Acute and chronic pulmonary thromboembolism: current perspectives. part i: glossary of terms, historic evolution and prevalence

Publisher Website
Google Scholar
Abstract
Despite considerable medical as well as surgical advances, the problem of pulmonary thromboem‐bolism, both acute and chronic, continues to plague clinicians of all medical disciplines. Approximately 650,000 to 700,000 patients per year suffer from acute pulmonary thromboembolism in the United States. Of these, approximately 60,000–70,000 die as a direct result of it. Our knowledge of the etiology, pathology, pathogenesis of pulmonary infarction, pathophysiology, accurate diagnosis, proper management (including both primary and secondary prophylaxis) of deep vein thrombi and pulmonary thromboemboli has advanced considerably during the past 15 years. These advances, which have now been adopted in the clinical practice, have already begun to indicate that not only more cases of acute and chronic pulmonary thromboembolism are being recognized than before, but also the morbidity and mortality of this disease process is declining. This is likely to improve further as our quest for safe, accurate, noninvasive and inexpensive diagnostic methods continues. Medical thromboembolectomy using thrombolytic therapy is fast replacing the surgical thromboembolectomy for patients with acute massive pulmonary thromboembolism. Better thrombolytic agents, such as tissue plasminogen activator, which selectively lyses the thromboemboli without producing significant systemic lytic state and now undergoing clinical investigation, is likely to revolutionize the management of both acute and chronic pulmonary thromboembolism because of its propensity to dissolve plasminogen‐bound thrombi of any age. The majority of the patients who suffer from acute pulmonary thromboembolism recover most of their lost lung function unless cardiopulmonary reserve was compromised prior to the onset of the acute episode. Conversely, patients with chronic pulmonary thromboembolism usually have relentless progression of their disease with progressive increase in mean pulmonary artery pressure, ultimately resulting in chronic cor pulmonale and death. However, recently pulmonary thromboembolectomy for those patients who have chronic pulmonary thromboembolism resulting from thromboemboli located in the main pulmonary artery or its main branches has been performed with success and acceptable mortality. This paper reviews the subject of pulmonary thromboembolism, both acute and chronic, from the days of Virchow to the present.

This publication has 0 references indexed in Scilit: