Management of peripheral pulmonary emboli with the use of transvenous catheter-directed thrombolysis and right ventricular assist device

Objectives: Pulmonary emboli (PE) can result in significant hemodynamic instability that requires urgent intervention; however, the management of peripheral emboli has been controversial. Patients and Methods: We present two patients in whom a right ventricular assist device (RVAD) was used in treating peripheral pulmonary embolism, applying the technique of pulmonary artery catheter-directed thrombolysis after resuscitation with an RVAD. Results: The clot burden was not suitable for surgical embolectomy due to its peripheral locations. The patients' hemodynamic conditions improved with thrombolytic therapy and gradually were weaned off the RVAD. Follow-up scans showed near resolution of all PE. Conclusion: Catheter-directed thrombolysis with an RVAD as an adjunct should be considered in management of peripheral PE. doi: 10.1111/jocs.12185 (J Card Surg 2013;28:611-615)