Abstract
There is mounting evidence to guide the clinician in the management of both the acute presentation of pulmonary embolus and its chronic state. In this article we will review the role of surgery in both. Its role in acute presentation is not so clear despite 85 years passing since the first reported case of surgical pulmonary embolectomy. Pulmonary embolus is a particularly life-threatening complication when combined with shock, hypotension or right ventricular dysfunction. Essentially, surgical embolectomy has been reserved for high-risk patients. The current survival rate is around 70%. The treatment of choice for most patients with symptomatic chronic thromboembolic pulmonary hypertension is surgical disobliteration by pulmonary endarterectomy, a comparatively novel surgical procedure. This is the only treatment proved to offer significant symptomatic and prognostic benefit and should be distinguished from pulmonary embolectomy for acute embolus. The in-hospital survival rate (95%) for pulmonary endarterectomy in specialist centres is excellent, and patients enjoy a significant reduction in symptoms and increased life expectancy.
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