Journal «Angiology and Vascular Surgery» • 

2017 • VOLUME 23 • №4

Use of local thrombolysis in patients with massive pulmonary thromboembolism and moderate-to-severe pulmonary hypertension

Klevanets Yu.E., Karpenko A.A., Shilova A.N.

Siberian Federal Biomedical Research Centre named after Academician E.N. Meshalkin under the RF Public Health Ministry, Novosibirsk, Russia

Presented herein are the results of treating a total of 110 patients with acute massive pulmonary thromboembolism. The patients included in the study were divided into 2 groups depending on the degree of severity of pulmonary hypertension. All patients underwent interventional treatment, i.e., endovascular mechanical fragmentation with local thrombolysis. Both short- and long-term outcomes were then analysed.

Performing local thrombolysis made it possible to achieve regression of clinical manifestations of acute respiratory insufficiency in more than 98% of patients. Stabilization of the clinical condition in the early postoperative period was accompanied by improvement of haemodynamics of the right heart in the remote terms of follow up after the intervention. There were 2 (1.8%) lethal outcomes resulting from progression of acute cardiovascular insufficiency. Clinically significant haemorrhage was observed in 1 (0.8%) case and was successfully arrested by conservative therapy.

It was shown that local thrombolysis contributed not only to improving perfusion of the lesser circulation, a reduction of pressure in pulmonary arteries and the right heart, but also to a decrease or normalization of the linear dimensions of the right auricle and right ventricle, as well as prevented the formation of chronic postembolic pulmonary hypertension in more than 90% of patients. It was also demonstrated that while performing this type of treatment, the initial level of pulmonary hypertension did not influence either the prognosis or the outcome of the disease.

KEY WORDS: acute massive pulmonary thromboembolism, local thrombolytic therapy, catheter-mediated fragmentation of thromboemboli, chronic postembolic pulmonary hypertension.

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