Addressing Venous Thromboembolisms in Cancer Patients with Urgency and Utilizing Combo Therapy (Penumbra with EKOS) in Treatment of Patients with Submassive Pulmonary Embolism

Sachi Khemka, Hannah Seo, Vivie Tran, Kailin Opella, Esther Burns, Hoang Ho, Marina Iskandir, MD, Mohammad M. Ansari, MD

PAD Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, USA

Introduction

Venous thromboembolisms (VTE), a condition including a deep vein thrombosis (DVT) and pulmonary embolism (PE), occur in approximately 1 per 1000 adults, often leading to cardiovascular death due to their undiagnosed but serious nature. Approximately 4-20% of cancer patients will develop a VTE after cancer diagnosis. VTEs in cancer patients can lead to grave consequences as patients often halt chemotherapy and experience VTE recurrence; therefore, this places patients in a position of great mortality and morbidity. VTE’s are associated with 9% of cancer-related deaths. However, VTE is both preventable and treatable if caught early on. Approximately 33% of patients with an untreated PE die; however, if the PE is diagnosed and treated immediately, the mortality rate drops significantly.

Case Presentation

Male patient age 69 with PMH of hypertension, kidney stone, hypercholesterolemia, hydronephrosis, gout, stage IV prostate cancer, acute DVT of left common femoral vein on doppler, and bilateral pulmonary emboli with a large right-sided pulmonary embolus on CT scan and echocardiogram showed right heart strain. The patient was diagnosed with metastatic prostate cancer in 2019, and is currently on hormone based chemotherapy. Decision was reached due to clot burden and right heart strain and patient was taken for mechanical aspiration thrombectomy of the right pulmonary embolism with bilateral EKOS catheter placement. Mechanical aspiration of VTE within the left iliac and left common femoral vein was also performed during the same procedure utilizing Penumbra catheter thrombectomy system.

Conclusion

Our case highlights the importance of prompt management and intervention of venous thromboembolism (VTE), especially in cancer patients. The thrombectomy was successful and performed with no complications. Additionally, the patient follow-up indicated no new acute symptoms, distress, and promising recovery. The case is a glaring example of combo therapy utilizing the Penumbra catheter mechanical thrombectomy system with EKOS (ultrasonic catheter system) in successful treatment of PE.