Massive Pulmonary Embolism

Heimbecker, R. O.; Keon, Wilfred J.; K, Richards

doi:10.1001/archsurg.1973.01350230092018

Cited by 30 publications

(1 citation statement)

References 13 publications

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“…Although most authors agree that the outlook is poor for patients who show persistent hypotension (Class IV), the reluctance to suggest open embolectomy has been due to both the high mortality rate and a morbidity that includes intra-alveolar bleeding [24] and pulmonary infarction [25]. The alternatives to open embolectomy in addition to intensive nonoperative management include embolectomy under inflow occlusion [26], closed chest massage [27], and prolonged partial cardiopulmonary bypass [28]. Each of these methods has obvious inherent limitations based on time and predictable effectiveness.…”

Section: Catheter Embolectomymentioning

confidence: 99%

Intraluminal techniques for vena caval interruption and pulmonary embolectomy

Greenfield

1978

World j. surg.

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Although most patients who sustain thromboembolism can be managed by anticoagulation, a number of them benefit from mechanical protection against further embolism or require embolectomy for survival. Intraluminal approaches have been developed recently as an alternative to major surgical procedures for these aims and show improved effectiveness and reduced morbidity and mortality rates. Clinical results using the Kimray-Greenfield vena caval filter in 76 patients since 1972 include a mortality rate of 4% within 2 weeks after operation and 17.1% thereafter due to underlying disease. Recurrent thromboembolism was seen in 2.6% and the incidences of thrombophlebitis and extremity edema were comparable to the experience with the Mobin-Uddin umbrella. In contrast to that experience, migration of the filter has not occurred and the postoperative vena cava patency rate at 11 months by venacavography is 97%. Transvenous pulmonary emboleetomy has been performed in 22 patients and the development of a steerable catheter with simultaneous insertion of the vena caval filter reduced the operative mortality rate from 40% to 17%. Emboli were removed in 86% of patients and overall survival has been 14 of 22 patients (64%). Catheter embolectomy under local anesthesia provides a useful alternative to open embolectomy requiring cardiopulmonary bypass.The majority of patients with documented pulmonary embolism can be managed successfully by anticoagulation with satisfactory control of the underlying thrombotic process and subsequent resolution of the embolus. A small percentage of patients, how-

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