LONG-TERM EXPERIENCE WITH TRANSVENOUS CATHETER PULMONARY EMBOLECTOMY

Purpose: Massive pulmonary embolism (PE), defined by systemic hypotens ion and need for inotropic support, has a high mortality rate. Transve nous catheter pulmonary embolectomy performed with the patient receivi ng local anesthetic provides an expeditious alternative to lytic thera py or open embolectomy on cardiopulmonary bypass. Methods: The indicat ion for embolectomy in this series of 46 patients was hypotension desp ite inotropic support in all but four patients (91%); the latter susta ined major embolism and were respirator dependent. In the first 10 pat ients treated from 1970 to 1974, a metal cup attached to a straight ca theter was used. Results: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prom pted addition of a vena caval filter and directional control to the ca theter. Subsequently 36 patients were treated with this combination fr om 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after embolectomy. Complications included wo und hematoma (15%), pulmonary infarct (11%), recurrent deep venous thr ombosis (6%), pleural effusion (4%), and myocardial infarction (4%). C onclusions: Successful embolectomy was most likely for categories of m ajor PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the s eries (range 1 to 237 months). Catheter pulmonary embolectomy by surge on and radiologist is of maximal benefit for major or massive PE but l ess likely to benefit patients with chronic recurrent PE.