HWN Suggests

The Role of Surgical Embolectomy

There are always situations that require surgical embolectomy, like if they are particularly young, in severe shock, and they have a really central clot. Also sometimes, if there is a clot in transit, particularly if there is a PFO or any type of intra-atrial shunt where the clot can cross over and cause arterial embolism, we'll bring them to the OR. But even treatments for intracardiac clots and clots in transit will change. Inari got approval for clot in transit, and I think that the less that we need to send people for surgery, the better. It's a good time in this space, because we've got a lot of development going on at the same time and they are very complementary.

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 Surgical embolectomy for acute massive pulmonary embolism: state of the art

Massive pulmonary embolism (PE) is a severe condition that can potentially lead to death caused by right ventricular (RV) failure and the consequent cardiogenic shock. Despite the fact thrombolysis is often administrated to critical patients to increase pulmonary perfusion and to reduce RV afterload, surgical treatment represents another valid option in case of failure or contraindications to thrombolytic therapy.

Articles of Interest

Acute Pulmonary Embolectomy

The precise indications for embolectomy will probably never be based on a randomized clinical trial. Clinical trials for management of critically ill PE patients have been dauntingly difficult to organize. Even the indications for PE thrombolysis have not been well established, and a large-scale definitive clinical trial to study thrombolysis is long overdue. Furthermore, the optimal role for catheter embolectomy remains uncertain.

Minimally Invasive Pulmonary Embolectomy With Thoracoscopic Assistance

Historically and most commonly, surgical pulmonary embolectomy has been performed through a median sternotomy with central cardiopulmonary bypass with or without cardioplegic arrest. Given advances in surgical technology along with improved safety of peripheral cardiopulmonary bypass, the authors have recently started to implement a minimally invasive approach to this procedure.

Percutaneous Pulmonary Embolectomy: Indications, Techniques and Outcomes

Catheter-directed thrombolytic therapy used selectively in conjunction with percutaneous embolectomy and fragmentation techniques in patients with acute PE and hemodynamic instability appears to be useful in rapidly restoring more normal hemodynamics and may prove to be useful in reducing mortality and the sequela of chronic pulmonary hypertension.

Surgical Embolectomy of Acute Pulmonary Embolism

Treatment options for pulmonary embolism include oral anticoagulation, systemic thrombolysis, catheter-directed the-rapy (CDT), and surgical pulmonary embolectomy with or without extra-corporeal life support.