[Embolectomy in patients with pulmonary embolism without symptoms of shock]

The therapeutic spectrum for the management of patients with pulmonary embolism includes either drug therapy with anticoagulants or with thrombolytic agents, or embolectomy. The indications for either form of therapy are not always clearly separable, but, in general, surgery is reserved for those patients with massive embolism and shock. Large, mobile thromboemboli located centrally, either within the right heart or in the main pulmonary artery, bear the risk of further, possibly fatal, embolisation that might actually be increased by thrombolytic therapy. Therefore, demonstration of such a thromboembolus seems to justify the decision for prompt surgical removal even in the absence of shock as exemplified in the two cases presented here.