Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients

OBJECTIVES

This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system.

MATERIAL AND METHODS

Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed.

RESULTS

Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU.

CONCLUSION

In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.

Zenith TX2LowProfile TAA Endovascular Graft: a next generation thoracic stent-graft

AIM

The aim of the present article is to describe a new thoracic stent graft (Zenith TX2 Low-Profile TAA Endovascular Graft).

METHODS

Feasibility of endovascular repair of thoracic aortic aneurysms depends on several anatomic factors. A primary limitation is an adequate arterial approach. Since most currently used endografts require large introducer sheaths, patients with severely diseased iliofemoral vessels are often excluded from this less-invasive technique. Attempts to overcome access difficulties increase the risk for arterial access-site complications such as aortoiliac rupture. In addition, highly angulated proximal landing zones provide challenges in obtaining proximal graft conformance and sealing.

RESULTS

The introduction of next-generation endografts such as the Zenith TX2LowProfile TAA Endovascular Graft provides a solution for a larger number of patients, including those with small vessels, vascular access problems and tortuous aortic anatomy.

CONCLUSION

The ongoing Zenith TX2 Low-Profile Endovascular Graft trial will build further understanding of the performance of the device allowing for treatment of a wider patient population.

Endovascular surgery as a bridge solution for selected vascular emergencies

Vascular emergencies patients present with several problems requiring immediate sufficient evaluation of the situation and intervention in order to save life, limb, or a serious health injury. Endovascular surgery may be very useful as bridging technique in order to obtain immediate bleeding control. Additionally, a remarkable number of patients has poor general health conditions and is unfit for open repair. The surgical solution would be invasive and prohibitive for this high-risk patient's subgroup. Endovascular techniques play an important role in the management of vascular emergencies. They allow treatment to be rapidly coupled with diagnosis, especially beneficial parameter for traumatic injuries. In particular, embolization is a well-established technique for hemostasis and is preferable when intervention for bleeding pelvic fractures is necessary. Additionally, in case of significant tissue destruction and contamination in the vicinity of the injury vascular access by endovascular techniques may be advantageous. Finally, endovascular balloon occlusion for vascular control may be used as an adjunct to surgery when conventional exposure is technically challenging and hazardous. The objectives of this review article are to highlight the utility of endovascular surgery in vascular emergencies and to compare current treatment options of urgent clinical entities, based on the literature.