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| __NOTOC__
| | #Redirect [[Pulmonary embolism embolectomy]] |
| {{Pulmonary embolism}}
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| {{CMG}}
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| ==Overview==
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| In [[thoracic surgery]], a '''pulmonary thrombectomy''', is an [[emergency procedure]] that removes [[blood clot|clotted]] [[blood]] ([[thrombus]]) from the [[pulmonary artery|pulmonary arteries]]. Embolectomy can be done via a catheter or surgically.
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| ==Types==
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| *Catheter embolectomy
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| **Rheolytic embolectomy
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| **Rotational embolectomy
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| *Surgical embolectomy
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| ==Description==
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| '''Rheolytic embolectomy''': Pressurized saline is passed through a catheter's distal tip, which breaks-down the emboli. The saline and clot fragments are then sucked back into an exhaust lumen of the catheter and disposed off.
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| Insertion of a large catheter increases the risk of bleeding which pose as the major disadvantage.
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| '''Rotational embolectomy''': As the name suggest, a rotational device is used to fragment the thrombus. In this, cardiac catheters are used, which does not require venotomy at the puncture site. The fragments are continuously aspirated.
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| '''Surgical embolectomy''': This procedure is typically limited to large medical centers (as it requires experienced surgeon and cardiopulmonary bypass).
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| *Indications
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| **Hypotensive patients in which thrombolysis is contraindicated.
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| **Embolus trapped within patent foramen ovale, right atrium or the right ventricle, as evident on Echocardiography.
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| *Benefits
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| **Among patients failing initial thrombolysis, surgical embolectomy was found to have fewer death rates and fewer major bleedings<ref name="pmid16608956">{{cite journal| author=Meneveau N, Séronde MF, Blonde MC, Legalery P, Didier-Petit K, Briand F et al.| title=Management of unsuccessful thrombolysis in acute massive pulmonary embolism. | journal=Chest | year= 2006 | volume= 129 | issue= 4 | pages= 1043-50 | pmid=16608956 | doi=10.1378/chest.129.4.1043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16608956 }} </ref>.
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| *Special Considerations
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| **A study had shown the presence of extrapulmonary thrombus in 13 out of 50 patients undergoing surgical embolectomy, thus emphasizing the need of transesophageal echocardiography. TEE should be performed before or during the procedure to look for extrapulmonary thrombus. Extrapulmonary thrombus are thrombus present in right atriam, right ventricle, or inferior vena cava.
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| ==Relation to PTE==
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| Pulmonary thrombectomies and [[pulmonary thromboendarterectomy|pulmonary thromboendarterectomies]] (PTEs) are both operations that remove thrombus. Aside from this similarity they differ in many ways.
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| *PTEs are done non-emergently whilst pulmonary thrombectomies are typically done as an emergency procedure.
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| *PTEs typically are done using hypothermia and full cardiac arrest.
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| *PTEs are done for chronic pulmonary embolism, thrombectomies for severe acute pulmonary embolism.
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| *PTEs are generally considered a very effective treatment, surgical thrombectomies are an area of some controversy and their effectiveness a matter of some debate in the medical community.
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| ==See also==
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| *[[Pulmonary embolism surgery|Pulmonary embolism Surgical Therapy]]
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| *[[Pulmonary embolism]]
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| *[[Heart-lung machine]]
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| *[[Pulmonary embolism ACC/AHA guidelines surgical embolectomy|ACC/AHA Guidelines Surgical Embolectomy]]
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| ==References==
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| {{Reflist|2}}
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| [[Category:Thoracic surgery]]
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| [[Category:Surgical procedures]]
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