Surgical Techniques of Pulmonary Embolectomy for Acute Pulmonary Embolism

Acute pulmonary embolism (PE) is a common occurrence in hospitalized patients. The majority of patients have low-risk PE (no right ventricular dysfunction or myocardial injury) that can be treated with anticoagulation. For patients with a massive PE (circulatory instability, shock, or arrest) or a high-risk submassive PE (maintained blood pressure, right ventricular dysfunction, and myocardial injury), anticoagulation alone is insufficient. Systemic thrombolysis, catheter-based procedures (with or without local thrombolytic therapy), and surgical pulmonary embolectomy are procedures that can be used; however, the choice is largely based on institutional and physician experience. Surgical pulmonary embolectomy is used preferentially for patients with contraindications to or for those who have failed thrombolysis and in patients with free-floating thrombus in the right atrium or right ventricle. Surgical pulmonary embolectomy has been undertaken infrequently in the past, but there has been an increased interest and some institutions are now using this procedure preferentially. The technique of surgical pulmonary embolectomy is outlined.