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PubMed2006

[Pulmonary embolectomy for acute massive pulmonary thromboembolism after failure of thrombolytic therapy].

Acute massive pulmonary thromboembolism (PTE) is associated with an exceptionally high mortality rate and results in death if not diagnosed early and treated properly. We observed 3 cases of acute massive PTE. One of the patients had undergone a surgery for femoral neck fracture. Ten days postoperatively, she developed severe dyspnea with hypoxia, and computed tomography (CT) pulmonary angiography confirmed the PTE diagnosis. She then had cardiac arrest when catheter examination. Although emergency surgical thrombectomy was successful with good postoperative hemodynamic stability and oxygenation, the patient did not recover from the unconsciousness caused by preoperative ischemic brain damage. Subsequently, she died 6 months after surgery. Of the 3 patients, 2 suffered from right ventricular dysfunction without hemodynamic instability. They underwent open thrombectomy after the failure of conservative treatment with a systemic injection of urokinase. Both patients demonstrated a good clinical course and were discharged from hospital in a good general condition 22 and 28 days postoperatively. Herein, we review the current literature on PTE treatment. We concluded that an aggressive surgical intervention might be preferred to thrombolytic therapy for PTE patients with massive thrombosis and progressive right ventricular dysfunction.

Acute Disease↗
PubMed1996

[Our experience in treating patients with embolisms of the aorta and major arteries of the extremities (on the centenary of the first embolectomy)].

The modern development of vascular surgery has a real possibility to reduce lethality and the amount of amputations in patients with embolism of the aorta and major arteries of the extremities. An analysis of treatment of 2042 patients during the recent 28 years has shown that the embolism is observed in 62,3% of patients with IHD and its complications, and in 34,5% in rheumatism patients, the arterial impassability prevailing in the abdominal aorta basin and lower extremity arteries (67,5%). Surgical procedures were used in 86,6% with the restoration of the main or collateral blood flow in 91,2% of the patients operated upon. Irreversible ischemia of the extremity was diagnosed in 89 patients at admission to the hospital. For prophylactics of rethromboses and infection, nonmedicamentous methods of treatment played an important role and the amount of rethromboses was reduced to 5,5% and suppuration of the wound to 6,2% which resulted in low percentage of amputations (5,8%).

Adult↗
PubMed1996

[Successful direct embolectomy for acute massive pulmonary thromboembolism].

A 35-year-old woman was bedridden because of a fall and developed pulmonary embolism after venous thromboembolism of lower extremity. Although anticoagulation therapy was immediately carried out, hemodynamics deteriorated gradually into the state of class IV in Green-field's classification. As a result, an urgent surgical procedure was performed. Under moderate hypothermic cardio-pulmonary bypass, the aorta was cross-clamped and the pulmonary artery was opened. An 18 gram clot was taken out directly and other small pieces of clot were removed with a fiberscope, a Fogarty catheter and an aspirating tube. After surgery the patient recovered from symptoms efficiently. Some cases of acute pulmonary thromboembolism have been reported, however, the generalized classification and surgical indication for this disease have not been established yet. But, as all of reports mentions, surgical procedure is recommended positively to these cases that resist anticoagulation therapy.

Acute Disease↗