Suction thrombectomy for management of pulmonary tumor embolism in the setting of hepatocellular carcinoma with macrovascular invasion

Pulmonary tumor thrombi are rare but challenging to treat given the generally poor health of the patients in whom they occur and the low likelihood of the embolism to respond to anticoagulation. Management options include therapeutic anticoagulation and surgery, but the mortality rate is high in either case. Thus, in patients who are symptomatic, the decision about whether to intervene may be challenging. Here the authors present an alternative minimally invasive approach, illustrated in the case of a patient with hepatocellular carcinoma who developed intermediate-risk pulmonary tumor embolism that was successfully managed via suction embolectomy. Such treatment should be considered not just as a life-saving intervention but as a palliative one as well.