Massive pulmonary embolism: embolectomy or thrombolysis?

The purpose of this paper is to evaluate the indications for surgical or thrombolytic treatment of massive pulmonary embolism. Analysis of the outcome of the disease depending on the indices of lung vascular damage volume and hemodynamics was performed. One hundred and thirty five patients with thromboembolism of truncus or main branches of the pulmonary artery were examined. Right cardiac catheterization, angiopulmonography and Tc-perfusion lung scanning were carried out. Predictive criteria of the lethal outcome (with 86% probability) were defined in patients without surgical treatment. These criteria included extensive volume of lung vascular damage (Miller angiographic index greater than or equal to 27, scannographic perfusion deficit greater than or equal to 60%) and significant hemodynamic disturbances (refractory systemic arterial hypotension or severe pulmonary arterial hypertension: right ventricular systolic pressure greater than or equal to 60 mmHg, right ventricular end-diastolic pressure greater than or equal to 15 mmHg, mean right ventricular pressure greater than or equal to 25 mmHg, and mean pulmonary arterial pressure greater than or equal to 35 mmHg). With these indices available these are indications for pulmonary artery embolectomy. With lower indices, but close to those estimated in the study, thrombolytic therapy is indicated.