Risk of Pulmonary Emboli from Mechanical Thrombolysis

Mechanical thrombolysis of clotted access grafts (i.e., without use of clot-dissolving enzymes) is gaining recognition and, probably, more widespread use. Is the safety of sending clot fragments to the lung for disposition established?     

Comparison of Surgical Managements for Pulmonary Emboli

The high incidence of pulmonary embolism is well documented. At first suspicion of an embolism attack, adequate anticoagulant therapy was administered to 86% of the patients in this study. With failure of anticoagulants preoperatively, 30 patients received partial interruption of the IVC, 26 patients had their IVC ligated. Postoperatively, anticoagulants were administered to 64% of the patients who subsequently suffered recurrent attacks of embolism or new episodes of acute thrombophlebitis. These patients also had a substantial hazard of hemorrhage since 48% of the patients on heparin required transfusion. Postoperative mortality for the ligation group was associated with underlying conditions of the patients. These patients subjected to IVC plication had more deaths due to recurrence of pulmonary emboli and were demonstrated to have a substantially higher recurrence rate of pulmonary embolus. Reasons for this recurrence in both groups are discussed. Severe leg sequlae problems often associated with ligation were not encountered but were present in several patients subjected to plication.     

Off-Pump Open Pulmonary Embolectomy for Major Bilateral Pulmonary Emboli: Report of a Case

Acute massive or submassive pulmonary artery thromboembolism causes sudden hemodynamic deterioration, warranting immediate surgery. We report the case of a 67-year-old woman who suffered a syncopal attack resulting in shock, 3 weeks after undergoing orthopedic surgery. Preoperative radiologic imaging studies, including a lung perfusion scan, chest scan, and venography, showed a major bilateral pulmonary artery embolism (PE) originating from a leg vein. An inferior vena cava filter was inserted preoperatively during the venography. We performed an open pulmonary embolectomy without cardiopulmonary bypass by using a submammary trans-sternal bilateral thoracotomy approach. The patient recovered uneventfully and has been well for 13 months.     

Microscopic Pulmonary Tumor Emboli: An Unusual Presentation of Breast Cancer

Abstract: We report a rare case of microscopic pulmonary tumor embolism from breast cancer in a young woman with no prior medical history. The patient presented with progressive dyspnea and questionable abnormalities of the left breast and axilla on physical examination. Results of an axillary lymph node biopsy and subsequent radiologic studies raised the possibility of either microscopic pulmonary tumor emboli or lymphangitic spread of cancer as a cause of the dyspnea. The patient died due to advanced breast cancer confirmed at autopsy despite chemotherapy.     

Pulmonary Embolism Rates Following Total Hip Arthroplasty With Prophylactic Anticoagulation: Some Pulmonary Emboli Cannot Be Avoided

Background

A symptomatic pulmonary embolism (PE) after total joint arthroplasty has been described as a “never event.” Despite potent anticoagulants and improvements in patient care, PE continues to occur following total hip arthroplasty (THA). This study evaluates symptomatic PE rates over time in THA patients enrolled in multicenter randomized clinical trials (RCTs) assessing the efficacy of venous thromboembolism prophylaxis regimens.

Bullet Emboli to the Pulmonary Artery: A Report of 2 Patients and Review of the Literature

Bullet embolization to the pulmonary artery is a rare event. The purpose of this study is to report our experience with 2 patients and to review the 15 patients reported in the literature, with special emphasis on a rather peculiar complication that has occurred in 4 of the 9 patients who underwent bullet embolectomy: dislodgment of the missile during the surgical procedure and migration to the down-side lung, for which a second thoracotomy was required in 3 of those patients.The usual untoward effects of foreign bodies in the vascular system were seen in this series: embolization with thrombosis, sepsis, erosion and hemorrhage, and vascular occlusion with infarction.This review suggests that operative removal of a bullet in the pulmonary artery is necessary. The operation is safe and uncomplicated if precautions are taken to prevent the missile from migrating during manipulation of the lung.     

The Clinical Severity of Patients Diagnosed With an In-Hospital Pulmonary Embolism Following Modern,Elective Joint Arthroplasty Is Unrelated to the Location of Emboli in the Pulmonary Vasculature

Background

In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature.