What is a saddle pulmonary embolism?
· A saddle pulmonary embolism (PE) is a rare kind of PE, named for its position in the lungs. Every type of PE needs urgent medical treatment. Learn more about the causes, risk factors, treatments ...
What is the earliest example of catheter-based intervention for pulmonary embolism (PE)?
· Saddle pulmonary embolism is an uncommon type of venous thromboembolism that can lead to sudden hemodynamic collapse and death. Saddle pulmonary embolism can be difficult to recognize, and data on its presentation, clinical features, and associated complications are sparse. We sought to characterize patients with saddle pulmonary embolism.
What is a saddle embolus on a CT scan?
· A pulmonary embolism is a blood clot that occurs in the lungs and blocks one of the arteries of the lung.Saddle pulmonary embolism occurs when a large blood clot gets stuck in the main pulmonary artery where the artery branches off into Y shape into each lung. It forms a saddle on the top of both branch arteries. Know the causes, symptoms, treatment, prevention …
Should patients with low-risk pulmonary embolism (PE) be considered for endovascular therapy?
· Treatment Options. Anticoagulation is the backbone of treatment for any pulmonary embolism. Aggressive measures are not always necessary, including for proximal PE. More advanced therapies are reserved for those patients who prove they require them because of hemodynamic or respiratory compromise: Endovascular Options
Causes of Saddle Pulmonary Embolism
A saddle pulmonary embolism starts as a blood clot in the vein of the leg or any other part of the body. The clot in parts or as a whole is carried to the lungs.
Symptoms of Saddle Pulmonary Embolism
The symptoms of saddle pulmonary embolism are the same as those of pulmonary embolism. They include:
How is Saddle Pulmonary Embolism Treated?
Treatment of saddle pulmonary embolism is similar to pulmonary embolism treatment. The treatment options include:
Is it Possible to Prevent Saddle Pulmonary Embolism?
It is not always possible to prevent pulmonary embolism as there is no exact reason for its occurrence.
Outlook for People with Pulmonary Embolism
Saddle pulmonary embolism is treatable, but urgent medical care is required.
What is saddle PE?
Articles by staff writers are not different than other articles, but are not assigned to any specific author. A saddle PE is a pulmonary embolism that is located over the main pulmonary arteries. Perhaps surprisingly, many patients do not have symptoms.
Is anticoagulation necessary for pulmonary embolism?
Anticoagulation is the backbone of treatment for any pulmonary embolism. Aggressive measures are not always necessary, including for proximal PE. More advanced therapies are reserved for those patients who prove they require them because of hemodynamic or respiratory compromise:
What is the purpose of transesophageal echocardiography?
Transesophageal echocardiography and contrast-enhanced spiral CT of the chest helped to avoid a pulmonary angiography in an elderly patient with saddle pulmonary thromboembolism and allowed for direct evaluation of its resolution during treatment with subcutaneous low molecular weight heparin.
Is PE a definitive confirmation?
Definitive confirmation of pulmonary embolism (PE) is still reserved for pulmonary angiography. Only then is aggressive treatment with thrombolysis or surgery considered fully justified. We present a case showing an alternative diagnostic approach as well as nonconventional treatment of a saddle PE in an elderly patient.
What are the key considerations for endovascular care?
Three key considerations should be factored into the decision to proceed with an endovascular approach : 1) disease severity and acuity; 2) likelihood of a major adverse bleeding event; and 3) patient-specific considerations.
What is the best treatment for acute PE?
Anticoagulation therapy is the primary treatment option for most patients with acute PE. The utilization of factor Xa antagonists and direct thrombin inhibitors, collectively termed Novel Oral Anticoagulants (NOACs) are likely to increase as they become incorporated into societal guidelines as first line therapy. 38 Adoption of these newer agents may mitigate the major limitation of VKA therapy, frequently found in studies of VTE/PE to have sub-therapeutic INRs in a significant number of patients. 50 Low molecular weight heparin is superior to unfractionated heparin in both treatment and thrombo-prophylaxis in cancer patients. 27,51 This is reflected in the recommendations made by the American College of Chest Physicians who recommend the use of low molecular weight heparin on the basis of the strength of evidence available. 38 The importance of prompt initiation of anticoagulation cannot be over emphasized; objective assessment of bleeding risk, set in the context of the risk of choosing not to use anticoagulation, should prevent overly conservative practices founded upon theoretical concerns over bleeding.
