Surgical treatment of acute pulmonary embolism

Summary

 Pulmonary embolism is a common event in hospitalized patients. In most cases, pulmonary embolism is asymptomatic and undergoes spontaneous resolution. Pulmonary embolectomy is required when refractory hypotension persists, despite all resuscitative efforts, and a thrombus has clearly been documented by angiography, computed tomography or magnetic resonance angiography. Embolectomy for massive embolism is performed through median sternotomy with the use of cardiopulmonary bypass. Usually the common pulmonary artery is incised and the emboli are extracted using forceps, suction or Fogarty catheters. For chronic embolisation or if no cardiopulmonary bypass is available, a lateral thoracotomy may be performed. The embolus may be removed after proximal occlusion of the pulmonary artery while normal circulation continues in the opposite lung. In patients with high risk of recurrence, the vena cava inferior may be interrupted or a vena cava filter may be implanted. Postoperatively, systemic anticoagulation should be administered for 3 months or longer depending on the patient’s risk profile. Interventional approaches for the treatment of pulmonary embolism are currently under investigation. Their benefit over surgical embolectomy remains to be established.