Long-Term Results of Surgical Treatment of Pulmonary Embolism (PE) by Balloon Angioplasty (BAP) in Combination with Thrombolytic Therapy

Introduction. Pulmonary Arterial Thromboembolism (PATE), which is characterised by low prognosis probability and potentially high danger, ranks third in the mortality structure of cardiovascular diseases. The primary method for treating PATE is recanalisation of the pulmonary arteries affected by embolism. Although the destruction of thromboemboli with thrombolytic drugs has proven effective, the right ventricular failure progresses faster in a majority of patients with massive pulmonary embolism. The aim of the present study is to evaluate the long-term results of surgical treatment of PATE by balloon angioplasty in combination with thrombolytic therapy in comparison with isolated systemic thrombolysis.
Materials and methods. The treatment of 80 patients with pulmonary embolism was analysed. Depending on the selected treatment approaches, the patients were divided into 2 groups as follows: group 1 — 39 patients, conducted by the BAP LA, in combination with thrombolysis; group 2 — 41 patients who underwent conservative treatment (thrombolysis and subsequent anticoagulation therapy).
Results. Despite the small sample and short period of observation, we may note the significantly better results of treatment in group 1 of the study. Positive dynamics of ECG indicators — in particular, pulmonary hypertension, RV KDR, functional class of heart failure NYHA as well as the reduction of right ventricular overload according to the ECG — indicates that the BAP LA method for the surgical treatment of pulmonary embolism, in combination with thrombolytic therapy, is effective and safe.
Conclusions. Balloon angioplasty of pulmonary arteries in combination with thrombolytic therapy can significantly reduce the degree of pulmonary hypertension (рχ2 = 0.034), as well as helping to normalise the size of the right ventricle (рχ2 < 0.001) and improvement in functional class of heart failure NYHA (рχ2 = 0.026) in patients with pulmonary embolism compared with patients with isolated thrombolytic therapy.

1. Nebylitsyn Y.S., Nazaruk A.A. Phlebology: present and future. I.P. Pavlov Russian Medical Biological Herald. 2017;25(1):133–48. (in Russ.). DOI:10.23888/PAVLOVJ20171133-148

2. Shaidakov E.V., Evlakhov V.I. Role of the endothelium in pathogenesis of chronic postembolic pulmonary hypertension. Angiology and vascular surgery. 2016;22(1):22–7. (in Russ.)

3. Klimenko A.A., Shostak N.A., Demidova N.A., Novikov I.V. Chronic thromboembolic pulmonary hypertension: new aspects of the development and progression of the disease. Klinitsist. 2011;(1):14–8. (in Russ.)

4. Lang I.M., Dorfmüller P., Vonk Noordegraaf А. The pathobiology of chronic thromboembolic pulmonary hypertension. Ann Am Thorac Soc. 2016;13(Suppl 3):S215–21. DOI: 10.1513/AnnalsATS.201509-620AS

5. Roik M., Wretowski D., Kostrubiec M., Dzikowska-Diduch O., Łabyk A., Irzyk K. et al. High prevalence of severe coronary artery disease in elderly patients with non-operable chronic thromboembolic pulmonary hypertension referred for balloon pulmonary angioplasty. Adv Interv Cardiol. 2016;12(4):355–9. DOI: 10.5114/aic.2016.63637

6. Ostapenko E.N., Novikova N.P. Modern approaches to the diagnostics and treatment of the pulmonary artery thromboembolism. Emergency medicine. 2013;(1):84–110. (in Russ.)

7. Ramesh D., Setty H.S., Kumarswamy, Kumar S., Jayanth, Manjunath C.N. Timely embolectomy in acute massive pulmonary embolism prevents catastrophe: An experience from two cases. J Nat Sci Biol Med. 2016;7(2):176–9. DOI: 10.4103/0976-9668.184706

8. Chen H., Ren C., Chen H. Thrombolysis versus anticoagulation for the initial treatment of moderate pulmonary embolism: a meta-analysis of randomized controlled trials. Respir Care. 2014;59(12):1880–7. DOI: 10.4187/respcare.03197

9. Kokov L.S., Mikhailov I.P., Lopotovskiy P.Yu., Zabavskaya O.A., Nikitina O.V., Matveev P.D. Use of rheolytic thrombectomy in massive pulmonary embolism. Russian Sklifosovsky Journal “Emergency Medical Care”. 2013;(1):65–70. (in Russ.)

10. Pasrija C., Kronfli A., Rouse M., Raithel M., Bittle G.J., Pousatis S. et al. Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: a single-center experience. J Thorac Cardiovasc Surg. 2018;155(3):1095–106.e2. DOI: 10.1016/j.jtcvs.2017.10.139

11. Konstantinides S.V., Torbicki A., Agnelli G., Danchin N., Fitzmaurice D., Galiè N. et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033–69, 3069a–3069k. DOI: 10.1093/eurheartj/ehu283

12. Pasechnik I.N. Venous thromboembolic events: new approaches to prevention and treatment. “Doctor.Rus”. Anesthesiology and Resuscitation. Medical Rehabilitation. 2015;(15–16):54–9. (in Russ.)

13. Nesterova E.A. Electrocardiography bases. Normal electrocardiography (the module for continuous medical education). Cardiology: News, Opinions, Training. 2016;(2):77–85. (in Russ.)