Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism



      Catheter-based intervention (CBI) has become an increasingly popular option for treating pulmonary embolism (PE); however, the real benefits are unknown. The purpose of the present study was to compare the outcomes of patients treated with CBI with the outcomes of those treated with medical or surgical approaches.


      We performed a retrospective analysis of patients admitted from October 2015 to December 2017 with a diagnosis of acute PE. We compared patients aged ≥18 years with a diagnosis of acute PE treated with CBI against a control group identified by propensity score matching. The control group was divided into those who had undergone surgical pulmonary embolectomy (SPE) as the surgical group and those who had not undergone SPE as the medical group. The primary outcome was mortality (in-hospital and overall mortality). The secondary outcomes were major bleeding, length of hospital stay, thrombus resolution, right ventricle improvement in systolic function and dilatation, and recurrent PE.


      Of the 108 patients, 30 were in the CBI group and 78 were in the control group (62 in the medical group and 16 in the surgical group). The patient characteristics on admission were similar, except for the body mass index, which was greater in the CBI group (P = .03). No difference was found in clinical severity, clot burden, right ventricle function, or biomarkers. Recurrent PE was less frequent in the CBI group than in the medical group (0% vs 6.4%). Otherwise, no significant differences were found in the outcomes between the CBI and medical groups. When CBI was compared with the surgical group, SPE was associated with improved mortality (0% vs 16.6%) but a longer median length of hospital stay (median, 7 days; interquartile range, 3-12 days; vs median, 8 days; interquartile range, 6.5-17 days).


      The use of CBI reduced the number of recurrent PE events compared with the medically treated patients; however, the mortality was higher than that in the surgical group.

