Massive pulmonary embolism: review of management strategies with a focus on catheter-based techniques.
Massive or high-risk pulmonary embolism (PE), defined as PE in the setting of (transient) arterial hypotension or frank cardiogenic shock, is associated with a poor prognosis. Fibrinolytic therapy is the mainstay of therapy, although data to support its effectiveness are limited. Although rarely performed, an alternate, accepted treatment strategy is surgical embolectomy. Contraindications to fibrinolytics are common in the setting of high-risk PE, and surgical embolectomy is frequently not performed owing to excessively high surgical risk. Under those circumstances, percutaneous, catheter-based thrombectomy or thrombus fragmentation is a reasonable alternative. In this article, we summarize the data available to date, evaluating the three different treatment options. We also attempt to synthesize a treatment algorithm to guide the practitioner in the treatment of patients with high-risk or massive PE.
The University of Hawaii, Department of Medicine, Honolulu, HI, USA.
Licheng
L
Lee
Clifford J
CJ
Kavinsky
Christian
C
Spies
D000465:Algorithms; D002404:Catheterization / Q000009:adverse effects; D000075202:Contraindications; D017128:Embolectomy / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000503:physiopathology; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects
D005343:Fibrinolytic Agents