Safety of Mechanical Thrombectomy in Obese Patients: Insights From a Single-Center Retrospective Analysis

Pulmonary embolism (PE) ranks as the third leading cause of cardiovascular death in the United States. 1 Obesity is an independent significant risk factor for venous thromboembolism. 2 Catheter-directed therapies are increasingly used for intermediate-risk and high-risk PE management.However, concerns arise regarding vascular access in obese patients, particularly in large-bore catheter-directed thrombectomies.Femoral access in obese patients has been associated with increased vascular complications in coronary artery catheterization, including need for transfusion, surgical repair, retroperitoneal bleed, large hematoma, pseudoaneurysm, and arteriovenous fistula. 3This study aimed to investigate the safety of mechanical thrombectomy specifically in patients with obesity.This retrospective study analyzed procedural data and outcomes of patients with a body mass index (BMI) of >35 kg/m 2 who underwent mechanical thrombectomy with a large-bore aspiration device for PE between 2020 and 2024.Procedural data were extracted from medical records (Table 1).We identified outcome data about access site complications, hospital stay duration, and major bleeding events within 7 days postprocedure.We defined major bleeding as bleeding events in which bleeding was accompanied by a decrease in the hemoglobin level of at least 2 g/dL, a transfusion of at least 2 units of packed red cells was required, bleeding occurred at a critical site (intracranial, intraocular, intraspinal, intra-articular, intramuscular with compartment syndrome, pericardial, retroperitoneal), or resulted in death within 4 months.The study included 64 patients with a mean age of 54.9 years and a BMI ranging from 35.0 to 72.0 kg/m 2 .Four patients were excluded as they were on extracorporeal membrane oxygenation or transitioned to extracorporeal membrane oxygenation, therefore confounding access site complications.Most cases of PE were provoked (80.0%), with the most common provocation type being cancer (30.0%), followed by surgery (25.0%).