Friedrich Trendelenburg and the surgical approach to massive pulmonary embolism

A surgical approach to embolectomy from the pulmonary artery had been worked out in laboratory animals prior to 1908 by Friedrich Trendelenburg, professor of surgery and director of the University Surgical Clinic at Leipzig, Germany. His technique was based on limited opening of the left side of the chest directly over the common or undivided pulmonary artery and encircling the proximal aorta and pulmonary artery together through the transverse sinus of the pericardium. Both vessels were to be occluded by traction on the encircling band. Emboli were to be extracted through a small pulmonary arteriotomy, which then was to be controlled by a tangentially applied clamp, while occlusion of the great blood vessels was released. Unfortunately, during the first clinical trial of the technique, the patient died because of technical difficulties. Not until 1924 was a surviving patient described, by Trendelenburg's former trainee, Martin Kirschner.