Current Status of Clot Removal for Acute Pulmonary Embolism

Mark G. Davies, Hosam F. El-Sayed

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Acute pulmonary embolism (PE) continues to carry a high mortality if not recognized early and treated aggressively. Rapid recognition and diagnosis remains the mainstay of all efforts. Risk stratification early is paramount to guide therapy and achieve successful outcomes. Pulmonary emboli can generally be classified as massive, submassive, or stable. Fibrinolysis and/or surgical embolectomy are recommended for the treatment of the patient with massive PE to rescue the patient and restore hemodynamic stability. Current trials support an aggressive approach. In submassive PE, determination of right ventricular (RV) strain by echocardiography and biomarker assessment (troponin and B-type natriuretic peptide) identify patients who can benefit from catheter-directed therapy with the therapeutic intent of achieving a rapid reduction of RV afterload, prevention of impending hemodynamic collapse and prolonged in-hospital and outpatient survival. Current trials have not shown long-term benefit for this approach to date, and thus, this therapy should only be offered to select patients. Stable PE can be treated using both an inpatient and an outpatient approach, based on the available infrastructure. Therapy for PE continues to evolve and stratification of risks and benefits remain the key to implementation of invasive strategies.

Original languageEnglish (US)
Pages (from-to)211-220
Number of pages10
JournalAnnals of Vascular Surgery
Volume31
DOIs
StatePublished - Feb 1 2016

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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