Key result
Catheter-directed therapies offer promising efficacy and manageable bleeding risk in selected acute PE and DVT.
Why the study?
Acute pulmonary embolism, often resulting from deep vein thrombosis, causes significant morbidity and mortality, warranting evaluation of the efficacy, safety, and outcomes of established and emerging treatment options.
Do percutaneous endovascular interventions improve hemodynamic and clinical outcomes while minimizing bleeding risk compared to systemic thrombolysis or anticoagulation alone in patients with acute pulmonary embolism and deep vein thrombosis?
Do percutaneous endovascular interventions improve hemodynamic and clinical outcomes while minimizing bleeding risk compared to systemic thrombolysis or anticoagulation alone in patients with acute pulmonary embolism and deep vein thrombosis?
This comprehensive review synthesizes current evidence and ongoing trials for catheter-directed and mechanical percutaneous interventions in acute PE and DVT, highlighting the importance of patient-tailored device selection based on risk stratification and bleeding profile.
Answers are grounded in this paper and cite their sources.
Supports individualized percutaneous use in selected PE/DVT patients; leaves open superiority over anticoagulation pending randomized trials.
Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate-high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions.
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Cavallino et al. (2024) conducted a review in Acute pulmonary embolism (PE) and deep vein thrombosis (DVT). Percutaneous interventions (catheter-directed thrombolysis, ultrasound-assisted thrombolysis, aspiration thrombectomy, mechanical fragmentation) vs. Systemic thrombolysis or standard anticoagulation therapy alone was evaluated. Percutaneous interventions such as catheter-directed thrombolysis and aspiration thrombectomy provide promising efficacy and manageable bleeding risk in selected patients with acute PE and DVT.
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