Percutaneous catheter fragmentation and distal dispersion of proximal pulmonary embolus.

Rapid restoration of pulmonary blood flow is important in preventing death due to a massive pulmonary embolus. Devices developed specifically for percutaneous transvenous removal of pulmonary emboli are bulky and their insertion through a cut down or by the use of a large venous sheath can lead to bleeding at the entry site. In 3 patients with acute massive pulmonary embolism, conventional cardiac catheters were used to break up the embolus and disperse the fragments distally. Cardiac output was rapidly restored in all patients. There were no serious complications. This technique requires no more specialist equipment or skill than those needed for temporary cardiac pacing and could be important for the emergency management of patients with acute severe pulmonary embolism.