Amy Butcher, MS, PA-C
Baylor Saint Luke's Medical Center
Houston, Texas
Disclosure information not submitted.
Cesar Castillo, MD
MD
Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas, United States
Disclosure information not submitted.
Diana Guerra
MD
Baylor College of Medicine, Baylor St. Luke's Medical Center, United States
Disclosure information not submitted.
Title: Unilateral Mechanical Thrombectomy and Thrombolysis for Pulmonary Embolism in Single Lung Transplant
Case Report Body: There is a higher incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in lung transplant patients (1-2). Due to a lower impedance of the blood flow to the allograft, the PEs tends preferentially to affect the transplanted lung. Here we describe selective unilateral mechanical thrombectomy for bilateral pulmonary embolism in single lung transplant. A 75-year-old male with history of hypertension, coronary artery disease with prior coronary artery stents and idiopathic pulmonary fibrosis underwent left single lung transplant. Post-operatively, he developed dyspnea during physical therapy and was found to have a pulmonary embolism in the left lower lobe. He was started on heparin infusion but developed hemothorax requiring cessation of anticoagulation. Although IVC filter was immediately deployed after cessation of heparin, he subsequently developed hemodynamically unstable hypoxia and shock requiring escalation to veno-arterial extracorporeal membrane oxygenation (ECMO) support. Imaging at the time of decompensation demonstrated increased pulmonary embolus disease burden in the right lower lobe as well as left upper and lower lobes of the lungs. He underwent mechanical thrombectomy and catheter assisted thrombolysis selectively to the lung allograft with immediate improvement of oxygenation and was weaned off VA-ECMO after three days. Tracheostomy was performed to facilitate ventilator weaning, and his pulmonary graft function continued to improve without further issues. This is the first documented case of unilateral thrombectomy and thrombolysis preferentially to a lung allograft in single lung transplant with VA-ECMO support. Unilateral intervention may lower procedural risk of bleeding in high risk patients without significant impact on global pulmonary function.