Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Sep 2017
ReviewSystemic Thrombolysis for Pulmonary Embolism: Who and How.
Anticoagulation has been shown to improve mortality in acute pulmonary embolism (PE). Initiation of anticoagulation should be considered when PE is strongly suspected and the bleeding risk is perceived to be low, even if acute PE has not yet been proven. Low-risk patients with acute PE are simply continued on anticoagulation. ⋯ Standard-dose thrombolysis, low-dose systemic thrombolysis, and catheter-based therapy which includes a number of devices and techniques, with or without low-dose thrombolytic therapy, have offered potential solutions and this area has continued to evolve. On the basis of heterogeneity within the category of intermediate-risk as well as within the high-risk group of patients, we will focus on the use of systemic thrombolysis in carefully selected high- and intermediate-risk patients. In certain circumstances when the need for aggressive therapy is urgent and the bleeding risk is acceptable, this is an appropriate approach, and often the best one.
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Tech Vasc Interv Radiol · Sep 2017
ReviewBalloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: New Horizons in the Interventional Management of Pulmonary Embolism.
Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. ⋯ In recent years, balloon pulmonary angioplasty has emerged as a primary and adjunctive treatment for these CTEPH patients at expert or specialized centers. This review outlines an approach to balloon pulmonary angioplasty for CTEPH, including clinical presentation and evaluation; patient selection and indications; treatment planning; equipment and technique; overcoming technical challenges; recognition and management of complications; postprocedural care and clinical follow-up; and expected outcomes.
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Tech Vasc Interv Radiol · Sep 2017
ReviewCatheter-Directed Therapy for Acute Submassive Pulmonary Embolism: Summary of Current Evidence and Protocols.
Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism.
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Tech Vasc Interv Radiol · Sep 2017
ReviewThe Future of Catheter-Directed Therapy: Data Gaps, Unmet Needs, and Future Trials.
This article will focus on 3 avenues for future research: (1) addressing the lack of short- and long-term clinical outcome research on catheter-directed therapy; (2) determining the safety and efficacy of novel thrombus removal devices; and (3) translating our knowledge of the pathobiology and pathophysiology of pulmonary embolism into novel diagnostic and therapeutic strategies.
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Tech Vasc Interv Radiol · Sep 2017
ReviewSurgical Embolectomy for Massive and Submassive Pulmonary Embolism and Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension.
Surgical therapy for massive acute pulmonary embolism has improved with the use of rapid response teams and selective bedside extracorporeal membrane oxygenation initiation. The chronic consequence of unresolved pulmonary embolism is a treatable form of pulmonary hypertension. Pulmonary thromboendarterectomy is a curative operation in selected cases, operated upon in an experienced center with the multidisciplinary team including imaging, pulmonary medicine, and cardiothoracic surgery.