Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/jvb.2014.059
Jornal Vascular Brasileiro
Case Report

Pulmonary embolism and stroke associated with mechanical thrombectomy

Embolia pulmonar e AVC isquêmico associado à trombectomia mecânica

Paulo Bastianetto; Daniel Mendes Pinto

Downloads: 0
Views: 138

Abstract

Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.

Keywords

thrombectomy, mechanical thrombolysis, pulmonary embolism, stroke

Resumo

A trombectomia mecânica tem a vantagem de levar à rápida remoção dos trombos. Permite a desobstrução venosa e a redução do tempo de infusão de trombolíticos. A aspiração dos trombos pode levar a complicações, principalmente embolia pulmonar e hemólise. Algo que não está definido é a validade do uso de filtros de veia cava durante a trombectomia, com o objetivo de evitar a TEP maciça. Os autores relatam um caso de embolia pulmonar maciça associada a AVC isquêmico, em uma paciente que apresentava forame oval patente. Não havia o diagnóstico prévio da PFO. A paciente evoluiu com insuficiência respiratória e déficit neurológico logo após a trombectomia. Neste caso, questiona-se o valor da trombectomia para o tratamento da trombose venosa proximal, devido aos riscos deste procedimento. Os autores discutem sobre a necessidade de filtro de veia cava e sobre a pesquisa de forame oval nos pacientes que serão submetidos à trombectomia.

Palavras-chave

trombectomia, trombólise mecânica, embolia pulmonar, acidente vascular cerebral

References

Nazir SA, Ganeshan A, Nazir S, Uberoi R. Endovascular treatment options in the management of lower limb deep venous thrombosis. Cardiovasc Intervent Radiol. 2009;32(5):861-76.

Gloviczki P, Comerota AJ, Dalsing MC. The care of patiens with varicoses veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5):2S-48S.

Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. J Vasc Surg. 2007;46(5):1065-76.

Malgor RD, Gasparis AP. Pharmaco-mechanical thrombectomy for early thrombus removal. Phlebology. 2012;27.

Bush RL, Lin PH, Bates JT, Mureebe L, Zhou W, Lumsden AB. Pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis: safety and feasibility study. J Vasc Surg. 2004;40(5):965-70.

Meissner MH, Gloviczki P, Comerota AJ. Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449-62.

Kim HS, Patra A, Paxton BE, Khan J, Streiff MB. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol. 2006;17(7):1099-104.

Biuckians A, Meier GH. Treatment of symptomatic lower extremity acute deep venous thrombosis: role of mechanical thrombectomy. Vascular. 2007;15(5):297-303.

Cynamon J, Stein EG, Dym RJ, Jagust MB, Binkert CA, Baum RA. A new method for aggressive management of deep vein thrombosis: retrospective study of the power pulse technique. J Vasc Interv Radiol. 2006;17(6):1043-9.

Kasirajan K, Gray B, Ouriel K. Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol. 2001;12(2):179-85.

Lin PH, Zhou W, Dardik A. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192(6):782-8.

Vedantham S, Thorpe PE, Cardella JF. Quality improvement guidelines for the treatment of lower ext.remity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2006;17(3):435-47.

Augustinos P, Ouriel K. Invasive approaches to treatment of venous thromboembolism. Circulation. 2004;110.

Kölbel T, Alhadad A, Acosta S, Lindh M, Ivancev K, Gottsäter A. Thrombus embolization into IVC filters during catheter-directed thrombolysis for proximal deep venous thrombosis. J Endovasc Ther. 2008;15(5):605-13.

Chamié F, Chamié D, Ramos S. Fechamento Percutâneo do Forame Oval Patente. Rev Bras Cardiol Invas. 2005;13(3):185-19.

5ddd84fb0e882598481da3e9 jvb Articles

J Vasc Bras

Share this page
Page Sections