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A conversation with Dr. Valentin Krastev about this urgent and life-threatening condition

Dr Krastev, what is pulmonary thromboembolism and why is it so important?
– In fact, pulmonary thromboembolism and deep vein thrombosis alone or together represent the third most common cardiovascular disease after ischemic heart disease and stroke. The two, united in venous thromboembolism, are often a transition from thrombosis/thrombophlebitis/ of the peripheral veins, most commonly of the legs, in which clots break off from the veins and go to the pulmonary artery. The significance is justified by the fact that it is common, rarely diagnosed and mortality in severe forms is as high as 50%. In survival, an accurate diagnosis is made in only 7% of cases.

Who are the most vulnerable groups to this disease?
– First of all, we should mention that in almost all cases the thrombus comes into the lungs from somewhere. Therefore, all conditions that imply immobility or increased clotting favour the formation of thrombi in the pelvic veins or veins of the lower limbs, and these are immobility, operations, recent hospital stay, pregnancy, malignancy, prolonged travel and genetically determined changes in clotting factors. It is also more commonly seen in women, and the likelihood increases manifold with age.

What are the most common symptoms?
– The severity of symptoms is determined by the size of the thrombus and the condition of the heart and lungs before the embolism occurs. In the most severe, there may be loss of consciousness, a drop in blood pressure or sudden severe shortness of breath. In the milder forms unexplained onset of easy fatigue, breathlessness on ordinary exertion, quickening of the pulse, etc.

How is the treatment you apply different from the standard one?
– For low-risk pulmonary embolisms, treatment is with anticoagulants and there is nothing new to offer at this stage. For high and moderate risk emboli, where the signs of heart burden are also present, we have 2 approaches. In the first, we have recently deployed equipment equipped with a system to suction the thrombi out of the pulmonary arteries via a special catheter connected to a negative pressure line. This makes it possible to remove a large part of the thrombus that is in the pulmonary artery and thus improve the patient’s chances of successfully getting through the critical condition. The second approach is by inserting catheters with side holes through the thrombi and incorporating a medication that melts them called a thrombolytic. This lasts for 24 hours and allows for a much better outcome at a much lower dose of thrombolytic – hence a much lower risk of complications as opposed to the widely used and unscientific method of a single injection of this medication into the pulmonary artery.

Have you already had positive results from the application of this clot suction system?
– In just one week we used it in two patients despite the fact that the cost is very high and not covered by the Health Insurance Fund. One case was particularly interesting as it was a very young man with a pulmonary embolism and a vein thrombus on one leg and with a blockage in the abdomen where the veins from both legs join. We treated the pulmonary embolism with a catheter and a thrombolytic, and unblocked the blocked vein with the new suction and stent system, which allows a full recovery for a man with the very important profession of being an aviator. In addition, I should note that we treat pulmonary embolism as a level of urgency as acute myocardial infarction, i.e. we are on call 24/7.

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