Quality of Life and Clinical Outcomes After Large Bore Mechanical Thrombectomy for Submassive Pulmonary Embolism

OBJECTIVE: The aim of this study is to evaluate short term clinical, and patient reported quality of life outcomes in patients who underwent large bore mechanical suction thrombectomy for acute submassive pulmonary embolisms (PE) by a group of three vascular surgeons at a community-based hospital. METHODS: In a single-center prospective cohort study, 86 patients with acute submassive pulmonary embolisms from January 2022 to June 2024 who underwent large bore mechanical suction thrombectomy using the FlowTriever thrombectomy system were analyzed. Massive pulmonary embolisms, with hemodynamic instability, were excluded. Short term clinical outcomes were measured perioperatively. Patients were surveyed after discharge using the 5-Level EuroQol (EQ-5D-5L) questionnaire at an average of 3 months post-procedure to assess patient-reported outcomes and quality of life. RESULTS: From January 2022 to June 2024, 86 patients underwent large bore mechanical suction thrombectomy for submassive PE. Demographics included 61.6% female and 60.5% black. At diagnosis, mean troponin was 169.1 ng/L, and 88.4% triggered a Pulmonary Embolism Response team (PERT) activation. Preoperatively, the majority of patients (58.6%) had moderate to severe right ventricular systolic pressure (RVSP) elevation. Post-procedure, significant improvements were observed in patient clinical status: oxygen saturation increased by 3.1% (p < 0.0001), heart rate decreased by 15.8 bpm (p < 0.0001), and pulmonary artery (PA) pressure dropped by 11.7 mmHg (p < 0.0001). RVSP improved, with 78.9% demonstrating normal or only mild elevations postoperatively (p < 0.0001). Median post-procedure length of stay was 3 days (IQR 2-6), and 30-day mortality was 2.4%. Patients were questioned postoperatively using the ED-5Q-5L survey which indicated favorable quality-of-life outcomes, with most patients reporting minimal or no issues across assessed domains. CONCLUSION: Large-bore mechanical suction thrombectomy was associated with significant short-term improvements in hemodynamic parameters and favorable early patient-reported quality-of-life outcomes in patients with acute submassive pulmonary embolism. These findings describe early clinical and functional recovery following intervention; however, further studies are needed to determine long-term outcomes and the impact on chronic post-pulmonary embolism sequelae.