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Assessment Of Safety And Procedural Learning Curve For Pulmonary Embolism Patients Undergoing Percutaneous Mechanical Thrombectomy Under Local Anesthesia: A Retrospective Chart Review
Perry Diaz, BS
1, Grace Knoer, BS
1, Allison Willett, MPP
1, Callie Fernandez, BS
1, Qingwen Kawaji, MD
2, Ricardo Quarrie, MD
2, Jason Crowner, MD
2, Steven Abramowitz, MD
3, Raghuveer Vallabhaneni, MD
3, Jason Chin, MD
2.
1Georgetown University School of Medicine, Washington, DC, USA,
2MedStar Union Memorial Hospital, Baltimore, MD, USA,
3MedStar Heart and Vascular Institute, Washington, DC, USA.
OBJECTIVES: Pulmonary embolism (PE) is a significant cause of morbidity and mortality. Advances in percutaneous mechanical thrombectomy have demonstrated a low 30-day mortality rate and a positive safety profile for intermediate- and high-risk PE. However, adoption as the first-line treatment remains limited. This study evaluates the adoption and learning curve of percutaneous mechanical thrombectomy, using fluoroscopy time, procedure time, and contrast volume as efficiency metrics.
METHODS: This retrospective study included 420 patients undergoing thrombectomy for PE between January 2020 and July 2024 across three centers with 16 surgeons. Trends in fluoroscopy time, procedure time, and contrast volume were analyzed over time since the first procedure. Regression and learning curve analyses assessed efficiency improvements. T-tests compared ICU and hospital length of stay and complication rates between the first and most recent 50 cases. Associations between efficiency metrics and patient factors (e.g BMI, sex, age, comorbidities, etc.) were also examined.
RESULTS: Regression analysis showed significant reductions in fluoroscopy time (Rē = 0.103, p < 0.001), procedure time (Rē = 0.071, p < 0.001), and contrast volume (Rē = 0.068, p < 0.001), indicating a learning curve. Proficiency plateaus were identified after 55 cases for fluoroscopy time and 138 cases for procedure time. T-tests revealed no significant differences between the first and last 50 cases in hospital length of stay (6.23 days vs 5.00 days, p = 0.406), ICU stay (2.31 days vs 1.23 days, p = 0.256), or complication rate (0.14 vs 0.00, p = 0.134). The overall mortality rate was 4.49%.
CONCLUSIONS: Percutaneous mechanical thrombectomy for PE improves with experience (as shown by reduced fluoroscopy time, procedure time, and contrast volume over time) while maintaining consistent outcomes. Proficiency is achieved after approximately 55 cases for fluoroscopy and 138 for procedure time. These results suggest a favorable learning curve with low mortality and complication rates, supporting the procedure's safety and feasibility across various settings. Future studies should assess long-term outcomes.
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