[Invasive treatment of pulmonary embolism]

Pulmonary embolism is high letal risk pathology often misdiagnosed, up to 70% cases, more frequent in hospitalized subjects, i. e. geriatric patients with chronic respiratory and circulatory diseases, or orthopaedic, neurosurgical, or neoplastic ones and trombophylic predisposing conditions. Medical pharmacological strategies include anticoagulative regimens (heparines, fibrinolitic drugs), either for prolonged therapeutical schedules or for prophylactic ones; within 30% of timely acquired diagnoses, compared to 70% non diagnosed cases, survival rates is directly related to the first approach, ranging from 60% after 7 days, to 48% survival during the first year, 39% and 34% after five and eight years respectively, considering the progressive relapsing risk. Radiological invasive devices such as caval filters or percutaneous trombolysis and reolysis are recommended for non responder subjects, in which medical programs failed. Time from diagnosis is infact the most important parameter conditioning therapeutic approach, that can rely on open surgery only in selected patients and in very specialized centers. The poor surgical prognosis is due infact to the cardiocirculatory emergency of patients that couldn't take advantage from any other therapeutical strategy.