2005 Volume 16 Issue 1 Pages 13-18
To investigate the impact of surgical pulmonary embectomy, thirty-six patients who had acute massive pulmonary thromboembolism were analyzed retrospectively. Patients were divided into two groups and compared: group S (n=14), patients who underwent pulmonary embolectomy, and group M, patients (n=22) who were treated medically. Average age of patients was 57±14 years, ranging from 24 to 84 years. There were 10 males and 26 females. All patients had hypoxia and cardiogenic shock was common in both groups (86% in group S vs. 72% in group M). Cardiopulmonary resuscitation and artificial ventilation was necessary in 29% and 64% in group S, 27% and 36% in group M, respectively. Seventy-one percent of patients in group S had a history of recent surgery, while 46% of patients had it in group M. Median interval between definitive diagnosis of pulmonary thromboembolism and the operation was 90 minutes, ranging from 40 minutes to 36 hours. In group M, fibrinolytic therapy, catheter intervention and insertion of the inferior vena cava filter was performed in 19, 2 and 4 patients, respectively. Hospital mortality was 0% in group S and 28% in group M. Morbidity in group S was intracranial bleeding in 1 and respiratory failure in 2, whereas that in group M was vegetative state due to prolonged hypoxia in 1.
In conclusion, surgical embolectomy for acute massive pulmonary thromboembolism is safe and efficacious if it is performed within short term after the onset. Emergency call for cardiopulmonary resuscitation team, early differential diagnosis and immediate cardiopulmonary support are important factors to save a patient with massive pulmonary thromboembolism.
