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CIRSE Standards of Practice on Endovascular Treatment of Acute Pulmonary Embolism
Juan José Ciampi-Dopazo1, José A Guirola2, John Moriarty3
1Hospital Universitario Virgen de Las Nieves, Granada, Spain.
Insights
Endovascular treatment for pulmonary embolism (PE) is safe and effective. This practice document outlines standards for diagnosis, intervention, and treatment of acute and chronic PE.
Area of Science:
- Interventional Radiology
- Vascular Medicine
- Cardiology
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Endovascular techniques offer minimally invasive treatment options for PE.
- Established standards are crucial for optimal patient outcomes.
Purpose of the Study:
- To establish comprehensive standards for endovascular treatment of acute and chronic pulmonary embolism (PE).
- To provide recommendations for imaging diagnosis, surveillance, and intervention indications.
- To guide endovascular treatment strategies for PE.
Main Methods:
- Consensus-based recommendations developed by an expert writing group.
- Evidence-based literature search of PubMed up to early 2024.
- Focus on interventional radiologists' expertise in PE.
Main Results:
- Endovascular treatment of PE demonstrates high success rates and low complication rates.
- Catheter-directed thrombolysis and mechanical thrombectomy are effective for intermediate-high and high-risk acute PE.
- These interventions are particularly valuable when systemic fibrinolysis is contraindicated or ineffective.
Conclusions:
- Endovascular therapy is a safe and effective approach for both acute and chronic PE.
- Early diagnosis, appropriate patient selection, and timely intervention are emphasized.
- Adherence to best practices ensures optimal management of PE.
Purpose:
This CIRSE Standards of Practice document aims to provide comprehensive standards for the endovascular treatment of acute and chronic pulmonary embolism and includes recommendations for the imaging diagnosis, surveillance, intervention indications and endovascular treatments.
Methods:
The CIRSE Standards of Practice Committee established a writing group of six internationally recognised interventional radiologists with expertise in pulmonary embolism interventions and one research assistant (C.I). The group conducted a pragmatic evidence-based PubMed search for relevant English-language reports on human subjects up to early 2024. The final recommendations are consensus-based.
Results:
Endovascular treatment of pulmonary embolism is highly successful with low complication rates. For acute pulmonary thromboembolic disease, catheter-directed thrombolysis and mechanical thrombectomy are options for patients with intermediate-high risk and high-risk pulmonary embolism, especially when systemic fibrinolysis fails or is contraindicated.
Conclusions:
Endovascular therapy for acute and chronic pulmonary embolism is both safe and effective. This best practice document emphasises early diagnosis, appropriate patient selection and timely intervention.
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