Step into the IR suite as Dr. Samuel Steerman, a Vascular Specialist, performs a pulmonary thrombectomy—a critical procedure to remove blood clots from the lungs. This video provides an in-depth view of the surgical techniques, advanced tools, and precision required to restore blood flow.
I'm Sam Stearman. I'm a vascular surgeon with Cento vascular specialists. Uh primarily working at Virginia Beach General Hospital, but we cover a lot of the hospitals in the area. Today, we have a case to talk about pulmonary embolism. Um As many of you are familiar with a pulmonary embolism is a clot that lodges itself in the pulmonary arteries. Most often it forms in the veins of the lower legs, detaches and then goes up through the heart into the lungs and blocks the blood flow to the lungs. Puts pressure against the heart too as it's continuing to pump. When people develop a pulmonary embolism, there's a whole spectrum of the way that they can present. It can be all the way from a slight cough or maybe a little bit of chest pain to low blood pressure, rapid heart rate. Um This can be a fatal condition in some situations when it's minor. It's typically treated with blood thinners when it's threatening the patient's life in front of you. Sometimes we give clot busting medication just as quickly as we can through an IV. And then there's a situation sort of in the middle where the patient is having a hard time with that clot, with the pulmonary embolism. It's in those situations where it makes sense for us to do some catheter based interventions, some ways of dissolving or sucking out that clot. And that's the case that we're going to share with you today. These patients are often very sick, but sometimes they're just having a particularly hard time getting back to the condition that they were before they suffered. The pulmonary embolism and removing the clot makes a lot of sense. So this case is of a woman in her sixties who came in with acute shortness of breath and was found to have a rapid heart rate and uh lab value test and an echo test showing that her heart was really having a hard time dealing with her pulmonary embolism. So we decided to take her to our, our lab where we access her left femoral vein in the groin under some light sedation. Um And we place our sheath. This is one of the larger the sheaths that we use to go into the vein. And the reason for that is to suck out the clot. As you can see here, we're running our wires and catheters or flexible plastic tubes up her inferior vena cava to the right atrium, the right ventricle up the pulmonary artery outflow track. And on this image, you can see the right pulmonary artery is catheterized. You can see the movement of the catheter as the heart's beating. And we're redirecting our catheters and wires to go deep down into the pulmonary vasculature so that we can have a good wire in place, a good uh rail for bringing in our device. This is our suction thrombectomy device, the purple catheter at the bottom of the screen, the white at the end of it is a small dilator that goes through it. So this device goes through the sheath over that wire that we had just placed through the heart as it goes through the heart into the pulmonary artery outflow tract and then into the right pulmonary artery. And you can see that we do this pretty slowly to make sure that it's going in the proper location in the way that we want it to. We're gonna zoom in a little bit and look at that again here again, you can see this 24 French device going through the heart into the lung and right into that area where the pulmonary embolism is on the right side, on the right pulmonary artery. Um After our dilator is removed, we apply some suction by using the syringe here where we aspirate the blood, pull the blood out right next to the clot and hopefully some clot at that same time, I'm now filtering the blood through this filter that the uh technician is using. We have the uh the blood that has the clot removed. Um Steve here is removing the clot from that filter. As I put the clean blood, uh the filtered blood back into the patient. And here's a specimen of the pulmonary embolism. You can see to the screen, right, some acute clot, um and then some more well organized clot. After we've done that several times, we'll inject some contrast, which shows up on the angiogram right here. And you can see well filling of the upper and middle pulmonary artery, there is some slight filling defects that are left. However, the patient had improved dramatically at this point. Um And we felt that there was adequate removal. Um more procedures equal more complications. So we try to do only what's necessary. Now, we've changed our angle a little bit and this is the left pulmonary artery and the device goes up there, we pull some blood out, filter it again. Um And then the clean blood goes back into the patient. So there's not a lot of blood loss that happens throughout this procedure here. The technician is again, uh cleaning that filter to remove the clot that came from the left pulmonary artery. And while this isn't a large volume of clot, we're looking to improve the physiology of the patient really the way that they feel their heart rate, blood pressure, not get large volumes of clot. Again, you can still see some filling defects um on this left lung. But there's dramatic improvement of the patient at this point. It's actually quite gratifying to see how quickly they get better. Um And then this is the clot that was removed. I want to pause here and look at this because you can see both the clot that's removed through the pulmonary artery. And then up at the top, you can see the pre and post heart rate, oxygen saturation and blood pressure. You can see the heart is not working as well as sorry, as hard as it had before dropping from a heart rate of 105 to 75. Um And the oxygen within the blood has increased as well from 90 to 99%. This was a successful procedure and the patient was able to be discharged home on an oral blood thinner to prevent further issues.
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