How many people die from venous thromboembolic disease annually?
Venous thromboembolic disease (VTE) is estimated to occur in at least 1 to 2 persons per 1000 population annually, manifesting as deep vein thrombosis (DVT), pulmonary embolism (PE) or in combination. 1-3 It is the cause of over 100,000 deaths annually and is the most preventable cause of death in hospitalized patients in the United States. 4 Despite treatment with anticoagulant therapy, a significant proportion of survivors of acute DVT or PE are at risk of suffering from the disabling sequelae such as the post thrombotic syndrome (PTS), recurrent VTE or chronic thromboembolic pulmonary hypertension (CTEPH). 1,5 Given the limitations of medical therapy, promising endovascular treatment modalities have evolved over the past two decades in an effort to mitigate the acute and chronic disability from VTE. 6,7 The purpose of this review is to discuss the rationale and evidence for an endovascular treatment approach for high-risk acute DVT and PE patients.
What is IVCF in VTE?
The role of inferior vena cava filters (IVCF) in the contemporary management of acute VTE has not been truly defined owing to a paucity of high quality evidence. At present the benefit of IVCF use seems to be in reducing the risk of acute PE in patients who have a clear contraindication to anticoagulation in the form of active bleeding. 54,55 In the absence of such a contraindication there appears to be no clear benefit and non-retrieval of IVCF exposes the patient to risk of recurrent VTE, PTS and other mechanical complications such as filter fracture or migration. 56,54,19 Societal guidelines appear to be congruent with this data but importantly differ in their recommendations where high quality evidence is lacking. 32,38,57,58 Notable examples of these disparate recommendations include free floating proximal LE-DVT, acute PE in the presence of a pre-existing IVCF, poor medication compliance and IVCF use as VTE prophylaxis in the setting of immobility, trauma or major surgery. The need for definitive evidence related to IVCF use in some of these circumstances has long been recognized though randomized control data continues to be lacking. 58
What are the outcomes of CDT?
Outcomes for CDT are likely to improve with technological advances in endovascular therapies and as physicians get better at patient selection, careful risk assessment and standardization of peri- and post-procedural monitoring. Data regarding the safety and efficacy of NOACs after catheter-based thrombus removal in VTE is acutely needed both in terms of therapeutic certainty as well as patient preference when compared to VKA therapy; these measures alone may be sufficient in reducing the burden of recurrent VTE as well as the risk of PTS. Dedicated technological advances, such as the development of catheters and pharmaco-mechanical devices, especially for massive and submassive PE may see the management of these patients evolve into a predominantly endovascularly treated disease entity. Moving toward the use of a PERT (Pulmonary Embolism Response Team) team approach, especially in complex decision-making, may also ensure that the best therapeutic plan is executed on an individualized basis while avoiding under treatment of high risk submassive PE. 42 Additionally, newer technologies such as drug-coated balloons, 99 bio-resorbable vascular scaffolds and bioresorbable IVCF are currently being studied. 100-1 Refinement of our current strategies, coupled with the exciting future technological developments will provide physicians and patients with options to relieve symptoms, delay morbidity and mortality and improve quality of life.
Is VTE a cause of mortality?
VTE is increasingly recognized as a cause of significant morbidity and mortality in the United States. An interventional approach to managing both acute LE-iliofemoral DVT and massive and submassive PE has great promise. There remains a paucity of robust long-term evidence, particularly addressing safety outcomes in therapies utilizing drugs and delivery systems that can result in bleeding complications. A highly individualized approach encompassing patient selection, type of therapy, operator and hospital level of experience should be followed to maximize the benefits of an interventional strategy as well as minimize the risk of harm.