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Massive and submassive pulmonary embolism

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https://www.readbyqxmd.com/read/29667126/treatment-of-submassive-and-massive-pulmonary-embolism-a-clinical-practice-survey-from-the-second-annual-meeting-of-the-pulmonary-embolism-response-team-consortium
#1
Thomas M Todoran, Jay Giri, Geoffrey D Barnes, Rachel P Rosovsky, Yuchiao Chang, Michael R Jaff, Kenneth Rosenfield, Christopher Kabrhel
There is a paucity of robust clinical trial data to guide the treatment of acute pulmonary embolism (PE) thus the clinical guidelines rely heavily on expert opinion. Pulmonary Embolism Response Teams (PERT) have been developed to streamline the care of patients with acute PE. We conducted a survey among 100 experts in the field of PE during the second annual meeting of the PERT Consortium. Respondents were queried with respect to their demographic information, clinical practice questions and clinical vignettes...
April 17, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29626452/peripheral-distribution-of-thrombus-does-not-affect-outcomes-after-surgical-pulmonary-embolectomy
#2
Chetan Pasrija, Aakash Shah, Praveen George, Isa Mohammed, Francis A Brigante, Mehrdad Ghoreishi, Jean Jeudy, Bradley S Taylor, James S Gammie, Bartley P Griffith, Zachary N Kon
BACKGROUND: Thrombus located distal to the main or primary pulmonary arteries has been previously viewed as a relative contraindication to surgical pulmonary embolectomy. We compared outcomes for surgical pulmonary embolectomy for submassive and massive pulmonary embolism (PE) in patients with central versus peripheral thrombus burden. METHODS: All consecutive patients (2011-2016) undergoing surgical pulmonary embolectomy at a single center were retrospectively reviewed...
April 4, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29615372/catheter-directed-interventions-compared-with-systemic-thrombolysis-achieve-improved-ventricular-function-recovery-at-a-potentially-lower-complication-rate-for-acute-pulmonary-embolism
#3
Efthymios D Avgerinos, Adham N Abou Ali, Nathan L Liang, Belinda Rivera-Lebron, Catalin Toma, Robert Maholic, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: Catheter-directed interventions (CDIs) are increasingly performed for acute pulmonary embolism (PE) as they are presumed to provide similar therapeutic benefits to systemic thrombolysis (ST) while decreasing the associated complications. The purpose of this study was to compare outcomes between CDI and ST. METHODS: Consecutive patients who underwent CDIs or ST for massive or submassive PE between 2006 and 2016 were identified. Clinical and echocardiographic parameters at baseline and after treatment were recorded...
March 31, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29514403/mechanical-circulatory-support-for-acute-right-ventricular-failure-in-the-setting-of-pulmonary-embolism
#4
Mahir Elder, Nimrod Blank, Amir Kaki, M Chadi Alraies, Cindy L Grines, Marvin Kajy, Reema Hasan, Tamam Mohamad, Theodore Schreiber
BACKGROUND: Right ventricular (RV) failure due to pulmonary embolism (PE) increases morbidity and mortality and contributes to prolonged hospital length of stay and higher costs of care. RV mechanical circulatory support (MCS) including Impella RP devices have been increasingly used in hemodynamically compromised PE patients who are refractory to intravascular volume expansion and inotropic therapy. However, effectiveness and safety of Impella RP, in hemodynamically unstable PE patients is unknown...
March 7, 2018: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29502109/cardiopulmonary-exercise-testing-in-patients-following-massive-and-submassive-pulmonary-embolism
#5
Mazen S Albaghdadi, David M Dudzinski, Nicholas Giordano, Christopher Kabrhel, Brian Ghoshhajra, Michael R Jaff, Ido Weinberg, Aaron Baggish
BACKGROUND: Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism. METHODS AND RESULTS: Survivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge...
March 3, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29452460/outcomes-after-surgical-pulmonary-embolectomy-for-acute-submassive-and-massive-pulmonary-embolism-a-single-center-experience
#6
Chetan Pasrija, Anthony Kronfli, Michael Rouse, Maxwell Raithel, Gregory J Bittle, Sheelagh Pousatis, Mehrdad Ghoreishi, James S Gammie, Bartley P Griffith, Pablo G Sanchez, Zachary N Kon
OBJECTIVES: Ideal treatment strategies for submassive and massive pulmonary embolism remain unclear. Recent reports of surgical pulmonary embolectomy have demonstrated improved outcomes, but surgical technique and postoperative outcomes continue to be refined. The aim of this study is to describe in-hospital survival and right ventricular function after surgical pulmonary embolectomy for submassive and massive pulmonary embolism with excessive predicted mortality (≥5%). METHODS: All patients undergoing surgical pulmonary embolectomy (2011-2015) were retrospectively reviewed...
March 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29399536/rationale-for-catheter-directed-therapy-in-pulmonary-embolism
#7
REVIEW
Sailen G Naidu, Martha-Gracia Knuttinen, J Scott Kriegshauser, William G Eversman, Rahmi Oklu
Pulmonary embolism (PE) is a widespread health concern associated with major morbidity and mortality. Catheter directed therapy (CDT) has emerged as a treatment option for acute PE adding to the current potential options of systemic thrombolysis or anticoagulation. The purpose of this review is to understand the rationale and indications for CDT in patients with PE. While numerous studies have shown the benefits of systemic thrombolysis compared to standard anticoagulation, these are balanced by the increased risk of major bleeding...
December 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/29322296/catheter-directed-ultrasound-facilitated-fibrinolysis-in-obese-patients-with-massive-and-submassive-pulmonary-embolism
#8
Brett J Carroll, Samuel Z Goldhaber, Ping-Yu Liu, Gregory Piazza
Obesity is a well-established risk factor for pulmonary embolism (PE). However, treatment of PE in obese patients is challenging because of limited outcomes data, especially with advanced therapies such as catheter-based fibrinolysis. We assessed the efficacy and safety of ultrasound-facilitated, catheter-directed fibrinolysis in obese patients with submassive and massive PE enrolled in the SEATTLE II Trial. Eligible patients had a right ventricular-to-left ventricular (RV/LV) diameter ratio ≥ 0.9 on chest computed tomography (CT)...
February 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29248101/design-and-rationale-of-a-randomized-trial-comparing-standard-versus-ultrasound-assisted-thrombolysis-for-submassive-pulmonary-embolism
#9
Efthymios D Avgerinos, Abhisekh Mohapatra, Belinda Rivera-Lebron, Catalin Toma, Christopher Kabrhel, Larry Fish, Joan Lacomis, Iclal Ocak, Rabih A Chaer
BACKGROUND: Catheter-directed interventions for the treatment of patients with submassive pulmonary embolism (sPE) have shown promise in rapidly improving right-sided heart strain and preventing decompensation to massive pulmonary embolism. Among various catheter interventions, ultrasound-assisted thrombolysis (USAT) has attracted interest as potentially having more efficient lytic effect that could achieve thrombolysis faster and with a reduced lytic dose. However, based on clinical evidence, it is unclear whether USAT is superior to standard catheter-directed thrombolysis (SCDT)...
January 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29191822/systemic-thrombolysis-in-a-patient-with-massive-pulmonary-embolism-and-recent-glioblastoma-multiforme-resection
#10
Joshua Lampert, Behnood Bikdeli, Philip Green, Matthew R Baldwin
While trials of systemic thrombolysis for submassive and massive pulmonary embolism (PE) report intracranial haemorrhage (ICH) rates of 2%-3%, the risk of ICH in patients with recent brain surgery or intracranial neoplasm is unknown since these patients were excluded from these trials. We report a case of massive PE treated with systemic thrombolysis in a patient with recent neurosurgery for an intracranial neoplasm. We discuss the risks and benefits of systemic thrombolysis for massive PE in the context of previous case reports, prior cohort studies and trials, and current guidelines...
November 29, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29146419/syncope-on-presentation-is-a-surrogate-for-submassive-and-massive-acute-pulmonary-embolism
#11
Hesham R Omar, Mehdi Mirsaeidi, Michael B Weinstock, Garett Enten, Devanand Mangar, Enrico M Camporesi
INTRODUCTION: There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE). METHODS: We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation. RESULTS: Among 552 subjects with APE (mean age 54years, 47% men), syncope occurred in 12...
February 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29102272/aspiration-thrombectomy-for-treatment-of-acute-massive-and-submassive-pulmonary-embolism-initial-single-center-prospective-experience
#12
Juan José Ciampi-Dopazo, Juan María Romeu-Prieto, Marcelino Sánchez-Casado, Beatriz Romerosa, Alfonso Canabal, María Luisa Rodríguez-Blanco, Carlos Lanciego
PURPOSE: To evaluate the feasibility of aspiration thrombectomy in patients with acute massive or submassive pulmonary embolism (PE). MATERIALS AND METHODS: This prospective study analyzed patient demographic data, procedural details, and outcomes in 18 consecutive patients (8 men and 10 women; mean age, 60.1 y; range, 36-80 y), 10 with acute submassive PE and 8 with massive PE, treated with an Indigo Continuous Aspiration Mechanical Thrombectomy Catheter between January 2016 and February 2017...
