HISTORY: 35 years Male with massive pulmonary embolism presents for emergent pulmonary artery thrombectomy. PROCEDURES PERFORMED: 1. Ultrasound-guided access right common femoral vein 2. Diagnostic venogram right external iliac vein, right common iliac vein, IVC 3. Right pulmonary arteriogram 4. Right pulmonary artery mechanical thrombectomy 5. Main pulmonary artery mechanical thrombectomy 6. Direct pulmonary artery pressure measurement 7. Closure right common femoral venotomy with Flowstasis device. TECHNIQUE: The patient was placed supine on the angiography table. Bilateral groins were prepped and draped in usual sterile fashion. 1% lidocaine was used for local anesthesia. Under ultrasound guidance, the right common femoral vein was accessed using micropuncture needle and standard upsize was made to an 035 system. Diagnostic venogram of the external iliac vein, common iliac vein and IVC was performed. A 7 French angled pigtail catheter was advanced under fluoroscopy to the main pulmonary artery and gentle hand injection pulmonary arteriogram was performed. A 7-French pigtail catheter was removed over a stiff guidewire. The subcutaneous tract was then serially dilated and a 24 French Gore Dryseal sheath was advanced into the infrahepatic IVC. A T16-T24 Flowtriever thrombectomy system was advanced coaxially into the right main pulmonary artery. Aspiration thrombectomy was performed. Progress was monitored on serial pulmonary arteriograms. Aspiration thrombectomy was then performed in the main pulmonary artery in a similar fashion. Final post thrombectomy pulmonary arteriogram was performed. Post thrombectomy pulmonary artery direct pressure measurements were obtained. All wires, catheters and sheaths were removed and hemostasis of the right common femoral vein access site was obtained with Flowstasis suture retention device. |
| IMPRESSION: Massive pulmonary embolism with complete obstruction of the right main pulmonary artery as well as saddle embolus to the main pulmonary artery status post successful emergent pulmonary artery thrombectomy with removal of large amount of thrombus. |