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PubMed1984

[Nonsurgical pulmonary embolectomy using catheterization].

Deoppilation of the pulmonary arteries by catheterization is infrequently used in severe pulmonary embolism. This technique can only be contemplated when conventional measures, such as injection of fibrinolytic agents or surgical removal of the emboli, cannot be applied. The catheter is introduced under local anaesthesia through the femoral vein or the internal jugular vein, and the emboli are aspirated by exerting a strong depression at the tip of the catheter. Satisfactory results can only be expected in cases with very recent (less than 72 hours), totally occlusive and proximal embolism. Three out of the authors' 6 attempts have been successful.

Aged↗
PubMed1984

Vena caval interruption and pulmonary embolectomy.

Surgery for pulmonary embolism has evolved to include intraluminal methods of vena caval filtration for prevention of recurrent pulmonary embolism and transvenous extraction of pulmonary emboli. Though the majority of patients who initially survive pulmonary embolism can be managed medically with anticoagulation, a significant number will require surgical intervention. The development of transvenous methods allows effective emergency management of major pulmonary embolism, even in hospitals that do not have the capability for cardiopulmonary bypass.

Aged↗
PubMed1983

[Massive pulmonary embolism: case report of successful embolectomy with transatrial vena cava blockade].

Massive pulmonary embolism occurred in a 42-year-old man 7 days after repair of a torn patellar ligament. Because of progressive deterioration in spite of full heparinization and supportive measures, and more than 60% occlusion of the pulmonary vascular bed on angiogram, partial cardiopulmonary bypass was instituted under local anesthesia by femoral artery and vein canulation. After improvement of hemodynamics and tissue oxygenation, general anesthesia was induced, the patient intubated and a longitudinal sternotomy carried out. The superior vena cava was canulated, the inferior vena cava occluded with a tourniquet and the pulmonary artery incised during temporary aortic occlusion. The left main pulmonary artery and its branches were nearly completely occluded, in addition, a large embolus was expressed into the right pulmonary artery by massaging the right lung. Finally, transatrial infrarenal caval interruption with a Mobin-Uddin umbrella filter was carried out. After 48 hours of mechanical ventilation, the patient was extubated; he made an essentially uneventful recovery.

Adult↗