Removal of Impacted Pulmonary Emboli by Retrograde Injection of Fibrinolysin into the Pulmonary Veins

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Abstract
Experimental emboli impacted in the pulmonary artery ted to remain intact, become organized and cause lung infarction in contrast to non-obstructive emboli which are usually lysed spontaneously. Removal of impacted emboli was facilitated by retrograde instillation of fibrinolysin solution in the pulmonary veins followed by retrograde injections of saline. Removal of emboli by this as well as other technics becomes more difficult as the time the embolus has been in place increases. Residual impacted emboli in distal branches of the pulmonary artery following open pulmonary embolectomy can cause persistent vascular obstruction. Retrograde pulmonary venous instillation of fibrinolysin was used in 2 patients with extensive embolization and in whom the embolus was impacted in the distal branch of the pulmonary artery. Fibrinolysin was helpful in these patients although side effects of extensive bleeding and transient pulmonary edema call for care in its use.

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