Thrombectomy Research Articles

Observation of the effect of urokinase thrombolysis combined the guide wire fragmentation and low molecular heparin anticoagulation for the treatment of arteriovenous fistula embolization

Objective To analyze the curative effect used the common urokinase thrombolysis combined with topo-guide-wire fragmentation and low molecular heparin in the treatment of hemodialysis patients with arteriovenous fistula embolization and explore the prospects of its application. Methods 30 hemodialysis patients with arteriovenous fistula embolization were divided into 15 cases of thrombolysis group and 15 cases of thrombectomy group according to the voluntary. The thrombolysis group was given simple urokinase thrombolysis, and the thrombectomy group was given thrombectomy combined with anticoagulant therapy. The curative effect and the difference in complication were compared. Results In curative effect, the recanalization rate,using time after recanalization, and dosage of urokinase of the thrombectomy group were better than those of the thrombolysis group[13cases vs.7cases,(22.13± 17.51)months vs.(11.05±10.55)months,(40.48±22.26)ten thousands IU vs.(60.29±15.81)ten thousands IU,χ2 =5.40,t=2.10,all P 0.05).For the thrombectomy group,there were fewer cases of re-embolization after recanalization(2 cases/13 cases vs.4 cases/7 cases,χ2=3.85,P<0.05),but more cases of organ embolism(4 cases vs.0 cases,χ2=4.62,P<0.05). Conclusion Compared with the traditional urokinase thrombolytic therapy, the guide wire fragmentation combined with low molecular weight heparin anticoagulant therapy has a higher fistula recanalization rate and a lower re-embolization rate.It does not increase the incidence of bleeding complications.Besides,it can extend the use of internal fistula.However,it may cause the serious organ embolism,so it is necessary to strictly grasp the indications,applying only to the patients who are in the poor efficiency of thrombolytic and unable to have another operation. Key words: Hemodiafiltration; Arteriovenous fistula; Thrombolytic therapy; Urokinase; Low molecular heparin

AB118. Feasibility and safety evaluation of pure laparoscopic radical nephrectomy and thrombectomy for renal tumor patients with venous tumor thrombus.

ObjectiveTo evaluate the feasibility and safety of pure laparoscopic radical nephrectomy and thrombectomy for renal tumor patients with venous tumor thrombus.MethodsFrom Jan 2013 to Dec 2014, records of patients with renal tumor and venous thrombus treated in our institute were retrospectively reviewed. Thirteen patients underwent pure laparoscopic radical nephrectomy and thrombectomy, including seven patients with renal vein (RV) thrombus and six patients with inferior vena cava (IVC) thrombus. Retroperitoneal approach was undertaken for RV thrombus patients, while transperitoneal approach or combined retroperitoneal and transperitoneal approach for IVC thrombus patients. During the combined approach surgery, renal artery and lumbar vein were controlled through retroperitoneal approach, and the thrombectomy procedure was completed through transperitoneal approach.ResultsThere were nine male patients and four female patients. All patients ranged from 30 to 78 years old (median, 55 years old). Seven patients were diagnosed by routine medical examination, while six patients had clinical symptoms, including four with gross hematuria and two with flank pain. All patients underwent operations successfully. Operation time ranged from 84 to 456 minutes (median 195 minutes). The blood loss ranged from 50 to 150 mL (median, 50 mL) for RV tumor thrombus patients, and 100 to 2,500 mL (median, 325 mL) for IVC tumor thrombus patients. All patients recovered well after surgery without major complications. With the postoperative pathological examination, the average tumor maximum diameter was 7.9±2.5 cm. Eleven cases of clear cell renal cell carcinoma, one case of chromophobe renal cell carcinoma and one case of renal metastatic osteosarcoma were showed in our study. Median follow-up time was 13 months (2-22 months). No decease was observed at the last follow-up. Three patients experienced distant metastasis after surgery, including two patients with multiple pulmonary metastases and one patient with lumbar vertebral metastasis.ConclusionsPure laparoscopic radical nephrectomy and thrombectomy is feasible and safe, with promising oncological prognosis. Combined retroperitoneal and transperitoneal procedures can take both the advantages of these two approaches and simplify operative manipulations.

AB065. Totally retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy (Mayo 0-3).

Background and ObjectiveManagement of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of totally retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy in such patients.Patients and MethodsFrom July 2014 to May 2015, 12 patients underwent laparoscopic radical nephrectomy for renal cell cancer combined with tumor thrombus of the inferior vena cava. Thrombus extension classified by the Mayo Clinic and the 2009 TNM classifications, complications, postoperative management, and survival results were analyzed. The surgeries were performed by retroperitoneal approach totally. For substantial level I-III involvement, complete caval isolation, including laparoscopic control of infra-renal and supra-renal IVC, contra-lateral renal vein and lumbar veins was performed. Following thrombus extraction, the cavotomy was repaired with 4-0 prolene suture on RB-1 needle.ResultsFour patients had level 0, two patients had level I, five had level II, and one had level III thrombi according to the Mayo Clinic staging, and 11 were T3c and one was T4 according to the 2009 TNM classifications. Totally retroperitoneal laparoscopic approach was performed in patients with stage 0 to 3 thrombi. There was no intraoperative mortality and open conversion. The median follow-up interval was 8.6 months.ConclusionsRenal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that Mayo level 0-3 caval vein tumor thrombus can be safely surgically treated by totally retroperitoneal laparotomy.

Catastrophic Acute Thrombotic Occlusion During Fractional Flow Reserve Measurement

This report describes a patient presenting with thrombotic occlusion of the left circumflex artery as a complication associated with the measurement of the fractional flow reserve. When we measured the fractional flow reserve with a pressure wire through a 5-Fr diagnostic catheter to assess myocardial ischemia in the left anterior descending artery, the pressure wave showed a damping curve. Then, the patient collapsed, and a coronary angiogram showed thrombotic occlusion of the proximal circumflex artery. The thrombus was successfully retrieved by means of ballooning and thrombectomy, and thereafter the coronary flow recovered. J Med Cases. 2015;6(6):279-281 doi: http://dx.doi.org/10.14740/jmc2174w

More Positive Trials of Mechanical Thrombectomy for Acute Ischemic Stroke

In 2013, the first randomized clinical trials of mechanical thrombectomy showed that it did not improve stroke outcomes. By then, however, researchers

Hemorrhagic transformation induced by mechanical reperfusion and acute hyperglycemia in a rat ischemic model

Objective To investigate an ideal animal model for hemorrhagic transformation(HT) after mechanical thrombectomy for acute ischemic stroke with large-vessel occlusion. Methods Hemorrhagic transformation was examined by 5 h transient middle cerebral artery occlusion and 19 h reperfusion combined with hyperglycemia induced by injection of 50% glucose. Results We found that 80% animals in the experimental group had HT in the basal ganglia and cerebral cortex.Most of HT was the kind of parenchymal hematoma.HT occurred more frequently in the group of multiple injection of high glucose than in the group of single injection of high glucose[88. 5%(23/26)vs.25. 0%(1/4),P< 0. 05].Blood-brain barrier permeability was increased in the ischemic-reperfusion hemisphere.The expression of matrix metalloproteinase-9 was increased in the ipsilateral hemisphere(0. 65±0. 06 vs.0. 37±0. 13,P<0. 01),and that of collagen typeⅣdecreased(0. 48±0. 10 vs.0. 84±0. 08,P<0. 01). Conclusion HT following endovascular mechanical thrombectomy can be successfully simulated by transient middle cerebral artery occlusion for 5 h combined with hyperglycemia induced by multiple injection of high glucose in rats. Key words: Hyperglycemia; Middle cerebral artery infarction

The treatment of venous thromboembolism with novel oral anticoagulants: warnings and limitations.

The treatment of venous thromboembolism with novel oral anticoagulants: warnings and limitations.

Ascending and Aortic Arch Thrombus: Cause of Myocardial Infarction and Lower Extremity Ischemia

Ascending aortic thrombus is a rare finding that might lead to life-threatening thromboembolic events. With no specific guidelines, controversy exists regarding management ranging from surgical resection, thrombolytic therapy, and thrombectomy to anticoagulation therapy. We report a particularly interesting case of a 61-year-old woman presenting with NSTEMI and lower extremity claudication from an embolic thrombus in the distal ascending aorta and proximal aortic arch treated medically with anticoagulation. Repeat imaging in 2 months revealed resolution of the thrombus. J Med Cases. 2015;6(4):156-158 doi: http://dx.doi.org/10.14740/jmc2074w

A second revolution for ischemic stroke: Welcome to the era of thrombectomy!

Vingt ans apres la publication de l’etude National Institute of Neurological Disorders and Stroke t-PA Study [1] qui a montre le benefice de la thrombolyse par voie intraveineuse (IV) a la phase aigue de l’infarctus cerebral (IC), voici venu le temps de la deuxieme revolution dans la prise en charge de l’IC. Ces dernieres semaines ont vu l’avenement de trois etudes randomisees montrant la superiorite de la thrombectomie (capture mecanique du caillot par voie endovasculaire) [...]

Mechanical Thrombectomy Improves Stroke Outcomes

Although thrombectomy devices became available years ago to treat acute ischemic stroke, whether this therapy actually improves outcomes was unclear.

Carotid endarterectomy alone or combined with fogarty catheter embolectomy for chronic symptomatic occlusion of the internal carotid artery

Objective To investigate the therapeutic effect of carotidendarterectomy(CEA) alone or combined with Fogarty catheter embolectomy in the treatment of chronic symptomatic internal carotid artery occlusion. Methods From April 2008 to December 2013, 12 patients with transient ischemic attack (TIA) or minor stroke underwent digital subtraction angiograph to confirmation t of ICA occlusion. All patients underwent operative exploration with CEA or CEA plus Fogarty thrombectomy. Patients who failed revascularization underwent external CEA and ICA ligation. All clinical and radiological data were retrospectively reviewed. Results CEA in 7 patients and CEA plus Fogarty thrombectomy in 3 patients were performed successfully to restore blood flow of internal carotid artery. External CEA and internal carotid artery ligation were performed in 2 patients. Postoperative CT angiography or DSA imaging demonstrated patency of the internal carotid artery in 10 patients. The ischemic symptoms were relieved in most of the patients. Postoperatively, 3 patients suffered from hyperperfusion syndrome, but there were no perioperative stroke or death.The duration of follow-up was 15-66 months. No patient developed a new stroke. No re-occlusion but one mild re-stenosis(40%) was detected. 2 patients suffered from TIA occasionally.One of the two patients failed in recanalization relieved from the symptom, the another still suffered from TIA. Conclusions Carotid endarterectomy alone or combined with Fogarty catheter embolectomy to treat chronic symptomatic internal carotid artery occlusion is feasible and safe, but preoperative evaluation and selection of patient should be carefully. Key words: Carotid artery, internal; Arterial occlusive diseases; Endarterectomy, carotid; Embolectomy; Fogarty catheter

Surgical Thrombectomy in an 81-Year-Old Patient with Right Atrial Thrombus and Pulmonary Embolism

Giris: Sag atriyumda trombus varligi pulmoner emboli icin potansiyel risk tasir. Akut pulmoner embolili hastalarin %3- 23’unde serbest (hareketli) trombus gorulebilir. Tespit edildiginde hemen tedavi baslatilmalidir. Akut pulmoner embolili hastalarda medikal ya da cerrahi tedavi yontemleri uygulanabilir. Olgu Sunumu: Bu yazida ani baslayan solunum guclugu, tasipne, tasikardi nedeniyle yapilan transtorasik ekokardiyografide sag atriyumda trombus ve ana pulmoner arter bifurkasyonunda lokalize trombus saptanan, cerrahi tromboembolektomi yaptigimiz 81 yasinda olguyu sunmak istedik. Sonuc: Sonuc olarak akut pulmoner emboli yasami tehdit eden ve tani kondugunda erken mudahale gerektiren tibbi acillerdendir

Clinical analysis of modified radical nephrectomy and inferior vena cava thrombectomy with deep hypothermic circulatory arrest

Objective To evaluate the safety and efficacy of modified radical nephrectomy and high level inferior vena cava thrombectomy with deep hypothermic circulatory arrest.Methods From March 1997 to February 2013,36 patients,diagnosed as renal cell carcinoma (RCC) associated with level Ⅲ-Ⅳ inferior vena cava (IVC) tumor thrombi,were accepted radical nephrectomy and IVC thrombectomy using cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA).Among them,24 patients were male and 12 patients were female.Their age ranged from 19 to 72 years old (mean 53.8± 13.1 years old).Level Ⅲ IVC tumor thrombi was found in 29 cases and level Ⅳ IVC tumor thrombi was found in 7 cases.Eight radical nephrectomies with IVC thrombectomies were performed according to the classic surgical procedures,including 7 cases with level Ⅲ IVC tumor thrombi and one case with level ⅣV IVC tumor thrombus.Twenty-eight radical nephrectomies with IVC thrombectomies were performed using modified techniques,including 22 cases with level Ⅲ IVC tumor thrombi and 6 cases with level Ⅳ IVC tumor thrombi.The mean size of tumor was 10.2±4.3 cm.There were no significant differences in patient and pathological characteristics,including age,sex gender,body mass index (BMI),Eastern Cooperative Oncology Group (ECOG) performance status,tumor size and thrombus levels (P＞0.05).The main modifications techniques included as follow:①Taking the 4th right intercostal incision and right inguinal incision to establish CPB in order to avoid the need of median sternotomy.Meanwhile,the right subcostal and lateral rectus incision was considered as the approach for nephrectomy; ②Applying the laparoscopic ultrasound probe to monitoring the thrombus level during the procedures ; ③Delaying the maximal mobilization of kidney tumor after thrombectomy.The operation time,CPB time,circulatory arrest time,estimated blood loss,intraoperative blood transfusions,postoperative hospital stays,perioperative complications and mortality were compared between the two groups.Results The mean operation time (580.0± 31.0 min vs.438.2 ± 87.1 min),CPB time (190.0±11.4 min vs.160.4±30.2 min),postoperative ICU stays (74.0±11.8 h vs.38.7±17.2 h) and postoperative hospital stays (12.9± 1.6 d vs.9.6± 1.9 d) were siguificantly shorter in the technique modified group than those in the traditional group (P＜0.05).At the same time,the estimated blood loss (4 166.7± 871.0 ml vs.2 547.1 ± 1 363.4 ml),intraoperative blood transfusions (3 133.3±575.0 ml vs.1 894.1±956.9 ml) and perioperative mortality (2/8 vs.0,i.e 25.0％ vs.0) were also significantly lower in the technique modified group than those in the traditional group (P＜0.05).The circulatory arrest duration (27.3±5.9 min vs.24.4±8.2 min),resuscitation time (4.6±0.9 h vs.3.8± 1.7 h) and perioperative complication rates (2/ 8 vs.4/28,i.e 25.0％ vs.14.3％)didn't show significantly different between the two group (P＞0.05).Conclusions Radical nephrectomy and level Ⅲ-Ⅳ tumour thrombectomy using CPB combined with DHCA is relatively safe and with low morbidity and mortality rate.The technical modifications may facilitate the operation,help minimize surgical trauma and improve perioperative outcomes. Key words: Renal cell carcinoma; IVC thrombus; Deep hypothermic circulatory arrest; Technical modifications

The preparation and evaluation of thrombus model used for acute ischemic stroke

Objective To prepare a new thrombus model by fluid model method , which is suitable for evaluation of mechanical thrombectomy devices for acute stroke.Methods The fluid model adopted the Chandler loop theory , while the static model adopted conventional method.Mechanical properties of thrombi prepared by fluid model and static model were measured by manual elongation test ( 15 samples in each group) and catheter injection test (15 samples in each group ).Histological structure was compared among the above thrombus models ( 5 samples in each group ) and specimens of five patients with stroke by hematoxylin-eosin staining method.Then, thrombi in fluid model were utilized to establish embolization of vessels in swine model ( two pigs ) for evaluation of radiopacity.Independent-Sample test was performed to compare the maximum tensile length of two methods , and Fisher′s exact test was used to compare the rate of thrombus fragmentation after catheter injection test.Results The maximum tensile length of two models were (4.28 ±0.23) and (3.16 ±0.13) cm, respectively, and the difference was statistically significant (t=16.38, P<0.01);After catheter injection, the fracture rates of thrombus were 13% (2/15) and 60%(9/15), which were also statistically significant (P<0.05).As to histological structure, thrombi prepared by fluid model showed mixed thrombus structure , which similar to thrombi of stroke patients , But thrombi prepared by static model were replete with erythrocytes under the microscope .A total of eight vessels ( lingual arteries and superficial cervical arteries ) in two swines were successfully occlusive ( TIMI 0 or 1 ) , and sufficient radiopacity of each injected thrombus was observed.Conclusions The thrombi prepared by fluid model not only have good mechanical stability and sufficient radiopacity , but their histological structure is similar to thromboemboli retrieved from cerebral arteries of patients with acute stroke. Key words: Stroke ; Thrombosis ; Models,animal ;

Clinical value of transesophageal echocardiography for surgical resection of inferior vena caval tumor thrombus with cardiac extension

Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC entrance to right atrium without further cardiac extension; for case five,the IVC tumor thrombus proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four,the IVC tumor thrombus extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible.Based on the TEE-provided information,the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB).For the other three cases,the intraoperative TEE showed similar results to preoperative findings.The huge IVC tumor thrombus extended into the right heart,presented almost no flexibility and dramatically compromised the intracardiac blood flow.For the three cases,CPB support was indispensable for the tumor resection.The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals,but in those three patients suffered with severely compromised cardiac extension,severe tricuspid regurgitation was noticed.All the six patients were closely monitored until discharged,and no TEE-related complications were observed.This paper reports about TEE' s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor thrombus with cardiac extension.In addition to its safety and effectiveness,TEE can provide valuable information for surgical decision making,surgical intervention assessment and anesthesiamanagement strategies. Key words: Echocardiography, transesophageal ; Thrombectomy ; Vena cava, inferior; Heart

Prevention of portal venous system thrombosis after splenectomy and devasculation

Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome. Key words: Hypertension, portal vein; Splenectomy; Venous thrombosis ; Heparin

Serial optical frequency domain imaging in STEMI patients: the follow-up report of TROFI study

To investigate the incidence of incomplete stent apposition and to explore the impact of the presence of thrombus and protruding plaque after stent implantation on neointima formation at follow-up in ST-segment elevation myocardial infarction (STEMI) patients with serial optical frequency domain imaging (OFDI) investigations. In a multi-centre study, 141 patients with ST elevation myocardial infarction <12 h from onset were randomized to either PPCI with thrombectomy (TB) using an Eliminate catheter (TB: n = 71) or without TB (non-TB: n = 70). OFDI after drug-eluting stenting was performed using TERUMO OFDI system. Per protocol, at follow-up 49 patients segments were reimaged. At post-procedure and follow-up, there were no differences in stent and lumen areas between the two groups. At follow-up, per strut-level analysis, percentage of incompletely apposed struts was 0.42 ± 0.94 vs. 0.38 ± 0.77% (P = 0.76), and percentage of covered struts was 92.7 ± 7.2 vs. 94.4 ± 9.2% (P = 0.47) in the TB and non-TB groups, respectively. There was a positive correlation between intra-stent structure (ISS) volume at post-procedure and the neointima volume at 6-month follow-up (Pearson's r = 0.409, P = 0.04). Up to 12 months, there have been two and four patients having target vessel failure in the TB and in the non-TB groups, respectively. In patients with STEMI, there were no significant differences in OFDI parameters between TB and non-TB groups at both post-procedure and 6-month follow-up. However, ISS volume at post-procedure was positively associated with neointimal volume at 6-month follow-up.

Surgical therapy for renal cell carcinoma with tumor embolism of the inferior vena cava and its prognostic factors

Objective To investigete the efficacy of radical nephrectomy and inferior vena cava thrombectomy and their prognostic factors.Methods We performed a retrospective study of 37 patients undergoing surgery between Jan 2006 and Jun 2013.The tumor embolism was level Ⅰ in 11 cases,level Ⅱ in 13 cases,level Ⅲ in 6 cases and level Ⅳ in 7 cases.Ten patients suffered from lymph node or distant metastasis before surgery and twenty-seven had no metastasis.Results All of the 37 patients successfully received radical nephrectomy plus thrombectomy.Thirty-two patients were followed up and the median follow-up period was 21 months (3-82).In the last follow-up,18 patients died.The median survival for all the patients was 24 months.The median survival for the patients with Ⅰ to Ⅳ IVC thrombus were 33,28,13 and 11 months.The survival of the patients with low level tumor thrombus (below hepatic vein) was significantly longer than that of patients with high level tumor thrombus (P=0.013).On univariate analysis,high level tumor embolism,lymph node or distant metastases and high Fuhrman grade were statistically significant prognostic factors predicting overall survival.Only high level tumor embolism (P =0.016 5) and high Fuhrman grade (P=0.010 7) were independent prognostic factors on multivariate analysis.Conclusions Radical nephrectomy and thrombectomy are effective treatment for RCC patients with IVC thrombus without lymph node or distant metastasis.The level of tumor thrombus and high Fuhrman grade are significant prognostic factors related with overall survival. Key words: Kidney neoplasms; Inferior vena cava tumor embolism; Surgery

Intraoperative acute pulmonary embolism: risk factors, diagnosis and treatment

Background Understanding the risk factors of intraoperative acute pulmonary embolism(APE) is beneficial for the prompt diagnosis and treatment.Objective This review is to discuss the diagnosis and treatment,and the subsequent research of APE.Content This review restrospectively analyzes the risk factors,clinical presentation,diagnosis and treatment of the intraoperative APE in relevant articles and case reports.Trend The examination of transthoracic or transesophageal echocardiography during operation may provide a relatively reliable diagnosis of APE.Hypodermic injection of low molecule weight heparin for short-term anticoagulation and thrombectomy for patients with tumor thrombus may produce a relatively good therapeutic effect. Key words: Operation; Acute pulmonary embolism; Risk factors; Diagnosis; Treatment

Clinical analysis of 15 cases of saddle pulmonary embolism

To improve recognition of saddle pulmonary embolism (SPE). A retrospectively review was performed for patients diagnosed with SPE determined by CTPA from Jan 2004 to Jan 2012. Fifteen SPE patients(4.44%) were found in 338 documented PE patients confirmed by CTPA. There were 7 males and 8 females, with an average age of (57 ± 13) years. The bifurcation of the main pulmonary artery was completely blocked in one case, while partial obstruction was found in the others. Hemodynamic stability was observed in 11 cases, shock in 1 case, and hypotension in 3 cases. Thromboembolectomy was performed in 1 case accompanied by patent foramen ovale straddling thrombus, and thrombolytic therapy was administered in 5 cases while anticoagulant therapy alone in 9 cases. All the cases survived. Minor bleeding was observed in 2 patients and no major bleeding occurred. The prevalence of SPE in this series was similar to that reported in the literature. But the incidence might be underestimated. Mortality rate was low. No more aggressive therapeutic interventions (thrombolytics or catheter thrombectomy) were needed in those patients with hemodynamic stability and without patent foramen ovale straddling thrombus.