Right heart thrombus and pulmonary embolism is a condition that requires emergent treatment with reported fatal outcomes. Endovascular mechanical thrombectomy of right heart clot has been described with the use of AngioVac. We describe the use of FlowTriever device as a feasible alternative to treat clot in transit.
The association of right heart thrombus (RiHT) and massive pulmonary embolism (PE) has an incidence of 4-18%. It is a life-threatening condition that requires emergent diagnosis and treatment with reported fatal outcomes up to 21% in 14 days. Endovascular mechanical thrombectomy of right heart clot has been described focused on the use of AngioVac (AngioDynamics, Latham, NY, USA), however, a recent report supported the safety of image guided FlowTriever(Inari Medical Inc., Irvine, CA, USA). Our case report describes the use of FlowTriever device as a unique modality to treat clot in transit and massive PE when thrombolysis is contraindicated.
Purpose: To determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram.(HSG) Methods: A retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had HSG confirmed tubal occlusion from a single academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within a year of the procedure. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26-42 years). All patients received peri- and post-procedure antibiotics. Results: Average follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. Conclusion: Infertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility