Percutaneous suction thrombectomy of large tumor thrombus causing massive pulmonary embolism

Abstract

We describe a patient who underwent a renal cell carcinoma resection with inferior vena cava thrombectomy complicated by tumor embolization. This resulted in massive pulmonary embolism requiring venous-arterial extracorporeal membrane oxygenation. The patient was ineligible for systemic or catheter-directed thrombolysis because of the recent surgical resection and postoperative hemorrhage. Hence, the patient underwent percutaneous suction thrombectomy with successful removal of the tumor thrombus and significant clinical improvement. This report represents a unique case of suction thrombectomy for the removal of tumor embolus from the pulmonary circulation and highlights the ability of suction thrombectomy in the management of massive pulmonary embolism.

Diagnostic transcatheter aspiration for pulmonary artery tumor embolism using an INARI Triever aspiration catheter

“…7 The use of the Indigo Continuous Aspiration Mechanical Thrombectomy device to successfully remove a tumor thrombus in the right pulmonary artery of a 66 year-old patient with renal cell carcinoma has been previously described. 8 The tumor was not only removed but pathologic specimens confirmed the diagnosis of tumor embolism like our case. The use of aspiration devices for percutaneous tumor thrombectomy serves to not only decrease the burden of the tumor in the pulmonary arteries but also gives a pathologic specimen through which a definitive diagnosis can be made.…”

“…The use of the Indigo Continuous Aspiration Mechanical Thrombectomy device to successfully remove a tumor thrombus in the right pulmonary artery of a 66 year‐old patient with renal cell carcinoma has been previously described 8 . The tumor was not only removed but pathologic specimens confirmed the diagnosis of tumor embolism like our case.…”

Percutaneous Large Bore Aspiration Thrombectomy of Tumor Embolism Causing Massive Pulmonary Embolism

“…In that case, the patient was ineligible for surgical embolectomy because of coagulopathy and the risk of hemodynamic collapse with general anesthesia, nor was he eligible for thrombolysis because of retroperitoneal bleeding. 6 In the present case, the kidney was resected, but caval thrombus resection was not attempted in the operating room because of the patient’s hemodynamic instability and the risk for further tumor embolization. Thrombolysis was contraindicated in the postoperative setting, and would be less effective for tumor thrombus.…”

“…Thrombolysis was contraindicated in the postoperative setting, and would be less effective for tumor thrombus. 6 Surgical embolectomy is the primary treatment option, but it carries the risk of hemodynamic collapse with induction of anesthesia. This case is unique in that a large bore, 24-F aspiration catheter was required for extraction.…”

Diagnosis and treatment strategies for intraoperative pulmonary embolism caused by renal tumor thrombus shedding

“…In addition, we reviewed 16 related literature 19–34 on Pubmed by keywords of renal tumor thrombus and pulmonary embolism. The total number of patients was 17, age ranging from 35 to 82 years old, with males accounting for 64.7% and females accounting for 35.3%.…”