Objective: Intermediate risk (IR)- and high risk (HR)-pulmonary embolism (PE) are associated with mortality rates that span 1.8% to 17% and greater than 31% respectively. Catheter-directed embolectomy (CDE) and surgical embolectomy (SE) for IR- and HR-PE offer alternatives to systemic thrombolysis, but data comparing CDE versus SE is limited. We assessed the outcomes of patients with acute PE who received CDE or SE for IR- and HR-PE.
Methods: A retrospective review of all adult patients who had undergone CDE or SE for IR- and HR-PE in the Mount Sinai Health System between August, 2019 to June, 2022 was performed. Fisher's exact test and Student's t-test (or Mann-Whitney U-test) were used for comparing qualitative and quantitative outcomes respectively between the CDE and SE groups.
Results: Fifteen (15) patients received SE, and 25 patients received CDE. Patients who received SE included 53% IR- and 47% HR-PE, while those who received CDE included 60% IR- and 40% HR-PE. CDE and SE had 96% and 100% technical success rates respectively. The 30-day all-cause mortality rates were 13.3% and 8% in the SE and CDE groups respectively (p > 0.05). The rates of major hemorrhagic complications in the CDE and SE groups were 4% and 26.7% respectively (p > 0.05).
Conclusion: CDE and SE were associated with high technical success rates in patients with IR- and HR-PE along with a low risk of major complications and acceptable 30-day all-cause mortality rates. In the absence of significant contraindications, CDE may provide a less invasive alternative to SE.
Keywords: Pulmonary embolism; embolectomy; hemorrhage; mortality; thrombectomy.
Pulmonary embolism (PE) occurs when a blood clot that has formed in the deep veins of the legs dislodges and blocks one of the main blood vessels of the lungs. Conventional treatment for PE typically involves the administration of blood thinners and, occasionally, clot-busting medications in severe cases. The present study assessed and compared the effectiveness and rates of complications of two novel procedures for the treatment of PE, namely catheter-directed embolectomy (CDE) and surgical embolectomy (SE).CDE entailed the removal of blood clots from the lungs’ blood vessels using a catheter inserted into one of the big veins of the groin or neck. SE involved the removal of blood clots from the lungs’ blood vessels using open-heart surgery after establishing total cardiopulmonary bypass (similar to a coronary artery bypass grafting). All patients who underwent CDE or SE at the Mount Sinai Health System between August 2019 and June 2022 were included in this study.We found that both procedures (CDE and SE) had high success rates for removing blood clots: 96% for CDE and 100% for SE. The number of patients who died by day 30 were also similar for both groups: 13.3% for SE and 8% for CDE. The rate of major bleeding complications seemed to be slightly lower in the CDE group (4%) compared to the SE group (26.7%), although this difference could have occurred by chance.Overall, we found that both CDE and SE were highly effective for removing blood clots with low complication rates and acceptable mortality rates. These results suggest that, compared to SE, CDE may be an equally effective and less invasive option for treatment of PE for some patients—depending on individual circumstances.