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| {{Pulmonary embolism}}
| | #Redirect [[Pulmonary embolism embolectomy]] |
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| {{CMG}}
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| '''Associate Editors-in-Chief:''' [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
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| ==Overview==
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| Surgical management of acute pulmonary embolism ([[pulmonary thrombectomy]]) is uncommon and has largely been abandoned because of poor long-term outcomes. However, recently, it has gone through a resurgence with the revision of the surgical technique and is thought to benefit selected patients.<ref>{{cite journal | author=Augustinos P, Ouriel K | title=Invasive approaches to treatment of venous thromboembolism | journal=Circulation | year=2004 | volume=110 | issue=9 Suppl 1 | pages=I27-34 | id=PMID 15339878 }}</ref>
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| Chronic pulmonary embolism leading to [[pulmonary hypertension]] (known as ''chronic thromboembolic hypertension'') is treated with a surgical procedure known as a [[pulmonary thromboendarterectomy]].
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| ==Inferior vena cava filter==
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| [[Image:Mar07 090.jpg|thumb|left|300px|Used inferior vena cava filter, presented with a British twenty pence coin for scale.]]
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| {{main|inferior vena cava filter}}
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| If anticoagulant therapy is [[contraindication|contraindicated]] and/or ineffective, an [[inferior vena cava filter]] should be implanted<ref name="pmid9459643">{{cite journal |author=Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral F, Huet Y, Simonneau G |title=A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group|journal=N Engl J Med |volume=338 |issue=7 |pages=409-15 |year=1998 |id=PMID 9459643}}</ref>. It provides a filter in the [[inferior vena cava]], allowing blood to pass through, while preventing large emboli from traveling from the lower extremities to the lung. IVC filters decreases PE recurrence but are not efficacious in preventing mortality<ref name="pmid16009794">{{cite journal |author=|title=Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study |journal=Circulation |volume=112 |issue=3|pages=416–22 |year=2005 |month=July |pmid=16009794 |doi=10.1161/CIRCULATIONAHA.104.512834|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16009794 |accessdate=2011-12-13}}</ref>.
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| In a study group comprising of 400 patients with proximal deep-vein thrombosis, which were followed for 2 years, it was found that the initial beneficial effect of vena caval filters for the prevention of pulmonary embolism was counterbalanced by an excess of recurrent deep-vein thrombosis, without any difference in mortality<ref name="pmid9459643">{{cite journal |author=Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral FG, Huet Y, Simonneau G |title=A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group |journal=N. Engl. J. Med. |volume=338 |issue=7|pages=409–15 |year=1998 |month=February |pmid=9459643 |doi=10.1056/NEJM199802123380701|url=http://dx.doi.org/10.1056/NEJM199802123380701 |accessdate=2011-12-13}}</ref>.
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| ==Embolectomy==
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| Embolectomy is a process of removal of an embolus via a catheter or surgically. The procedure should be used when a high risk patient present with persistent hypotension and thrombolysis has either failed or is contraindicated.
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| To read more about embolectomy (types, procedure), click [[Pulmonary thrombectomy|'''here''']].
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| ==References==
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| {{reflist|2}}
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| [[Category:Hematology]]
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| [[Category:Pulmonology]]
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| [[Category:Cardiology]]
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| [[Category:Emergency medicine]]
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| {{WH}}
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| {{WS}}
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