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[From deep venous thrombosis to pulmonary embolism]
P Biglioli1, F Alamanni, R Spirito
1Cattedra di Cardiochirurgia, Università degli Studi, Milano.
Cardiologia (Rome, Italy)
|December 1, 1991
Summary
Pulmonary embolism (PE) treatment involves surgery or thrombolytic therapy. Surgical pulmonary embolectomy, while life-saving, carries a significant mortality risk, highlighting the need for careful patient selection.
Area of Science:
- Cardiovascular Medicine
- Surgical Innovation
- Thromboembolic Disease Management
Context:
- Acute, symptomatic pulmonary embolism (PE) presents a significant clinical challenge.
- Deep venous thrombosis (DVT) of the lower extremities is the primary risk factor for PE (90%).
- Untreated PE carries a high mortality rate (38%), emphasizing the need for timely intervention.
Purpose:
- To review a 5-year experience with the management of acute, serious pulmonary embolism.
- To evaluate the outcomes of surgical and thrombolytic treatments for PE.
- To assess the role of surgical intervention in PE management.
Summary:
- Between 1985 and 1990, 15 patients with acute PE were treated; 6 underwent urgent surgery, and 9 received thrombolytic therapy (3 successful, 6 requiring subsequent embolectomy).
- Eleven patients underwent pulmonary embolectomy with a 27.5% operative mortality rate.
- Medical treatment is often successful, but surgery is crucial for treatment failures or contraindications, with a high mortality rate (11-55%) in critically ill patients.
Impact:
- Surgical pulmonary embolectomy, though necessary in 3-6% of cases, has a high mortality rate, underscoring the importance of patient selection and advanced medical management.
- This study highlights the critical role of surgeons in both preventive and therapeutic interventions for thromboembolic disease.
- Effective management of PE requires a multidisciplinary approach, balancing medical and surgical options to improve patient outcomes.