Surgical Embolectomy in Acute Massive Pulmonary Embolism

Background- Acute pulmonary embolism is a serious condition and despite diagnostic and therapeutic advances, mortality is still high. Anticoagulation, thrombolytic therapy, catheter embolectomy and open pulmonary embolectomy are therapeutic options. Surgical embolectomy was considered the management of last resort, but recent studies have shown the effectiveness of this therapeutic modality. Methods- We reviewed our 7-year experience with pulmonary embolectomy in patients with acute massive pulmonary embolism from 1997 to 2004. Results- Eleven patients underwent open embolectomy. Seven (63.6%) were male and the average age was 45.6. In 5 patients (45.4%), pulmonary embolism occurred after major surgery. Two patients were diagnosed with malignancy and spinal cord injury. No risk factor was detected in 4 patients. The diagnosis was made by spiral CT scan alone in 4 and by angiography in 7 patients. Cardiac arrest occurred in 3 patients pre-operatively. Two patients survived after pre-operative cardiac arrest. Conclusion- Open pulmonary embolectomy is the most effective method of treatment of acute massive pulmonary embolism. CT scan is the best diagnostic modality and cardiac arrest is the worst prognostic factor. Less aggressive clot evacuation in patients who are diagnosed late seems to be effective in minimizing post-operative hemoptysis (Iranian Heart Journal 2007; 8 (1): 6-12).