| Endovascular Treatment of a Haemodynamically Unstable Massive Pulmonary Embolism using Fibrinolysis and Fragmentation. Experience with 111 Patients in a Single Centre. Why don't we follow ACCP Recommendations? | |
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MedLine Citation:
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PMID: 21208705 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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INTRODUCTION: Fibrinolysis is recommended in several consensus documents for the treatment of a haemodynamically unstable massive pulmonary embolism (HUMPE). MATERIAL AND METHODS: A total of 111 patients were treated in a single centre from January 2001 to December 2009. They were 55 males and 56 females diagnosed with HUMPE (systolic arterial pressure>90 mmHg) with at least two of the following criteria: Miller index>0, ventricular dysfunction, and need of vasoactive drugs. Local fibrinolysis with urokinase was performed in all cases, and fragmentation with a pig-tail catheter in the majority of them. An inferior vena cava (IVC) filter was implanted in 94 patients as a prophylactic measure. RESULTS: Technical success was 100%. The Miller index improved from 0.7±0.12, pre-treatment, to 0.09±0.16. The mean pulmonary arterial pressure fell from 39.93±7.0 mmHg to 20.47±3.3 mmHg in the 30-90 days review. Of the 94 patients with IVC filters implanted, 79% were withdrawn satisfactorily. Seven patients died: 3 due to their neoplasia, 3 due to right cardiac failure at 1, 7 and 30 days, and another died of a brain haemorrhage in the first 24hours. There were complications in 12.6% of the cases, of which 4.5% were major. CONCLUSION: Local fibrinolysis with fragmentation achieves a rapid return to normal of the pulmonary pressure and is a safe and effective method for the treatment of HUMPE. |
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Authors:
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Miguel Ángel de Gregorio; Alicia Laborda; Ignacio de Blas; Joaquín Medrano; Antonio Mainar; Mikel Oribe |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-1-5 |
Journal Detail:
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Title: Archivos de bronconeumologia Volume: 47 ISSN: 1579-2129 ISO Abbreviation: - Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-2-1 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0354720 Medline TA: Arch Bronconeumol Country: - |
Other Details:
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Languages: ENG; SPA Pagination: 17-24 Citation Subset: - |
Copyright Information:
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Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved. |
Affiliation:
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Grupo de Investigación Técnicas de Mínima Invasión (GITMI), Universidad de Zaragoza, Añadir Unidad de Cirugía Minimamente Invasiva Guiada por Imagen, Hospital Cínico Universitario Lozano Blesa, Zaragoza, España. |
Vernacular Title:
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Tratamiento endovascular mediante fibrinolisis y fragmentación del embolismo pulmonar masivo con inestabilidad hemodinámica. Experiencia de un solo centro en 111 pacientes. ¿Por qué no seguimos las recomendaciones de la ACCP? |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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