Abstract
Objective. To evaluate the outcomes of the surgical treatment of patients with pulmonary thromboembolism and outline the means for their
improvement.
Material and methods. The total of 80 patients with subtotal obstruction of the trunk of the pulmonary artery and/or its main branches underwent
the surgery i.e. 38 men and 42 women. Upon admission into hospital the electrocardiography, echocardiography, ultrasonography of lower
extremities and small pelvic veins, pulmonary angiography was performed for all patients. In all cases the pulmonary thromboembolism was
assessed as massive, of high risk, rated pressure in the pulmonary artery at average amounted for 59.7 ± ± 7.3 mmHg. The Miller index scored
21–29 points. Duration of the illness was 6.2 ± 8.4 days. 5 patients underwent surgery immediately due to embolism to the right heart and trunk
of the pulmonary artery, 3 patients out of them after clinical death with the cardiopulmonary resuscitation. 7 patients with detected thromboembolus
of the right ventricle and massive pulmonary thromboembolism underwent emergency surgery.
In 33 cases the injection of thrombolytic did not resulted in positive dynamics and open embolectomy was administered.
20 patients with massive pulmonary thromboembolism of high risk as well underwent the surgery as they had absolute contraindications for
administration of thrombolytic therapy and 15 patients transferred from other hospitals after unsuccessful treatment within 12–30 days with
increasing symptoms of right ventricular failure.
Results. Pulmonary thrombembolectomy was performed for 80 patients. Mortality made up 5%. 12 patients underwent intervention without
cardiopulmonary bypass, 68 patients underwent on-pump surgery.
In the long-term follow up the recurrent thrombosis of lower extremities deep veins was observed in 7 patients, the recurrent thrombosis of
shank deep veins was observed in 2 patients.
The condition of 65 patients remained satisfactory, rated pressure in the pulmonary trunk kept at the level of 27.1 ± 3.1 mmHg.
Conclusion. While determining the symptoms of pulmonary thromboembolism it is necessary to urgently verify the diagnosis and start thrombolytic
therapy (consultation of cardiovascular surgeon is advisable).
Upon diagnosing as thromboembolism of high risk the treatment should begin with the thrombolytic therapy. Should the thrombolytic therapy
proven to be ineffective or there are contraindications for its administration then the thrombembolectomy is to be performed. Surgical
disobstruction of vessels that was performed timely for the central or combined pulmonary thromboembolism has been a safe and effective
operation permitting to save the patient's life.
References
1. Савельев В.С. Флебология: Руководство для врачей. М.: Медицина, 2001.
2. Goldhaber S.Z. Pulmonary embolism. Lancet. 2004: 363 (9417): 1295–305.
3. The Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N. Engl.
J. Med. 1997; 337: 657–62.
4. Goldhaber S.Z., Visani L., De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary
Embolism Registry. Lancet. 1999; 353: 1386–9.
5. Leacche M., Unic D., Goldhaber S.Z., Rawn J.D., Aranki S.F., Couper G.S. et al. Modern surgical treatment of massive pulmonary
embolism: Results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J. Thorac. Cardiovasc. Surg.
2005; 129: 1018–23.
6. Немирова С.В. Приверженность пациентов хирургического профиля к профилактике венозных тромбоэмболических
осложнений. В кн.: Тезисы научно-практической конференции «Актуальные вопросы современной сосудистой
хирургии». СПб.: Альта Астра; 2011: 39.
7. Eichinger S., Weltermann A., Minar E., Stain M., Schonauer V., Schneider B. et al. Symptomatic pulmonary embolism and the risk
of recurrent venous thromboembolism. Arch. Intern. Med. 2004; 164: 92–6.
8. Van de Werb F., Ardissino D., Betriu A., Cokkinos D.V., Folk E., Fox K.A. et al. Management of acute myocardial infarction in patients
presenting with ST-segment elevation. The task force on the management of acute myocardial infarction of the European Society
of Cardiology. Eur. Heart J. 2003; 24: 28–66.
9. Uflacker R. Interventional therapy for pulmonary embolism. JVIR. 2001; 12 (2): 147–64.
10. Heit J.A., Silverstein M.D., Mohr D.N., Petterson T.M., Lohse C.M., O'Fallon W.M. The epidemiology of venous thromboembolism
in the community. Thromb. Haemost. 2001; 86 (1):452–63.
11. Wood K.T. Mayor pulmonary embolism. Review of pathophysiologic approach to the golden hour of hemodinamically significant
pulmonary embolism. Chest. 2002; 121: 877–905.
About the authors
Medvedev Aleksandr Pavlovich, Doctor of Medical Sciences, professor, head of the chair of Nizhniy Novgorod State
Medical Academy Ministry of Health of the Russian Federation.
