SIR 2024
Venous Interventions
Ernest N. Barral, B.S. (he/him/his)
Medical Student
Duke School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Jon G. Martin, MD (he/him/his)
Assistant Professor of Radiology
Duke University Medical Center
Disclosure information not submitted.
Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
James Ronald, MD, PhD
Associate Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Waleska Pabon-Ramos, MD, MPH (she/her/hers)
Associate Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Brendan Cline, MD
Assistant Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas T. Befera, MD
Assistant Professor
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Alan Alper Sag, MD
Assistant Professor, Interventional Radiology and Orthopaedic Surgery
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Paul Suhocki, MD
Associate Professor of Radiology
Duke University Medical Center
Disclosure information not submitted.
Tony P. Smith, MD
Professor of Radiology
Duke University Medical Center
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131 patients with intermediate-risk PE were treated with LBAT. All-cause mortality was 5% at 30 days and 12% at one year. 2 patients expired within 72 hours, excluding them from further analysis. The complication rate was 6%, including 2 severe adverse events (1 intraprocedural mortality and 1 cardiac arrest) and 4 moderate AEs (3 groin hematomas, 1 procedure related anemia necessitating transfusion). PE recurrence was 1.5% within one year.
95 patients presented with hypoxia and an increased oxygen requirement. Of these, 90 (95%) showed immediate post LBAT improvement in respiratory function and decrease in oxygen requirement. Pre and post invasive PAPs were measured in 69 cases, with a significant mean decrease (32.49 +/- 9.07 to 24.93 +/- 8.70; p < 0.001). Presenting HR decreased from 104.37 +/- 19.29 to 87.96 +/- 14.29 at 72 hours (p < 0.001).
Pre and post RV/LV ratio were measured for 41 patients, with a 31.1% average decrease (1.59 +/- 0.49 to 1.04 +/- 0.30, p < 0.001). Pre- and post PA diameter was available for 47 patients, with an average decrease of 3.1 mm (31.6 +/- 4.4 to 28.5 +/- 5.1, p = 0.001). Of 73 patients with both baseline and follow-up echocardiograms, 66 (90%) showed improvement or normalization of RV function.
Conclusion:
This single-arm retrospective review demonstrated similar mortality rates to other modalities while maintaining acceptable adverse events rates. Despite limited follow-up data, first-line LBAT was observed to significantly improve the RV/LV ratio, reduce mean PAP and PA diameter, and decrease HR at 72 hours. Further studies could benefit from prospective standardized protocols and more consistent clinical and imaging follow-up.