Document Detail


Long-term experience with transvenous catheter pulmonary embolectomy.
MedLine Citation:
PMID:  8377239     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
L J Greenfield; M C Proctor; D M Williams; T W Wakefield
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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    
Affiliation:
Department of Surgery, University of Michigan Medical School, Ann Arbor.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Catheterization, Central Venous / instrumentation,  methods
Embolectomy / methods*
Female
Follow-Up Studies
Hemodynamics*
Humans
Male
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


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