Modern Surgical Treatment of Massive Pulmonary Embolism: Results in 47 Consecutive Patients After Rapid Diagnosis and Aggressive Surgical Approach

Leacche, Marzia; Unić, Daniel; Goldhaber, S.Z.

doi:10.1016/j.accreview.2005.08.088

Cited by 87 publications

(152 citation statements)

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“…Older case series observed mortality rates for surgical embolectomy of >20%;3 however an intraoperative mortality of 6% was reported in 47 consecutive patients 64. Catheter-directed therapies include mechanical disruption of thrombi by catheter, ultrasound or pressurised saline injection 65.…”

Section: Clinical Dilemmasmentioning

confidence: 99%

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Management dilemmas in acute pulmonary embolism

Condliffe

Elliot

Hughes

et al. 2013

Thorax

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BackgroundPhysicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent.MethodsFourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested.ResultsManagement dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants.ConclusionThe suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.

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Section: Clinical Dilemmasmentioning

confidence: 99%

“…Current guidelines restrict surgical embolectomy to situations when thrombolysis has failed or is contraindicated 1. Although there is increasing interest in the expansion of surgical embolectomy to the initial management of massive PE, randomised trial data are required 62 64 67–70…”

Section: Clinical Dilemmasmentioning

confidence: 99%

Management dilemmas in acute pulmonary embolism

Condliffe

Elliot

Hughes

et al. 2013

Thorax

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show abstract

“…Patients in whom thrombolysis has been unsuccessful it can be used as rescue procedure. Perioperative mortality for patients undergoing surgical embolectomy has declined in the recent years and it has been shown to be a safe and effective technique in the treatment of acute PE when performed by experienced surgeons 21 22. However no randomised trials or prospective observational studies have evaluated surgical embolectomy in patients with acute PE and evidence related to surgical embolectomy is sparse 16…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis in submassive pulmonary embolism, prudent or puerile?

2013

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Pulmonary embolism (PE) remains one of the leading causes of cardiovascular mortality. The safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator (tPA) for acute PE in clinical practice remain unclear. We describe a case of life-threatening submassive PE causing extreme refractory hypoxaemia, where thrombolysis was successfully administered. Current consensus suggests that patients with features of hemodynamic instability as a result of an acute PE, that is, massive PE, should receive thrombolysis. Patients, not in shock however, but with evidence of right-ventricular (RV) dysfunction echocardiographically, that is, submassive PE may also benefit. Serum troponin and brain-type natriuretic peptide have been suggested as biomarkers of RV injury that may identify a subset of submassive PE patients who may particularly benefit from thrombolytic therapy. The clinical response of this patient to thrombolysis is important, as it may identify a subgroup of patients with submassive PE who warrant this intervention.

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“…Recently, however, it was reported that technical advances in transportable extracorporeal assist systems, and particularly the timely involvement of the cardiac surgeon as part of an interdisciplinary approach to high risk PE, may be associated with better postoperative outcomes 14. Currently, pulmonary embolectomy is a recommended therapeutic option in patients with high risk PE in whom there are absolute contraindications to thrombolysis, or if thrombolysis has failed.…”

Section: Severity Adjusted Therapeutic Conceptsmentioning

confidence: 99%

Acute pulmonary embolism revisited

Konstantinides¹

2008

Postgraduate Medical Journal

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Modern Surgical Treatment of Massive Pulmonary Embolism: Results in 47 Consecutive Patients After Rapid Diagnosis and Aggressive Surgical Approach

Cited by 87 publications

References 0 publications

Management dilemmas in acute pulmonary embolism

Management dilemmas in acute pulmonary embolism

Thrombolysis in submassive pulmonary embolism, prudent or puerile?

Acute pulmonary embolism revisited

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