Pulmonary Embolectomy In Acute And Recurrent Massive Embolism

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Abstract
A series of seven patients surviving an acute massive embolization or with severe recurrent emboli of the lung were considered as embolectomy candidates and closely followed in pump stand-by. Embolectomy and caval ligation was performed in three of four patients with acute massive embolism. Two of them were saved and free from symptoms at follow-up. One patient died after embolectomy because of complications of her primary disease; at autopsy all pulmonary arteries were patent. The fourth patient was not embolectomized because of absence of persistent arterial hypotension until sudden death. Three patients had recurrent massive embolism during 4 to 6 months. Embolectomy was not performed in one patient because of arterial normotension. Sudden death occurred without leaving time for embolectomy. Autopsy revealed that the emboli could easily have been removed. The second patient with cor pulmonale and occlusion of most pulmonary arterial branches was prepared for embolectomy but she died just before the planned operation. Autopsy showed that a sizable part of the occluding masses could have been removed at surgery. The situation was similar in the third patient with only one segmental artery patent in each lung and severe cor pulmonale. Thromboembolectomy restored blood flow to large parts of both lungs. Recovery was amazingly good. The experiences seem to favour an active attitude to removal of both acute and recurrent massive pulmonary emboli.