot extraction without arterial wall injury is essential. In this study, we performed balloon catheter embolectomy under direct visual control by using a flexible choledochoscope. For clear visualization, we introduced deep hypothermic circulatory arrest, and cold normal saline solution was flushed through the irrigation channel. From our experience, we believe that balloon catheter embolectomy with a choledochoscope allows easy access to the secondary and tertiary pulmonary branches and enables complete clot extraction.