Pulmonary embolism remains a clinically challenging diagnosis, more after missed than confirmed. The management of pulmonary embolism is equally difficult but is life saving if undertaken promptly and timely.
We scrutinize patients of massive pulmonary embolism coming to our Institute and select patients came from peripheral centers after failed thrombolysis and persisting cardiogenic shock. After confirming pulmonary embolism , mechanical breakdown of embolus was done with 5F multipurpose catheter and after confirming the pulmonary artery flow, intralesional urokinase 4400 IU/kg over 10 min followed by 4400 IU/kg /hr for 24 hours given and observed.
Out of 48 patients of pulmonary embolism, 6(12.5%) patients were presented to hospital after a period of 12–18 days of clinical symptoms with average of 13 days. 4 (66.7%) out of 6 were thrombolyzed by urokinase, 1 (16.7%) with recombinant tissue-type plasminogen activator (rtPA) and 1 (16.7%) with streptokinase before 24–48 hours of admission. Average Pulmonary Arterial Pressure was 72.4 mmHg at the time of presentation and post operatively goes down to average of 40.66 with lowest value of 28 mmHg.
Breakdown of thrombus provides a large exposed area for subsequent thrombolysis and combined approach is a more cost effective, minimally invasive and life saving procedure as compared to usual technique for the management of massive sub acute pulmonary embolism.
Combined approach of mechanical breakdown and thrombolysis is very effective, but more Meta analysis is required to prove the superiority.
Anil Kashyap, No Financial Disclosure Information; No Product/Research Disclosure Information