Medical Student Sam Houston State College of Osteopathic Medicine Lufkin, Texas
Introduction: A saddle pulmonary embolus is a rare type of sudden blockage in the main pulmonary artery preventing proper blood flow to each lung, causing heart failure and sudden death without critical medical treatment. The Inari FlowTriever is the first mechanical thrombectomy device indicated for the nonsurgical removal of embolus through the peripheral blood vessels. This case illustrates a successful application of the Inari System in the treatment of an acute saddle pulmonary embolus and chronic bilateral pulmonary embolus with near-complete obstructions.
Case Study: A 55-year-old white male with a history of right eye blindness, tobacco use, and alcohol use presented to the emergency department for shortness of breath and chest pain with slight exertion for approximately one month. This sensation resolved with rest. The patient admitted to prolonged sitting at home. He mentioned night sweats but denied palpitations or abdominal pain. He had not seen a physician in years. A CT pulmonary angiography confirmed saddle pulmonary embolus with near-complete obstruction of the pulmonary arteries. Additionally, a venous duplex ultrasound showed a deep vein thrombosis in the right popliteal and posterior tibial veins. D-dimer was elevated at 8.50. He was referred to a larger hospital for an emergent mechanical thrombectomy. CT of the chest showed right ventricular strain. The patient underwent the FlowTriever mechanical thrombectomy later the same day. A clot measuring 15cm spanning across both pulmonary arteries was removed. Subsequent selective angiography of the pulmonary system demonstrated significant improvement in flow to the lungs. The patient was placed on a heparin drip and remained hemodynamically stable. He expressed marked improvement in his ability to breathe and had no residual chest pain.
Discussion: This case demonstrates how innovative medical devices can improve patient safety and treat dire health circumstances with more accurate problem detection. The Inari FlowTriever System offers promise of an advanced therapeutic option for both acute and chronic embolus removal with minimal risks. The procedure yields high post-thrombectomy benefits by reducing adverse events or the need for long-term anticoagulation, promoting the body’s inherent structure and function interrelationship. Compared to previous cases, our case uniquely presents how the patient was hospitalized for less than 24 hours from the time of admission to discharge, even with severe acute on chronic saddle pulmonary embolus. The structural removal of the clot quickly allowed the patient’s body to begin its self-healing process.
