Catheter Directed Thrombolytic Therapy for Acute Pulmonary Embolism Via Dual Basilic Vein Access

Author: Obadah Aqtash, MD, Additional Authors^**

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Background: Acute pulmonary embolism (PE) has a high early mortality rate. The development of catheter directed thrombolysis (CDT) in the early treatment of PE has offered some promise in improving outcome in selected intermediate to high risk PE patients. The EkoSonic Endovascular System^TM (EKOS) uses combined ultrasound and CDT to enhance the lysis of acute thrombi. Patients often have difficulty maintaining supine position required for femoral or jugular venous access.

Objective: We present a case series showing that dual basilic vein cannulation for bilateral CDT is safe, efficient and effective and provides improved patient comfort.

Method: A total of 13 patients (Figure 1) presenting with bilateral intermediate to high risk acute PE underwent CDT with EKOS via dual right basilic vein cannulation. The basilic vein was isolated with ultrasound guidance, accessed via micropuncture needle, and cannulated with a 0.035 guidewire proximally (Figure 1). The procedure was then repeated distally with a second guidewire before placement of both 6F sheaths.

Results: All patients in this series had successful dual cannulation of the right basilic vein with placement of bilateral pulmonary EKOS catheter. There was universally improved patient comfort with less bed rest restrictions and no reports of complications such as superficial thrombophlebitis, infusion catheter malfunction, bleeding or limb swelling during the hospital stay or at outpatient follow up. 

Conclusions: Dual cannulation of superficial vein through the basilic route offers an approach to CDT with EKOS that is more comfortable for patients without a compromise in safety and efficacy.

**Additional Authors:

Obadah Aqtash, MD, University of Cincinnati College of Medicine, Cincinnati, Ohio

Chris Mahida, MD, University of Cincinnati College of Medicine, Cincinnati, Ohio

Imran Arif, MD, University of Cincinnati College of Medicine, Cincinnati, Ohio

Fahad Waqar, MD, University of Cincinnati College of Medicine, Cincinnati, Ohio