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Case Study: Interventional Thrombolysis

A 68-year-old woman presented with acute onset of shortness of breath and shock after recent abdominal surgery. She had an increased oxygen requirement and was on pressors for hemodynamic support.

The evaluation

A  CT scan of the chest diagnosed pulmonary embolism with a saddle embolus.
Her echocardiogram showed a flattened ventricular septum and a positive McConnell sign suggestive of a significant pulmonary embolism.

Figure 1

The procedure and results

Catheter-directed thrombolysis was performed from a percutaneous right femoral approach with:

  • Almost immediate hemodynamic improvement and decreased oxygen requirement.
  • Complete thrombus resolution within eight hours (figures).
  • Complete clinical recovery with normalization of echocardiographic findings.
Figure 2

About UPMC’s interventional thrombolysis program

UPMC’s interventional thrombolysis program for patients with pulmonary embolism is a joint multidisciplinary effort between:

  • pulmonary/critical care medicine
  • cardiology
  • cardiac surgery
  • vascular surgery

Potential candidates for percutaneous catheter-directed intrathrombus thrombolysis include patients with acute PE with evidence of increased oxygen requirement, hemodynamic compromise, or heart strain.

This procedure can rapidly restore cardiopulmonary hemodynamics and oxygenation, and potentially improve quality of life by minimizing the long-term sequelae of pulmonary hypertension and heart failure.

How to refer

To refer a patient to UPMC’s interventional thrombolysis program, call the 24-hour physician referral line at 1-800-544-2500.

© 2011 UPMC