January 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29074107/risk-factors-for-presence-and-severity-of-pulmonary-embolism-in-patients-with-deep-venous-thrombosis
#13
Nancy Huynh, Wassim H Fares, Kirstyn Brownson, Anand Brahmandam, Alfred I Lee, Alan Dardik, Timur Sarac, Cassius Iyad Ochoa Chaar
OBJECTIVE: The Caprini model estimates patients' risk for venous thromboembolism by 30 different factors. Hemodynamically significant pulmonary embolism (PE), defined as high-risk (massive) or intermediate-risk (submassive) PE, has high morbidity and mortality rates. This study tests whether the Caprini model and deep venous thrombosis (DVT) characteristics correlate with the prevalence of PE and hemodynamically significant PE in patients with DVT. METHODS: A retrospective review of patients diagnosed with DVT between January 2013 and August 2014 in a tertiary care center was performed...
January 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29029713/techniques-and-devices-for-catheter-directed-therapy-in-pulmonary-embolism
#14
REVIEW
Alok Bhatt, Ramsey Al-Hakim, James F Benenati
The clinical presentation of a patient with acute pulmonary embolism (PE) can be classified into 3 categories: low-risk, submassive (presence of right heart strain), and massive (hemodynamic compromise). Massive PE is associated with high morbidity or mortality and typically treated with systemic intravenous thrombolysis. Over the last 2 decades, however, catheter-directed techniques have become an increasingly popular treatment modality for patients with a contraindication to systemic thrombolysis or without clinical improvement after systemic thrombolysis...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029711/surgical-embolectomy-for-massive-and-submassive-pulmonary-embolism-and-pulmonary-thromboendarterectomy-for-chronic-thromboembolic-pulmonary-hypertension
#15
REVIEW
Richard J Shemin
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.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029710/systemic-thrombolysis-for-pulmonary-embolism-who-and-how
#16
REVIEW
Victor F Tapson, Oren Friedman
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. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. However, despite clear evidence that parenteral thrombolytic therapy leads to more rapid clot resolution than anticoagulation alone, the risk of major bleeding including intracranial bleeding is significantly higher when systemic thrombolytic therapy is administered...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029706/pulmonary-embolism-in-2017-how-we-got-here-and-where-are-we-going
#17
REVIEW
Geno J Merli
In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28958757/clinical-characteristics-risk-factors-and-outcomes-of-south-east-asian-patients-with-acute-pulmonary-embolism
#18
Kwang How Mok, Shiun Woei Wong, Yee May Wong, David Foo, Timothy James Watson, Hee Hwa Ho
BACKGROUND: The clinical features of acute PE have not been well studied in South-East Asia. We therefore sought to evaluate the clinical characteristics, risk factors and outcomes of patients diagnosed with acute pulmonary embolism (PE) in our region. METHODS: From January 2008 to March 2013, 343 patients were admitted to our tertiary institution with acute PE. Data were collected retrospectively on baseline clinical characteristics, presenting signs and symptoms, results of electrocardiographic and imaging studies, therapeutic modality and hospital course...
December 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28920554/a-pulmonary-embolism-response-team-s-initial-20-month-experience-treating-87-patients-with-submassive-and-massive-pulmonary-embolism
#19
Akhilesh K Sista, Oren A Friedman, Eda Dou, Brendan Denvir, Gulce Askin, Jamie Stern, Jaclyn Estes, Arash Salemi, Ronald S Winokur, James M Horowitz
Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded...
February 2018: Vascular Medicine
https://www.readbyqxmd.com/read/28890217/saddle-vs-nonsaddle-pulmonary-embolism-clinical-presentation-hemodynamics-management-and-outcomes
#20
Bashar Alkinj, Bibek S Pannu, Dinesh R Apala, Aditya Kotecha, Rahul Kashyap, Vivek N Iyer
OBJECTIVE: To understand the clinical significance, hemodynamic presentation, management, and outcomes of patients presenting with saddle pulmonary embolism (PE). METHODS: All patients with saddle PE diagnosed at Mayo Clinic in Rochester, Minnesota, from January 1, 1999, through December 31, 2014, were included in this study. These patients were age and simplified Pulmonary Embolism Severity Index (sPESI) matched (1:1) to a nonsaddle PE cohort. Both groups were then classified into massive, submassive, and low-risk PE based on established criteria and compared for clinical presentation, management, and outcomes...
October 2017: Mayo Clinic Proceedings
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