Document Detail

Long-term experience with transvenous catheter pulmonary embolectomy.
MedLine Citation:
PMID:  8377239     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open embolectomy on cardiopulmonary bypass.
METHODS: The indication for embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used.
RESULTS: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%).
CONCLUSIONS: Successful embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the series (range 1 to 237 months). Catheter pulmonary embolectomy by surgeon and radiologist is of maximal benefit for major or massive PE but less likely to benefit patients with chronic recurrent PE.
L J Greenfield; M C Proctor; D M Williams; T W Wakefield
Related Documents :
8515569 - Late percutaneous extraction of an intracardiac catheter fragment.
17882399 - Do antibiotics administered at the time of central venous catheter removal interfere wi...
15758129 - Case-controlled comparison of a percutaneous collagen arteriotomy closure device versus...
20230479 - Cryoablation with an 8-mm tip catheter for pediatric atrioventricular nodal reentrant t...
11180779 - Ureteroneocystostomy with and without the use of an intravesical catheter.
15466279 - Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systema...
20512779 - Alumina-on-alumina hip replacement in developmental dysplasia of the hip.
23739149 - The inhibitory effect of thalidomide analogue on corneal neovascularization in rabbits.
21255869 - Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the trea...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  18     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-10-18     Completed Date:  1993-10-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  450-7; discussion 457-8     Citation Subset:  IM    
Department of Surgery, University of Michigan Medical School, Ann Arbor.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Catheterization, Central Venous / instrumentation,  methods
Embolectomy / methods*
Follow-Up Studies
Middle Aged
Postoperative Complications
Pulmonary Embolism / mortality,  physiopathology,  surgery*
Survival Rate
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Treatment of chronic expanding dissecting aneurysms of the descending thoracic and upper abdominal a...
Next Document:  Multiple organ dysfunction after mesenteric artery revascularization.