Pulmonary embolectomy

Case contributed by Varun Patel

Presentation

Shortness of breath and elevated D-dimer

Patient Data

Age: 50 years
Gender: Male

CT pulmonary angiogram

ct

Large pulmonary embolism burden including non-occlusive saddle embolus and emboli extending into all 5 lobar arteries. There are occlusive thrombi in the left lower lobar artery and more distal segmental arteries. The remainder lobar arteries emboli are nonocclusive.

Prior to embolectomy

Fluoroscopy

Non-occlusive saddle embolus and large occlusive embolus in left lower pulmonary artery are visualized.

Right femoral access was obtained and a 24 French introducer sheath was used.

Inari Flowtriever Retrieval/Aspiration system was used to perform a bilateral pulmonary artery embolectomy. Inari FlowSaver Blood Return System was also used to minimize blood loss.

A significant number of emboli were removed as seen in the picture below.

Emboli

Photo

Numerous large and small pulmonary emboli removed from bilateral pulmonary arteries.

After embolectomy

Fluoroscopy

Improvement of filling defects in left lower pulmonary artery following embolectomy.

Venogram

Fluoroscopy

Venogram done during the procedure shows reflux of contrast into the right common iliac vein due to possible compression of right common iliac vein by lumbar hardware.

Case Discussion

This patient's imaging demonstrated multiple large occlusive and non-occlusive pulmonary emboli bilaterally. Lumbar hardware compressing the right common iliac vein and causing an iatrogenic May-Thurner-like syndrome is the proposed mechanism for the development of this patient's pulmonary emboli.

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