Abstract Introduction Pulmonary embolism (PE) in lung transplant patients is a common post-procedure complication, with studies citing an incidence of 9% to 43%. Treating PE in lung transplant patients is more nuanced than the general population given the increased bleeding risk and often abnormal vascular anatomy. With these challenges, timely treatment is imperative to spare parenchyma from ischemic change given the lack of collateral vasculature. The role of catheter directed thrombolysis in intermediate risk PE is increasing in the general population. Here, we show this method is also beneficial and safe for treatment of PE in transplanted patients. Case Report 69-year-old female with single right lung transplant one year ago presents with pre-syncope and tachypnea, found to have evidence of pulmonary embolism with multiple lobar and segmental pulmonary emboli involving the right lung on CT scan. Corresponding laboratory data was significant for elevated biomarkers including troponin and brain-natriuretic peptide. Echocardiogram was significant for right heart strain and septal flattening, not present on prior evaluation 2.5 years ago. The patient was started on IV heparin infusion, but had persistent symptoms and worsening work of breathing. Two days later, she underwent catheter directed thrombolysis with employment of the Bashir endovascular catheter (BEC). This catheter, compared to the standard, offered a smaller diameter capable of navigating her tortuous pulmonary artery affected by her hyperinflated transplant lung and severely fibrosed native lung. The catheter was advanced into the pulmonary artery and two 1mg TPA boluses were administered. TPA infusion was started through the right-sided BEC basket at 1 mg/hr with infusion for 5 hours. Following thrombolysis, the patient had improved respiratory status. Sheath was removed at bedside, she was transitioned to an oral anticoagulant, and was discharged home four days after the procedure. Discussion Treatment of intermediate risk emboli continues to be controversial. Though many studies have shown efficacy of mechanical thrombectomy and catheter directed thrombolysis, this evaluation is lacking in lung transplant patients. On literature review, few cases of PE in transplant patients have been treated with minimally invasive endovascular procedures. This case shows rapid and safe improvement in respiratory status following catheter directed thrombectomy and successful use of the BEC in a patient, without significant bleeding sequelae or prolonged hospitalization. It serves as a basis for case review to develop guidelines for early involvement of these techniques to spare transplant lung parenchyma and navigate post-surgical anatomy. This abstract is funded by: None
Gandhi et al. (Fri,) studied this question.