Arterial Interventions and Peripheral Arterial Disease (PAD)

Session: Educational Exhibit Presentations - Station 11: Venous Interventions

Updates in Catheter-Directed Therapy for Pulmonary Embolism, A Review of New Devices and Guidelines

Monday, March 6, 2023

5:40 PM – 5:45 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Alexander Andrew Argame, BSN, RN (he/him/his)

Medical Student
Kaiser Permanente Bernard J. Tyson School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Kevin Zhou, BA

Medical Student
Kaiser Permanente School of Medicine
Anthony R. Zamary, MS

Medical Student
Kaiser Permanente School of Medicine
WG

William Gombrich, BS

Medical Student
Kaiser Permanente School of Medicine
Kartik Kansagra, MD

Vascular and Interventional Physician
KP VISLA
GV

Geogy Vatakencherry, MD, FSVM,FSIR

Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
AB

Alok Bhatt, MD

Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente Los Angeles

Disclosure(s):

Alexander Andrew Argame, BSN, RN: No financial relationships to disclose

Kevin Zhou, BA: No financial relationships to disclose

Anthony R. Zamary, MS: No financial relationships to disclose

Kartik Kansagra, MD: No financial relationships to disclose

Geogy Vatakencherry, MD FSIR: No financial relationships to disclose

Learning Objectives:

Differentiate classifications of pulmonary embolism (PE)

Detail an updated review of various options involving catheter-directed therapy of pulmonary embolism

Highlight the latest devices in use of treating PE including advantages and disadvantages of each option

Compare and contrast societal guidelines in treatment of PE

Background: Acute pulmonary embolism (PE) is estimated to account for 100,000 deaths per year in the United States alone. Management of acute PE can depend upon several factors including a patient’s hemodynamic stability and bleeding risk. When hemodynamic instability persists despite first line thrombolysis treatment and/or patient has moderate to high bleeding risk, catheter directed therapy (CDT) is an effective strategy for PE. CDT can involve clot dissolution or mechanical removal. Clot dissolution involves use of pressurized saline or ultrasound. Mechanical removal involves rotational devices, suction, or embolectomy. We present an overview of recent advancements in PE treatment including INARI, alphaVac, AngioVac, AngioJet, and Penumbra Lightning 12 as well as technical pearls in the use of these devices. In addition, we review American College of Chest Physicians (CHEST), Society of Interventional Radiology (SIR), American College of Cardiology (ACC), and European Society of Cardiology (ESC) guidelines in treatment of PE.

Clinical Findings/Procedure Details:

This exhibit will:

Define low risk, submassive, and massive pulmonary embolism

Discuss the device specifications of INARI, alphaVac, AngioVac, AngioJet, and Penumbra Lightning 12 In a graphical format.

Differentiate technical considerations related to the use of each device and highlight situational advantages and disadvantages of each device

Discuss updated societal guidelines related in the treatment of submassive and massive pulmonary embolism including American College of Chest Physicians (CHEST), Society of Interventional Radiology (SIR), American College of Cardiology (ACC), and European Society of Cardiology (ESC)

Conclusion and/or Teaching Points:

Treatment options for pulmonary embolism depend on several factors including status of right ventricular function, hemodynamic stability, and biomarkers. Guidelines offer varied recommendations on when to use catheter-directed therapy for treatment of PE. This educational exhibit serves to highlight risk stratifying patients with PE, current devices used in treating pulmonary emboli, as well as updated guidelines from relevant societies.