      Graphical abstract


      To read this article in full you will need to make a payment
      SVS Member Login
      Society Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Beckman M.G.
        • Hooper W.C.
        • Critchley S.E.
        • Ortel T.L.
        Venous thromboembolism: a public health concern.
        Am J Prev Med. 2010; 38: S495-S501
        • Riedel M.
        Acute pulmonary embolism 1: pathophysiology, clinical presentation, and diagnosis.
        Heart. 2001; 85: 229-240
        • Kucher N.
        • Rossi E.
        • De Rosa M.
        • Goldhaber S.Z.
        Massive pulmonary embolism.
        Circulation. 2006; 113: 577-582
        • Kearon C.
        • Akl E.A.
        • Ornelas J.
        • Blaivas A.
        • Jimenez D.
        • Bounameaux H.
        • et al.
        Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
        Chest. 2016; 149: 315-352
        • Chatterjee S.
        • Chakraborty A.
        • Weinberg I.
        • Kadakia M.
        • Wilensky R.
        • Sardar P.
        • et al.
        Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis.
        JAMA. 2014; 311: 2414-2421
        • Kucher N.
        • Boekstegers P.
        • Müller O.J.
        • Kupatt C.
        • Beyer-Westendorf J.
        • Heitzer T.
        • et al.
        Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.
        Circulation. 2014; 129: 479-486
        • Piazza G.
        • Hohlfelder B.
        • Jaff M.R.
        • Ouriel K.
        • Engelhardt T.
        • Sterling K.
        • et al.
        A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study.
        JACC Cardiovasc Interv. 2015; 8: 1382-1392
        • Tapson V.F.
        • Sterling K.
        • Jones N.
        • Elder M.
        • Tripathy U.
        • Brower J.
        • et al.
        A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial.
        JACC Cardiovasc Interv. 2018; 11: 1401-1410
        • Jaff M.R.
        • McMurtry M.S.
        • Archer S.L.
        • Cushman M.
        • Goldenberg N.
        • Goldhaber S.Z.
        • et al.
        Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.
        Circulation. 2011; 123: 1788-1830
        • Jiménez D.
        • Aujesky D.
        • Moores L.
        • Gomez V.
        • Lobo J.L.
        • Uresandi F.
        • et al.
        Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.
        Arch Intern Med. 2010; 170: 1383-1389
        • Kaatz S.
        • Ahmad D.
        • Spyropoulos A.C.
        • Schulman S.
        Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH.
        J Thromb Haemost. 2015; 13: 2119-2126
        • Wible B.C.
        • Buckley J.R.
        • Cho K.H.
        • Bunte M.C.
        • Saucier N.A.
        • Borsa J.J.
        Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever device.
        J Vasc Interv Radiol. 2019; 30: 1370-1375
        • Avgerinos E.D.
        • Abou Ali A.
        • Toma C.
        • Wu B.
        • Saadeddin Z.
        • McDaniel B.
        • et al.
        Catheter-directed thrombolysis versus suction thrombectomy in the management of acute pulmonary embolism.
        J Vasc Surg Venous Lymphat Disorders. 2019; 7: 623-628
        • Pasrija C.
        • Kronfli A.
        • Rouse M.
        • Raithel M.
        • Bittle G.
        • Pousatis S.
        • et al.
        Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: a single-center experience.
        J Thorac Cardiovasc Surg. 2018; 155: 1095-1106.e2
        • Neely R.C.
        • Byrne J.G.
        • Gosev I.
        • Cohn L.
        • Javed Q.
        • Rawn J.D.
        • et al.
        Surgical embolectomy for acute massive and submassive pulmonary embolism in a series of 115 patients.
        Ann Thorac Surg. 2015; 100: 1245-1251
        • Kuo W.T.
        • Banerjee A.
        • Kim P.S.
        • DeMarco F.J.
        • Levy J.R.
        • Facchini F.R.
        • et al.
        Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry.
        Chest. 2015; 148: 667-673
        • Kasper W.
        • Konstantinides S.
        • Geibel A.
        • Olschewski M.
        • Heinrick F.
        • Grosser K.D.
        • et al.
        Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry.
        J Am Coll Cardiol. 1997; 30: 1165-1171
        • Pasrija C.
        • Kronfli A.
        • George P.
        • Raithel M.
        • Boulos F.
        • Herr D.
        • et al.
        Utilization of veno-arterial extracorporeal membrane oxygenation for massive pulmonary embolism.
        Ann Thorac Surg. 2018; 105: 498-504
        • Pesavento R.
        • Filippi L.
        • Palla A.
        • Visona A.
        • Bova C.
        • Marzolo M.
        • et al.
        Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism.
        Eur Respir J. 2017; 49: 1601980
        • Nijkeuter M.
        • Hovens M.M.C.
        • Davidson B.L.
        • Huisman M.V.
        Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review.
        Chest. 2006; 129: 192-197
        • Heresi G.A.
        • Bair N.
        • Dweik R.A.
        • Auger W.
        • Sockrider M.
        Chronic thromboembolic pulmonary hypertension.
        Am J Respir Crit Care Med. 2018; 197: P5-P6
        • Simonneau G.
        • Torbicki A.
        • Dorfmüller P.
        • Kim N.
        The pathophysiology of chronic thromboembolic pulmonary hypertension.
        Eur Respir Rev. 2017; 26: 160112
        • Piazza G.
        • Goldhaber S.Z.
        Chronic thromboembolic pulmonary hypertension.
        N Engl J Med. 2011; 364: 351-360
        • Prandoni P.
        Residual clot in patients with deep vein thrombosis and pulmonary embolism: prognostic implications.
        J Hematol Thromb. 2015; 1: 1-3
        • Prandoni P.
        • Lensing A.W.A.
        • Prins M.H.
        • Pesavento R.
        • Piccioli A.
        • Sartori M.
        • et al.
        The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation.
        Semin Thromb Hemost. 2015; 41: 133-140
        • Meyer G.
        • Vicaut E.
        • Danays T.
        • Agnelli G.
        • Becattini C.
        • Beyer-Westendorf J.
        • et al.
        Fibrinolysis for patients with intermediate-risk pulmonary embolism.
        N Engl J Med. 2014; 370: 1402-1411
        • Giri J.
        • Sista A.K.
        • Weinberg I.
        • Kearon C.
        • Kumbhani D.J.
        • Desai N.
        • et al.
        Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association.
        Circulation. 2019; 140: e774-e801
        • Kahn S.R.
        • Akaberi A.
        • Granton J.T.
        • Anderson D.R.
        • Wells P.S.
        • Rodger M.A.
        • et al.
        Quality of life, dyspnea, and functional exercise capacity following a first episode of pulmonary embolism: results of the ELOPE cohort study.
        Am J Med. 2017; 130 (990.e9-990.e21)
        • Kahn S.R.
        • Hirsch A.M.
        • Akaberi A.
        • Hernandez P.
        • Anserson D.R.
        • Wells P.S.
        • et al.
        Functional and exercise limitations after a first episode of pulmonary embolism: results of the ELOPE prospective cohort study.
        Chest. 2017; 151: 1058-1068
        • Kucher N.
        • Rossi E.
        • De Rosa M.
        • Goldhaber S.Z.
        Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher.
        Arch Intern Med. 2005; 165: 1777-1781