Safety of Endovascular Therapy for Acute Pulmonary Embolism in the Geriatric Population: A Single Center Retrospective Study

Wednesday, April 15, 2026

11:15 AM - 11:24 AM ET

Location: 718B

Presenting Author(s)

JA

Jamil Ahmed, MD

Resident
ChristianaCare, Delaware, United States

Author/Co-author(s)

MO

Moussa Omidvar, DO

VIR Fellow
Christianacare - - Newark, DE, Delaware, United States
DK

Deepak Kesani, DO

VIR Fellow
Christianacare - - Newark, DE, Delaware, United States
Daniel A. Leung, MD, FSIR

Professor, Program Director
Christiana Care Health Services, Delaware, United States
Assaf Graif, MD (he/him/his)

Attending Physician
ChristianaCare, Delaware, United States

Purpose: To evaluate the safety of catheter directed thrombolysis (CDL) and large bore aspiration thrombectomy (LBAT) used to treat acute pulmonary embolism (PE) in geriatric patients (≥65 years old).

Materials and Methods: A retrospective review of medical records was performed to find 154 consecutive patients ≥65 years old (age: 73.2±6.4 years, 51.9% female) and who underwent CDL (37.7%), LBAT (≥16F, 59.1%), or both (3.2%) for acute PE in the years 2010-2025, after excluding patients with chronic PE (n=16), or who received systemic thrombolysis prior to intervention (11). Patients with intermediate-low (22.1%), intermediate-high (68.2%) and high (9.7%) risk PE were included. Sub analysis was performed for 26 patients ≥80 years old (83.9±3.3 years, 69.2% female) who underwent CDL (23.1%) or LBAT (76.9%). Safety was assessed according to GUSTO classification for hemorrhagic adverse events (AE). SIR classification was used for all AE, and only AE that were caused by the procedure or if unknown if they were caused by the procedure were reported (categories 3 & 2).

Results: CDL was discontinued prematurely in 4/63 cases (6.3%) due to hemorrhagic AE. There were 7.2% minor, 5.2% moderate and 3.3% major hemorrhagic GUSTO complications. Blood was transfused in 7.2% of patients. There was a single case of intracranial hemorrhage (0.7%). SIR AE rates were: mild 11.8%, moderate 6.5%, severe 2% and life-threatening 5.8%. There was a single event of hemoptysis (0.65%, that occurred in a patient older than 80 years, 1/26 (3.9%)). Hemodynamic decompensation during or after the procedure occurred in 5.9% of patients while pulmonary decompensation (requiring positive pressure ventilation) occurred in 2.6%. One-year all-cause mortality was 6.5% and procedure related mortality was 1.3%. In the ≥80 years old cohort CDL was not discontinued prematurely (0/6). There were 7.7% minor, 3.8% moderate and 7.7% major hemorrhagic GUSTO complications. Blood was transfused in 3.8% of patients. There were no intracranial hemorrhages. SIR AE rates were: mild 15.4%, moderate 7.7%, severe 3.8%, and life-threatening 11.5%. Hemodynamic decompensation during or after the procedure occurred in 11.5% of patients while pulmonary decompensation occurred in 7.7%. One-year all-cause mortality was 3.8% with no procedure related mortalities.

Conclusion: Endovascular intervention in the geriatric population appears to have a higher AE rate than reported for all comers in the existing literature. Patients ≥80 years old had higher AE rates than the general geriatric population.