Pulmoner emboli vakalarında AngioJet yardımı ile yapılan reolitik farmako-mekanik trombektomi uygulamalarında anestezi deneyimimiz

Bu çalışmada pulmoner emboli endikasyonu ile reolitik trombektomi uygulanan olgulardakierken dönem anestezi deneyimlerimizi sunmayı amaçladık.Gereç ve Yöntem: Eylül 2016-Mayıs 2018 tarihleri arasında pulmoner emboli tanısı ile hibritameliyathanede AngioJet reolitik trombektomi uygulanan 25 hasta retrospektif olarak incelendi.Hastaların demografik verileri, ameliyat sırasında ve sonrasında gelişen komplikasyonlardeğerlendirildi.Bulgular: AngioJet yardımı ile reolitik trombektomi uygulanan toplam 25 hastada (11 erkek, 14 kadın;ort. yaş 61,4 ± 14,9 yıl; dağılım 22-83 yıl) lokal anestezi ile birlikte sedasyon uygulamalasının tercihedildiği görüldü. İşlem esnasında bradikardi ve öksürük sık olarak karşımıza çıkan yan etkiler olarakbelirlendi. İki hastamızda öksürük sonrası hemoptizi gelişti. Hasta pozisyonuna veya anesteziye bağlıkomplikasyon gelişmedi.Sonuç: Gelişen yeni cerrahi ve perkütan girişimsel tekniklere paralel olarak anestezi uzmanları dauygun anestezi planı ve yönetim stratejisi oluşturmalıdır. Perkütan temelli girişimsel yöntemlerin,özellikle hibrit ameliyathanelerde ve kardiyak anestezi prensipleri uygulanarak yakın monitörizasyon ileizlenmesi gerektirmektedir. Bununla beraber oluşabilecek komplikasyonlar ve acil cerrahi embolektomiihtiyacı oluşabileceği akılda tutulmalıdır.

Our anesthesia experience in reolytic pharmaco-mechanical thrombectomy performed by AngioJet in pulmonary embolism cases

Aim: This study aims to present our early anesthetic experiences in patients undergoing AngioJet rheolytic thrombectomy for the treatment of pulmonary embolism. Materials and Methods: Twenty-five patients who underwent AngioJet rheolytic thrombectomy in the hybrid operating room with the diagnosis of pulmonary embolism between September 2016 - May 2018 were retrospectively analyzed. Demographic data of the patients and complications that developed during and after the procedure were evaluated. Results: It was observed that local anesthesia with sedation was preferred in 25 patients (11 males, 14 females; mean age 61.4 ± 14.9 years; range 22 to 83 years) who underwent rheolytic thrombectomy with the assistance of AngioJet. During the procedure, bradycardia and cough were frequently identified side effects. Hemoptysis developed after cough in two of our patients. No complications developed related with patient position or anesthesia. Conclusion: In parallel with the new surgical and percutaneous angiographic techniques, anesthesiologists should also develop an appropriate anesthesia plan and management strategy. Percutaneous-based interventional methods should take place in hybrid operating theaters and require the implementation of cardiac anesthesia principles with close monitoring. However, it should be kept in mind that there may be complications and the need for urgent surgical embolectomy.

