Advertisement

Surgical treatment of acute pulmonary embolism

  • C. Schlensak
  • T. Doenst
  • F. Beyersdorf
Chapter
  • 82 Downloads

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.

Key words

Emergency surgery pulmonary embolectomy vena cava filter 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brofman BL, Charms BL, Kohn PM, Elder J, Newman R, Rizika M (1957) Unilateral pulmonary artery occlusion in man. J Thorac Surg 34:206PubMedGoogle Scholar
  2. 2.
    Coon WW (1984) Venous thromboembolism: Prevalence, risk factors, and prevention. Clin Chest Med 5:391PubMedGoogle Scholar
  3. 3.
    Coon WW, Coller FA (1959) Some epidemiologic considerations of thromboembolism. Surg Gynecol Obstet 109:487PubMedGoogle Scholar
  4. 4.
    Cruveilhier J (1829) Anatomie pathologique de corps humain. Paris: Bailliere, J B; pp 42Google Scholar
  5. 5.
    Dalen JE, Alpert JS (1975) Natural history of pulmonary embolism. Prog Cardiovasc Dis 17:259PubMedCrossRefGoogle Scholar
  6. 6.
    Fedullo PF, Moser KM (1997) Advances in acute pulmonary embolism and chronic pulmonary hypertension. Adv Int Med 42:67Google Scholar
  7. 7.
    Flemma RJ, Young WG Jr, Wallace A et al. (1964) Feasibility of pulmonary embolectomy. Circulation 30:234PubMedGoogle Scholar
  8. 8.
    Gulba DC, Schmid C, Borst HG, Lichtlen P, Dietz R, Luft FC (1994) Medical compared with surgical treatment for massive pulmonary embolism. Lancet 343:576PubMedCrossRefGoogle Scholar
  9. 9.
    The PIOPED investigators. Value of ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED) (1990) JAMA 263: 2753Google Scholar
  10. 10.
    Jakob H, Vahl C, Lange R et al. (1995) Modified surgical concept for fulminant pulmonary embolism. Eur J Cardio-Thorac Surg 9:557CrossRefGoogle Scholar
  11. 11.
    Kirschner M (1924) Ein durch die trendelenburgsche Operation geheilter Fall von Embolie der Arteria pulmonalis. Arch Klin Chir 133:312Google Scholar
  12. 12.
    Laennec RTH (1819) De l’auscultation mediate. Paris: Brossen et ChaudeGoogle Scholar
  13. 13.
    Long J, Cohenca N, Rivera-Camilon MS (1994) Pulmonary Thromboendarterectomy. Clinical profile, surgical treatment. AORN Journal 59:801PubMedCrossRefGoogle Scholar
  14. 14.
    Luciano N, Gaudin M, Possati G (1996) Surgical treatment of massive pulmonary embolism. Rays 21:432Google Scholar
  15. 15.
    Lyerly HK, Reves JG, Sabiston DC Jr (1986) Management of primary sarcomas of the pulmonary artery and reperfusion of intrabronchial haemorrhage. Surg Gynecol Obstet 163:291PubMedGoogle Scholar
  16. 16.
    Meaney JF, Weg JG, Chenevert TL, Statford-Johnson D, Hamilton BH, Prince MR (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336:1422PubMedCrossRefGoogle Scholar
  17. 17.
    Meyer G, Diehl JL, Philippe B, Reynaund P, Sors H (1995) Pulmonary embolectomy in pulmonary embolism: Surgery and endoluminal techniques. Arch Mal Coeur Vaiss 88:1770Google Scholar
  18. 18.
    Sabiston DC Jr (1997) Pulmonary Embolism. In: Sabiston, 4th (ed.) pp 1502–1512Google Scholar
  19. 19.
    Schulte HD (1979) Lungenarterienembolie. Dt Ärztebl 2:85Google Scholar
  20. 20.
    Sharp EH (1962) Pulmonary embolectomy: Successful removal of a massive pulmonary embolus with the support of cardiopulmonary bypass: A case report. Ann Surg 156:1PubMedCrossRefGoogle Scholar
  21. 21.
    Silver D, Sabiston DC Jr (1975) The role of vena cava interruption in the management of pulmonary embolism. Surgery 77:1Google Scholar
  22. 22.
    Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG (1991) Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no preexisting cardiac or pulmonary disease. Chest 100:598PubMedCrossRefGoogle Scholar
  23. 23.
    Storti S, Crucitti P, Cina G (1996) Risk factors and prevention of venous thromboembolism. Rays 21:439PubMedGoogle Scholar
  24. 24.
    Stulz P, Schläpfer R, Feer R, Habicht J, Gradel E (1994) Decision making in the surgical treatment of massive pulmonary embolism. Eur J Cardio-Thorac Surg 8:188CrossRefGoogle Scholar
  25. 25.
    Tschirkov A, Krause E, Elert O et al. (1978) Surgical management of massive pulmonary embolism. J Thorac Cardiovasc Surg 75:730PubMedGoogle Scholar
  26. 26.
    Virchow R (1858) Die Zellularpathologie und ihre Begründung auf physiologische und pathologische Gewebelehre. Berlin: Hirschwald, AGoogle Scholar
  27. 27.
    Wakefield TW, Greenfield LJ (1993) Diagnostic approaches and surgical treatment of deep venous thrombosis and pulmonary embolism. Hematology/Oncology 7:1251Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 2000

Authors and Affiliations

  • C. Schlensak
    • 1
  • T. Doenst
    • 1
  • F. Beyersdorf
    • 1
  1. 1.Abteilung für Herz- und GefäßchirurgieUniversität FreiburgFreiburgGermany

Personalised recommendations