ABSTRACT
Surgical pulmonary embolectomy has a storied history in the domain of cardiothoracic surgery. This article provides insight on the history, current data, and future directions of surgical pulmonary embolectomy.
Subject(s)
Cardiopulmonary Bypass/standards , Embolectomy/history , Embolectomy/standards , Embolectomy/trends , Practice Guidelines as Topic , Pulmonary Embolism/surgery , Adult , Aged , Aged, 80 and over , Embolectomy/statistics & numerical data , Female , Forecasting , History, 20th Century , History, 21st Century , Humans , Male , Middle AgedSubject(s)
Embolectomy/history , Endovascular Procedures/history , Ischemia/surgery , Leg/blood supply , Peripheral Vascular Diseases/surgery , Acute Disease/therapy , Embolectomy/instrumentation , Embolectomy/methods , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , History, 16th Century , History, 17th Century , History, 19th Century , History, 20th Century , Humans , Ischemia/etiology , Peripheral Vascular Diseases/complications , Treatment Outcome , Vascular Access Devices/historyABSTRACT
Massive pulmonary embolism (MPE) is a life-threatening condition. The management of MPE has changed over the course of the last few years. Since the emergence of thrombolytic therapy, only a few patients remain amenable for surgical treatment. Currently, surgical embolectomy is advised only in very specific indications. This chapter will review the background, history, indications, surgical technique and results of surgical pulmonary embolectomy in patients with MPE.
Subject(s)
Cardiopulmonary Bypass/methods , Embolectomy/methods , Pulmonary Embolism/surgery , Thrombolytic Therapy/methods , Cardiopulmonary Bypass/history , Computed Tomography Angiography , Disease Management , Echocardiography , Embolectomy/history , Embolectomy/instrumentation , History, 20th Century , History, 21st Century , Humans , Magnetic Resonance Imaging , Practice Guidelines as Topic , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/history , Pulmonary Embolism/pathologySubject(s)
Embolectomy , Pulmonary Embolism/surgery , Adult , Aged , Aged, 80 and over , Embolectomy/adverse effects , Embolectomy/history , Embolectomy/mortality , Embolectomy/trends , Female , History, 20th Century , History, 21st Century , Humans , Male , Middle Aged , Patient Care Team , Pulmonary Embolism/history , Pulmonary Embolism/mortality , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
The most efficient treatment for acute arterial embolism is operative embolectomy using Fogarty's balloon catheter, especially if a single large artery is involved. Unfortunately, although the early surgical success of arterial thromboembolectomy often seems acceptable, the early clinical outcome still remains unsatisfactory. This may be related to the incomplete restoration of perfusion (i.e., residual thrombus in distal vessels not reached by the balloon catheter thromboembolectomy), propagation of residual thrombi or presence of underlying steno-occlusive lesions. In such a situation a meticulous intraoperative assessment of the adequacy of clot removal is decisive. Residual thrombus, chronic atherosclerotic disease and even vessel injuries secondary to balloon catheter passage can be corrected by endovascular techniques (hybrid procedures). The combination of surgical and endovascular options may overcome the limitations that characterize the traditional approach, and it is likely that in the future many treatments will be a mix of techniques that can be performed by vascular surgeons in the operating room or in a dedicated endovascular suite. This review article summarizes the hybrid treatment options for acute arterial occlusion caused by either embolism or local thrombosis.
Subject(s)
Angioplasty, Balloon , Embolectomy , Embolism/therapy , Endarterectomy , Extremities/blood supply , Ischemia/therapy , Thrombolytic Therapy , Thrombosis/therapy , Acute Disease , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/history , Angioplasty, Balloon/instrumentation , Catheters , Embolectomy/adverse effects , Embolectomy/history , Embolectomy/instrumentation , Embolism/complications , Embolism/diagnostic imaging , Embolism/surgery , Endarterectomy/history , History, 20th Century , History, 21st Century , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Ischemia/surgery , Limb Salvage , Radiography, Interventional , Stents , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/history , Thrombosis/complications , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment OutcomeABSTRACT
The history of clot removal consists primarily of efforts at procedures, techniques, and instruments that had suboptimal performance. In the 1960s, the amputation and death rates following attempts at removal were as high as 50%. A wide variety of instruments were used but none were specifically designed for embolus and thrombus removal. The need was obvious but the problem was unresolved.
Subject(s)
Arterial Occlusive Diseases/history , Catheterization/history , Embolectomy/history , Embolism/history , Extremities/blood supply , Ischemia/history , Thrombectomy/history , Thrombosis/history , Acute Disease , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/surgery , Catheterization/instrumentation , Embolectomy/instrumentation , Embolism/complications , Embolism/surgery , Equipment Design , History, 20th Century , Humans , Ischemia/etiology , Ischemia/surgery , Thrombectomy/instrumentation , Thrombosis/complications , Thrombosis/surgery , Treatment OutcomeABSTRACT
Although enormous progress has been made in understanding the physiology of pulmonary embolism, developing new diagnostic modalities and strategies, and constant refinement in the use of heparin therapy and thrombolytic therapy, venous thromboembolism remains a common and lethal process. As the history of this disease illustrates, advances continue to be made and it is anticipated that with newer diagnostic studies and anticoagulants under development, diagnosis and treatment of pulmonary embolism will continue to improve.
Subject(s)
Pulmonary Embolism/history , Venous Thrombosis/history , Angiography/history , Anticoagulants/history , Anticoagulants/therapeutic use , Biomedical Research/history , Blood Gas Analysis/history , Critical Care/history , Echocardiography/history , Electrocardiography/history , Embolectomy/history , Embolectomy/instrumentation , Europe , Heparin/history , Heparin/therapeutic use , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , Humans , Lung/diagnostic imaging , Perfusion Imaging/history , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Pulmonary Heart Disease/diagnosis , Pulmonary Heart Disease/etiology , Radiography, Thoracic/history , Thrombolytic Therapy/history , Tomography, X-Ray Computed/history , Venous Thrombosis/diagnosis , Venous Thrombosis/therapyABSTRACT
The authors describe the pathology and the symptoms of pulmonary embolism with possible therapies, including thrombolysis and suction extraction. We performed two successful operations and after the examination of the data of the literature we think that in most patients the conditions for immediate surgery are not present. After the acute period, when the cardio-respiratory status is stabile, pulmonary embolectomy can result in complete recovery. Extracorporeal circulation and cardiac surgical background are necessary for the intervention. The seven Hungarian adult cardiac surgical centers could save the life of many patients.