title: [Indication margins for pulmonary embolectomy].
abstract: Pulmonary embolectomy is the most effective form of treatment in acute, massive pulmonary embolism. Persistent cardio-respiratory failure, in spite of intensive medical therapy, presents a clear indication for embolectomy. A relative indication is given with the occlusion of more than 50% of the pulmonary arterial tree, especially in the case of beginning circulatory failure and contraindications to fibrinolytic therapy. Preoperative angiography is essential and should be performed whenever possible. A dramatic deterioration of the patient's condition may, however, require a prior reestablishment of sufficient circulation with relief of the right ventricle. According to the clarity of symptoms, either immediate thoracotomy or peripheral canulation and partial cardio-pulmonary bypass with subsequent angiography on the operating table should be preferred. Even a long resuscitation with persistently dilated, non-reactive pupils does not exclude operative success, and justifies neither the ommission nor the premature discontinuance of a resolute and consistent therapy.
mesh_terms: D000208:Acute Disease; D000792:Angiography; D005260:Female; D005860:Germany, West; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000209:etiology; D013997:Time Factors
vernacular_title: Indikationsgrenzen der Pulmonalisembolektomie.