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Related Experiment Videos

[Embolectomy in massive lung embolism].

B Eisenmann1, J C Thiranos, H Petit

  • 1Service de Chirurgie Cardiovasculaire, Hôpital Central, Hospices Civils de Strasbourg, France.

Herz
|June 1, 1989
PubMed
Summary
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Surgical embolectomy for massive pulmonary embolism is indicated when obstruction reaches 60% or more, especially when extracorporeal circulation is unavailable. Early surgical intervention based on obstruction degree, rather than shock alone, improves survival rates.

Area of Science:

  • Cardiovascular Medicine
  • Thoracic Surgery
  • Pulmonary Medicine

Background:

  • Pulmonary embolism (PE) has a long history, with surgical embolectomy techniques evolving since the early 20th century.
  • Historical survival rates for modified Trendelenburg embolectomy with vena cava clamping were around 45%.
  • Surgical intervention remains a viable option when extracorporeal circulation is not accessible.

Purpose of the Study:

  • To establish clear indications for surgical pulmonary embolectomy in massive PE.
  • To define the anatomical extent of obstruction necessitating surgical intervention.
  • To compare outcomes based on different criteria for surgical indication.

Main Methods:

  • Literature review of historical surgical embolectomy cases.

Related Experiment Videos

  • Analysis of patient survival rates based on surgical techniques and indications.
  • Evaluation of anatomical obstruction levels using pulmonary angiography.
  • Assessment of clinical parameters like shock and pre-existing cardiopulmonary disease.

    • Main Results:

    • Massive PE involves at least 60-70% obstruction of the pulmonary arterial bed.
    • Survival rates can be improved by basing surgical indication on obstruction degree (≥60%) rather than solely on refractory shock.
    • Delaying surgery until shock is irreversible, despite embolectomy, leads to poorer outcomes.

    Conclusions:

    • Surgical embolectomy is justified for massive PE with ≥60% obstruction, particularly without extracorporeal circulation.
    • Indications should prioritize the degree of obstruction over solely relying on shock severity for better surgical outcomes.
    • Pulmonary angiography is crucial for quantifying obstruction and guiding surgical decisions.