Surgical Management of Pulmonary Embolism

Surgical pulmonary embolectomy was once considered a salvage procedure in patients who were dying or dead. Improvements in surgical technique, technologies, and patient selection mean that surgical embolectomy is a safe procedure, potentially more effective than thrombolytics or percutaneous thrombectomy procedures. The specific patient populations who may benefit most from surgical embolectomy are discussed. The surgical technique, using cardiopulmonary bypass, is described in detail. Special situations such as clots in transit, pregnant patients with pulmonary embolism, and the emerging role of mechanical circulatory support in the management of this condition are also discussed.