Acute pulmonary artery embolism during transcatheter embolization: successful resuscitation with veno-arterial extracorporeal membrane oxygenation.

Abstract

Versatile particles from transcatheter embolization may accidentally enter the pulmonary circulation, causing severe pulmonary embolism. A 36-yr-old woman patient suffering from an arteriovenous malformation in the left shoulder underwent embolization with micro coils, N-butyl-2-cyanoacrylate/lipiodol and polyvinyl alcohol particles. During embolization, acute onset of tachycardia, hypotension, and decline in oxygen saturation indicated right ventricular failure and decreased pulmonary perfusion confirmed by angiography. As mechanical resuscitation failed to stabilize cardiocirculatory function, veno-arterial extracorporeal membrane oxygenation support was preformed until hemodynamic stability was regained. Extracorporeal membrane oxygenation should be considered for cases where pulmonary embolism causes right ventricular failure and circulatory arrest during transcatheter embolization.