Case
A 76-year-old male with history of coronary artery disease and chronic obstructive pulmonary disease presented to an outside hospital with acute-onset dyspnea. The patient was hemodynamically stable with initial laboratory evaluation significant for anion-gap metabolic acidosis, venous lactate 7.6, D-dimer 11.65, and proBNP 17,056; SARS-CoV-2 RNA testing was negative. CT angiography of the chest revealed saddle pulmonary embolus with near complete occlusion of the main pulmonary arteries and evidence of right ventricle (RV) strain. The patient was treated initially with intravenous heparin. Despite this, the patient began experiencing increasing dyspnea with repeat echocardiogram showing a new 4.8cm-by-1.4cm mobile thrombus in the RA going in and out of the RV during the cardiac cycle with additional clot extending into the inferior vena cava (IVC) (Figure 1 ). Due to concerns for distal embolization causing massive PE, thrombolytic therapy was deferred and the patient was transferred to our facility for urgent suction embolectomy using the AngioVac system.