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| {{Pulmonary embolism}}
| | #REDIRECT [[Pulmonary embolism ACC/AHA guidelines surgical embolectomy]] |
| {{CMG}}
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| '''Associate Editors-in-Chief:''' [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
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| '''''Synonyms and keywords:''''' PE
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| ==Overview==
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| Emergency surgical embolectomy with [[cardiopulmonary bypass]] is an effective treatment strategy for
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| *[[Pulmonary embolism massive|Massive PE]] patients
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| *[[Pulmonary embolism submassive|Submassive PE]] with RV dysfunction when contraindications preclude thrombolysis.
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| *[[Pulmonary embolism acute|Acute PE]] patients who require surgical excision of a right atrial thrombus or paradoxical embolism.
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| ==ACC/AHA Guidelines- Recommendations for Catheter Embolectomy and Fragmentation (DO NOT EDIT)<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>==
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| {{cquote|
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
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| '''1.'''Depending on local expertise, either catheter embolectomy and fragmentation or surgical embolectomy is reasonable for patients with massive PE and contraindications to fibrinolysis''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.
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| '''2.'''Catheter embolectomy and fragmentation or surgical embolectomy is reasonable for patients with massive PE who remain unstable after receiving fibrinolysis ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.
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| '''3.'''For patients with massive PE who cannot receive fibrinolysis or who remain unstable after fibrinolysis, it is reasonable to consider transfer to an institution experienced in either catheter embolectomy or surgical embolectomy if these procedures are not available locally and safe transfer can be achieved ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
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| '''4.'''Either catheter embolectomy or surgical embolectomy may be considered for patients with submassive acute PE judged to have clinical evidence of adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe RV dysfunction, or major myocardial necrosis) ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
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| '''5.'''Catheter embolectomy and surgical thrombectomy are not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}}''.
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| ==Guidelines Resources==
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| *Guidelines on the management of Pulmonary embolism: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]]
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| [[Category:Hematology]]
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| [[Category:Pulmonology]]
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| [[Category:Emergency medicine]]
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| {{WH}}
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| {{WS}}
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