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PULMONARY THROMBOEMBOLISM
Pulmonary embolism is the blockage of the blood vessels in the lungs usually due to blood clots from the veins, especially the veins in the legs and pelvis.
Dyspnea, chest pain, syncope or tachypnea (respiratory rate of ≥20/min) occur in most cases of pulmonary embolism.
Pleuritic chest pain with or without dyspnea is one of the most frequent presentations of this disease.
Syncope or shock are the hallmark signs of central pulmonary embolism and usually result in severe hemodynamic repercussions.
Signs of hemodynamic compromise and reduced heart flow are also usually present.

Surgical Intervention

Catheter Extraction

  • Catheter extraction involves suction extraction of pulmonary embolism (PE) under fluoroscopy w/ electrocardiogram (ECG) monitoring
  • Reserved for highly compromised patients who cannot receive thrombolytic therapy due to contraindications, as an adjunct when thrombolytic therapy failed to improve circulation, or as alternative to surgery if
  • immediate access to cardiopulmonary bypass is not available

Inferior Vena Cava (IVC) Filter Placement

  • Recommended for patients unresponsive &/or intolerant to anticoagulant/thrombolytic therapy, patients w/ active bleeding complications, & those w/ recurrent acute PE w/ underlying pulmonary hypertension
  • Studies show decreased incidence of PE in patients w/ proximal deep vein thrombosis (DVT) on anticoagulant therapy

Pulmonary Embolectomy

  • Performed in emergency situations when more conservative measures have failed
  • Reserved for patients w/ massive PE (preferably angiographically documented), hemodynamic instability despite Heparin & resuscitation, or failure of thrombolytic therapy or contraindication to its use
  • May be considered in patients w/ submassive acute PE who are hemodynamically unstable, severe worsening lung/RV failure, or cardiac necrosis
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