Catheter-directed interventions for acute pulmonary embolism

J Vasc Surg. 2015 Feb;61(2):559-65. doi: 10.1016/j.jvs.2014.10.036. Epub 2014 Dec 16.


Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Systemic anticoagulation is the standard of care, and treatment can be escalated in the setting of massive or submassive PE, given the high mortality risk. A secondary consideration for intervention is the prevention of late-onset chronic thromboembolic pulmonary hypertension. Treatment options include systemic thrombolysis, catheter-directed interventions, and surgical thromboembolectomy. Whereas systemic thrombolysis seems to be beneficial in the setting of massive PE, it appears to be associated with a higher rate of major complications compared with catheter-directed thrombolysis as shown in recent randomized trials for submassive PE. The hemodynamic and clinical outcomes continue to be defined to determine the indications for and benefits of intervention. The current review summarizes contemporary evidence on the role and outcomes of catheter-directed therapies in the treatment of acute massive and submassive PE.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / instrumentation*
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Hemodynamics
  • Humans
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / physiopathology
  • Pulmonary Embolism / therapy*
  • Risk Factors
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / instrumentation*
  • Treatment Outcome
  • Vascular Access Devices*


  • Anticoagulants
  • Fibrinolytic Agents