Surgical management

Surgical thromboembolectomy must be considered in compromised patients (classes III, IV, and V) in whom there is a poor response to thrombolytic therapy or the clinical deterioration is rapid ( Robison.ef..a/ 1986). The procedure is performed through a median sternotomy, with the patient on full cardiopulmonary bypass. An incision is made over the main pulmonary artery, with the thrombus being retrieved using forceps and a balloon thromboembolectomy catheter. This procedure carries a mortality approaching 50 per cent, with complications that include massive endobronchial hemorrhage and reperfusion pulmonary edema.

Suction catheter embolectomy has been advocated for acute embolic events (< 72 h). The catheter can be manipulated from a remote site, such as the femoral or jugular vein, and controlled using fluoroscopy. Repeated passes of the suction device are necessary for retrieval, with the fall of pulmonary artery pressure as an indicator of effectiveness.

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