PROCEDURE:
- Main pulmonary artery angiogram.
- Right pulmonary artery angiogram.
- Left pulmonary artery angiogram.
- Removal of bilateral pulmonary artery infusion catheters
DATE OF PROCEDURE:
CLINICAL HISTORY: ___-year-old male with recent travel presenting with submassive pulmonary embolus status post catheter directed thrombolysis returning for follow-up evaluation.
OPERATOR:
Dr. ___ (Faculty)
Dr. ____ (Fellow)
MEDICATIONS: Ativan 1 mg.
CONTRAST: 60 ml of Isovue 350
ACCESS SITE: Existing right-sided internal jugular vein sheaths.
TECHNIQUE:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient, and written informed consent obtained.
The patient was placed in supine position on the angiography table and the right neck and pre-existing catheters were prepped and draped in sterile fashion. The right pulmonary artery UniFuse catheter was removed and a 5 French pigtail catheter was advanced over the wire through the sheath and positioned in the main pulmonary artery. The left pulmonary artery UniFuse catheter was also removed over a guidewire. Pulmonary angiography was performed in AP projection using non-ionic contrast. The pigtail catheter was then repositioned over a Rosen guidewire into the main right pulmonary artery and pulmonary angiography was performed in the AP projection.
The pigtail catheter was pulled back and again repositioned over a Rosen guidewire into the main left pulmonary artery and pulmonary angiography was again performed.
The pigtail catheter and left UniFuse catheter were then removed, followed by the sheaths and hemostasis was achieved at both access sites utilizing pursestring 2-0 Ethilon sutures.
The procedure was well-tolerated, and the patient discharged in stable condition.
FINDINGS: Comparison is made with chest CT from ______.
- Main pulmonary artery angiogram demonstrates improvement in distal flow and decreased clot burden within the lower lobes bilaterally.
- Right pulmonary artery angiogram demonstrates markedly improved blood flow throughout the right lung. There is some persistent filling defects in the right upper lobe pulmonary artery, and to a lesser degree the lower lobe pulmonary artery.
- Left pulmonary artery angiogram shows improved distal flow and decreased clot burden.
IMPRESSION: Technically successful bilateral pulmonary artery catheter directed thrombolysis for pulmonary emboli with improved perfusion of both lungs.
The patient will be scheduled in Dr. _____ clinic in approximately 3 months for discussion of filter removal.
Frequently Asked Questions
What is pulmonary artery thrombolysis?
Pulmonary artery thrombolysis is a medical procedure used to dissolve blood clots in the pulmonary arteries. It involves using medication delivered directly to the site of the clot through a catheter. This technique helps improve blood flow and oxygen delivery to the lungs, which is crucial in treating conditions like pulmonary embolism.
Why is catheter removal necessary after pulmonary thrombolysis?
Catheter removal is necessary after pulmonary thrombolysis to prevent complications such as infection, bleeding, or damage to the blood vessels. Once the medication has been administered and the clot has been dissolved, the catheters are no longer needed and are safely removed to ensure proper healing and recovery.
What are the risks of pulmonary artery angiography?
Pulmonary artery angiography carries risks similar to other invasive procedures, such as bleeding, infection, or reaction to contrast dye. There is also a small risk of damaging the blood vessels or heart during catheter insertion. However, these risks are minimized through careful technique and monitoring by experienced medical professionals.
How is hemostasis achieved after catheter removal?
Hemostasis, or the stopping of bleeding, is achieved after catheter removal by applying pressure to the access site, often with a suture technique like the pursestring 2-0 Ethilon sutures. This method helps close the small hole created by the catheter insertion, preventing bleeding and facilitating healing.
What improvements are expected after pulmonary thrombolysis?
After pulmonary thrombolysis, improvements include increased blood flow in the lungs and a decrease in clot burden, which enhances oxygen delivery and reduces symptoms such as shortness of breath and chest pain. Radiological imaging, like angiograms, is used to confirm these improvements by showing enhanced perfusion in the treated areas.
Why is follow-up important after pulmonary embolism treatment?
Follow-up is essential to ensure that the treatment was successful and to monitor for any potential complications. It allows healthcare providers to assess the patient’s recovery, manage any ongoing symptoms, adjust medications if needed, and plan for additional interventions, such as filter removal, if necessary.
What medications are used during pulmonary thrombolysis?
During pulmonary thrombolysis, thrombolytic agents are used, which are medications that help dissolve blood clots. Additionally, sedatives like Ativan may be administered to help the patient remain calm and comfortable during the procedure. Contrast agents are also used to enhance imaging during angiography.