Pulmonary embolism diagnosis and management

Percutaneous Aspiration Thrombectomy in Treatment of Massive Pulmonary Embolism

“…The direct cause of death was PE in 62.5% of patients with massive PE, with an in-hospital bleeding rate of 17.6% [4]. These findings coupled with the high mortality of this group have stimulated the development of other therapies for massive acute PE such as surgical or percutaneous thrombectomy [8,9,22,23].…”

“…Despite that the American College of Chest Physicians recommends the use of PMT only in patients with contraindication for thrombolysis (grade 2C) [29]. Indications currently considered are arterial hypotension (sSBP < 90 mm Hg or a drop > 40 mm Hg), cardiogenic shock, cardiopulmonary resuscitation, right ventricular dysfunction, precapillary pulmonary hypertension (mPAP > 20 mm Hg in the presence of normal pulmonary capillary wedge pressure), an alveolararterial oxygen difference > 50 mm Hg, and clinically serious PE with contraindications for thrombolytic treatment [4,9]. In our series, RVD and a severe pulmonary vascular compromise (preprocedure Miller score of 22.7 AE 3.8) was documented in all cases.…”

“…The goal of the catheter directed procedure is to reduce pulmonary vascular resistance and right ventricular afterload and to increase cardiac output and systemic arterial pressure. PMT has been developed over the past years as a reliable alternative method to treat patients with acute PE and RVD [9].…”

Intraluminal techniques for vena caval interruption and pulmonary embolectomy

“…This directional control has allowed more extensive manipulation within the pulmonary vascular bed and eliminated the need for balloon isolation of the involved pulmo-nary artery segment. The technique of catheter embolectomy has been described [ 1]. The procedure is indicated in those patients requiring vasopressors for support of the systemic circulation in whom the diagnosis has been confirmed by pulmonary arteriography (Class IV).…”

Χρησις Του Πληθυσμογραφου Ηλεκτρικης Αντιστασεως (Impedance Phlebography) Εις Την Διαγνωσιν Της Οξειας Εν Τω Βαθει Φλεβικης Θρομβωσεως Των Κατω Ακρων

“…'Υπολογίζεται δτι πλέον τών 200.000 ασθενών θνήσκουν ετησίως είς Η.Π.Α. έκ πνευμονικής εμβολής καί έτεροι 600.000 εμφανίζουν μή θανατηφόρον διαδρομήν τής νόσου (Greenfield 1976).…”