| Long-term experience with transvenous catheter pulmonary embolectomy. | |
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MedLine Citation:
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PMID: 8377239 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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L J Greenfield; M C Proctor; D M Williams; T W Wakefield |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Journal of vascular surgery Volume: 18 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 1993 Sep |
Date Detail:
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Created Date: 1993-10-18 Completed Date: 1993-10-18 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 450-7; discussion 457-8 Citation Subset: IM |
Affiliation:
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Department of Surgery, University of Michigan Medical School, Ann Arbor. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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