Pulmonary thrombectomy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In thoracic surgery, a pulmonary thrombectomy, is an emergency procedure that removes clotted blood (thrombus) from the pulmonary arteries. Embolectomy can be done via a catheter or surgically.
Types
- Catheter embolectomy
- Rheolytic embolectomy
- Rotational embolectomy
- Surgical embolectomy
Description
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.
Insertion of a large catheter increases the risk of bleeding which pose as the major disadvantage.
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.
Surgical embolectomy: This procedure is typically limited to large medical centers (as it requires experienced surgeon and cardiopulmonary bypass).
- Indications
- Hypotensive patients in which thrombolysis is contraindicated.
- Embolus trapped within patent foramen ovale, right atrium or the right ventricle, as evident on Echocardiography.
- Benefits
- Among patients failing initial thrombolysis, surgical embolectomy was found to have fewer death rates and fewer major bleedings[1].
Relation to PTE
Pulmonary thrombectomies and pulmonary thromboendarterectomies (PTEs) are both operations that remove thrombus. Aside from this similarity they differ in many ways.
- PTEs are done non-emergently whilst pulmonary thrombectomies are typically done as an emergency procedure.
- PTEs typically are done using hypothermia and full cardiac arrest.
- PTEs are done for chronic pulmonary embolism, thrombectomies for severe acute pulmonary embolism.
- 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.
See also
References
- ↑ Meneveau N, Séronde MF, Blonde MC, Legalery P, Didier-Petit K, Briand F; et al. (2006). "Management of unsuccessful thrombolysis in acute massive pulmonary embolism". Chest. 129 (4): 1043–50. doi:10.1378/chest.129.4.1043. PMID 16608956.