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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.

Treatment

Surgical Intervention

Main purpose is to remove the obstructing thrombi from the main pulmonary arteries
Preferred for patients w/ contraindications to systemic thrombolysis

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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