Intraluminal management of acute massive pulmonary thromboembolism

Abstract

Clinical experience with acute massive thromboembolism from 1975 to 1977 has been reviewed. The series consists of 15 patients treated by transvenous intraluminal catheter embolectomy and insertion of a vena caval filter. Twelve patients were in shock and receiving vasopressor therapy (Class IV), and the remainder had acute thromboembolism superimposed on chronic pulmonary hypertension (Class V). Emboli were extracted from 13 patients (87 percent) but could not be removed from two patients, one of whom had cardiac arrest at the time of pulmonary angiography. One additional death occurred after angiography and one patient died after embolectomy because the Swan-Ganz catheter balloon caused rupture of the pulmonary artery (27 percent mortality rate). The number of emboli removed had little effect on pulmonary vascular resistance, and both cardiac output and Pa O2 increased in all but one of the surviving patients. Complications included postoperative myocardial infarction in two patients, heparin-induced thrombocytopenia in two patients, and groin wound hematomas in two patients. Nine vena cavograms have been obtained in six patients at intervals in excess of 1 year after operation, and all show patency of the vena caval filter. No recurrent pulmonary embolism has been seen, and only one late death has occurred from pancreatic carcinoma. Intraluminal management of acute massive thromboembolism can be performed without general anesthesia or cardiopulmonary bypass and achieves satisfactory survival rates (73 percent) and control of recurrent thromboembolism.