Rheolytic embolectomy

Q: What is Rheolytic embolectomy in pulmonary embolism (PE)?

 Answer: Data is very limited and efficacy is not fully established but rheolytic embolectomy consists of injecting pressurized saline through the catheter's distal tip while macerated thrombus is being aspirated through a catheter port.

This technique should be used in selected cases as it requires a venous cut-down for the insertion of the catheter. It is also suggested that the release of adenosine from disrupted platelets can lead to bradycardia, vasospasm, and hypoxia, and red blood cell fragmentation can result in hemoglobinuria. It is suggested to utilize this route when systemic thrombolysis fails in PE.

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References:

1.  Kuo WT, van den Bosch MAAJ, Hofmann LV, et al. Catheter-directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis. Chest 2008; 134:250. 

2. Chechi T, Vecchio S, Spaziani G, et al. Rheolytic thrombectomy in patients with massive and submassive acute pulmonary embolism. Catheter Cardiovasc Interv 2009; 73:506. 

3. Margheri M, Vittori G, Vecchio S, et al. Early and long-term clinical results of AngioJet rheolytic thrombectomy in patients with acute pulmonary embolism. Am J Cardiol 2008; 101:252. 

4. Ferrigno L, Bloch R, Threlkeld J, et al. Management of pulmonary embolism with rheolytic thrombectomy. Can Respir J 2011; 18:e52.