PROCEDURE: 

  1. Main pulmonary artery angiogram.
  2. Right pulmonary artery angiogram.
  3. Left pulmonary artery angiogram.
  4. 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 ______.

  1. Main pulmonary artery angiogram demonstrates improvement in distal flow and decreased clot burden within the lower lobes bilaterally.
  2. 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. 
  3. 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.