Endovascular treatment of pulmonary embolism: Selective review of available techniques

Abstract

Acute pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.

Keywords: Pulmonary embolism; Thrombolysis; Endovascular; Interventional radiology; Thrombectomy; Fibrinolysis

Core tip: Endovascular treatment of pulmonary embolism (PE) represents several methods of minimally invasive therapy of this important clinical entity, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. With this paper, we hope to provide a detailed review of these methods, which is critical to understanding the tools that are available to the clinician for the treatment of PE.