Background: The incidence of pulmonary thromboembolism has been considered rare in Japan. However, its occurrence has been increasing because of westernized lifestyle and diet, increased diagnostic technique, and recognition of this disease. Method: Between January 2003 and September 2014, 179 patients were treated for pulmonary thromboembolism. We classified these patients into 3 groups; Massive (n=35), Sub-massive (n=29) and Non-massive (n=115) and retrospectively reviewed the treatment options and the outcome. Results: Percutaneous cardiopulmonary support (PCPS) was applied for patients with hemodynamic instability and IVC filter was inserted if there was proximal DVT. In non-massive group (n=115), 95.7％ of the patient underwent anticoagulant therapy and 47.0％ of the patients received IVC filter. In sub-massive group (n=29), 48.3％ of the patient received thrombolytic therapy and 93.1％ of the patient underwent IVC filter insertion. Surgical pulmonary embolectomy was performed in 3 patients who had high risk of thrombolytic therapy in sub-massive group. There was no death in this group. In massive group, 4 patients who had cardiogenic shock died in acute phase. PCPS was applied in 5 patients, pulmonary embolectomy was performed in 13 patients, thrombolytic therapy was performed in 4 patients and 13 patients underwent anticoagulant therapy alone. There were 7 deaths (20.0％) in this group. Conclusions: In sub-massive group, treatment should be decided depending on the bleeding risk. In massive group, pulmonary embolectomy was effective.

View full abstract