PDF

___

1. Essien E-O, Rali P, Mathai SC. Pulmonary Embolism. Med Clin North Am. 2019; 103 (3): 549–64.
2. Çelik M, Avci A, Karataş R, et al. Akut Pulmoner Emboli’de Galectin-3. Bozok Tıp Derg. 2020; 9 (1): 75-82.
3. Gündüz C; Erdinç M. Dispnenin pulmoner nedenlerine yaklaşım. Ege Tıp Derg. 2014; 53 (Suppl): 7-13.
4. Er CZ, Atılgan K, Demirdaş E. Kronik Derin Ven Trombozu Olan Hastada Akut Gelişen İliyak Ven Trombozunun Farmokomekanik Tedavisi: Olgu Sunumu. Bozok Tıp Derg. 2018; 8 (3): 136-8.
5. Acar E, Yılmaz MF, Barutçu S, et al. Yan ağrısı olan bir hastada renal embolinin perkütan tedavisi. Ege Tıp Derg. 2016; 55 (4): 196–8.
6. Taşolar H, Taşolar S, Pakdemir H. Akut pulmoner emboli tedavisinde perkütan girişimsel tekniklere güncel yaklaşım. Bozok Tıp Derg. 2013; 2 (3): 50–7.
7. Schmittling ZC, Hodgson KJ. Thrombolysis and mechanical thrombectomy for arterial disease. Surg Clin North Am. 2004; 84 (5): 1237–66.
8. Ierardi AM, Xhepa G, Piffaretti G, et al. Clinical experience with Angiojet: a comprehensive review. Int Angiol. 2015; 34 (6 Suppl 1): 1–14.
9. Blackwood S, Dietzek AM. Pharmacomechanical thrombectomy: 2015 update. Expert Rev Cardiovasc Ther. 2016; 14 (4): 463–75.
10. Ferrigno L, Bloch R, Threlkeld J, et al. Management of pulmonary embolism with rheolytic thrombectomy. Can Respir J. 2011; 18 (4): e52-8.
11. Kucher N, Rossi E, De Rosa M, et al. Massive pulmonary embolism. Circulation. 2006; 113 (4): 577–82.
12. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123 (16): 1788–830.
13. Konstantinides S V, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020; 41 (4): 543-603.
14. Bonvini RF, Righini M, Roffi M. Angiojet Rheolytic Thrombectomy in Massive Pulmonary Embolism: Locally Efficacious but Systemically Deleterious? J Vasc Interv Radiol. 2010; 21 (11): 1774–6.
15. Biederer J, Schoene A, Reuter M, et al. Suspected pulmonary artery disruption after transvenous pulmonary embolectomy using a hydrodynamic thrombectomy device: clinical case and experimental study on porcine lung explants. J Endovasc Ther. 2003; 10 (1): 99–110.
16. Jeyabalan G, Saba S, Baril DT, et al. Bradyarrhythmias during rheolytic pharmacomechanical thrombectomy for deep vein thrombosis. J Endovasc Ther. 2010; 17: 416–22.
17. Karnabatidis D, Katsanos K, Kagadis GC, et al. Re: Bradyarrhythmias during use of the angiojet system. J Vasc Interv Radiol. 2007; 18 (7): 937-8.
18. Zhu DWX. The potential mechanisms of bradyarrhythmias associated with AngioJet thrombectomy. J Invasive Cardiol. 2008; 20 (8 Suppl A): 2A-4A.
19. Antoniucci D. Management of dysrhythmias during coronary AngioJet: how to minimize the need for temporary pacemaker during rheolytic thrombectomy. J Invasive Cardiol. 2008; 20 (8 Suppl A): 22A-4A.
20. Fontaine AB, Borsa JJ, Hoffer EK, et al. Type III heart block with peripheral use of the Angiojet thrombectomy system. J Vasc Interv Radiol. 2001; 12 (10): 1223–5.
21. DeLago A, El-Hajjar M, Kirnus M. Aminophylline for prevention of bradyarrhythmias induced by rheolytic thrombectomy. J Invasive Cardiol. 2008; 20 (8 Suppl A): 9A-11A.
22. Dukkipati R, Yang EH, Adler S, et al. Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Clin Pract Nephrol. 2009; 5 (2): 112–6.
23. Saeed M, Braun SD, Cohan RH, et al. Pulmonary angiography with iopamidol: patient comfort, image quality, and hemodynamics. Radiology. 1987; 165 (2): 345–9.
24. van Loveren M, van Beek EJR, Oudkerk M. Pulmonary Angiography: Technique, Indications and Complications. In: van Beek EJR, Büller HR, Oudkerk M (eds) Deep Vein Thrombosis and Pulmonary Embolism. Chichester, UK: John Wiley & Sons, Ltd; 2009: 221–46.
25. Nilsson T, Carlsson A, Mâre K. Pulmonary angiography: a safe procedure with modern contrast media and technique. Eur Radiol. 1998; 8 (1): 86–9.
26. Smith DC, Lois JF, Gomes AS, Maloney MD, Yahiku PY. Pulmonary arteriography: comparison of cough stimulation effects of diatrizoate and ioxaglate. Radiology. 1987; 162 (3): 617–8.