A pulmonary embolectomy is one treatment for pulmonary embolism (PE), or blood clots in the lungs. The clots are caused by a deep vein thrombosis (DVT) that has traveled through the bloodstream to the lung. Usually more than one clot is involved. Pulmonary embolism can permanently damage the lung, lower your blood oxygen levels and damage other oxygen-deprived organs. A blocked artery to any part of your lung deprives it of blood and may cause the tissue to die (pulmonary infarction). When this happens, it much harder for your lungs to provide oxygen to the rest of your body. A large clot or numerous clots can cause death.
The goal of treatment is to break up clots and prevent others from forming. Depending on the type of PE, it may be treated with medicine or with surgery.
Nonsurgical treatment, for patients with low-risk PE, includes:
- Anticoagulants (blood thinners) — These prevent new clots from forming and break up existing clots. Heparin can be given intravenously or subcutaneously, often in combination with an oral anticoagulant such as warfarin. Other medications can be taken by mouth, without heparin, and have fewer contraindications with other medications. The most common side effect is bleeding.
- Thrombolytics (clot dissolvers) — Clots can dissolve on their own, but some medications given intravenously can dissolve them quickly. Because clot-busting drugs may cause sudden, severe bleeding, they usually are given only in life-threatening situations.
- Preventive treatment — Compression stockings, pneumatic compression, leg elevation, physical activity and anticoagulants when appropriate.
For massive or submassive PE, open surgical pulmonary embolectomy is necessary, along with anticoagulation medications. Surgical options also include:
- Catheterization — A clot may be removed through a thin, flexible tube threaded through your blood vessels.
- Catheter-directed pharmacomechanical intervention — Patients undergoing catheter-directed therapy should have healthy hearts; those with circulation problems usually achieve best results with surgical embolectomy.
- Insertion of an inferior vena cava filter — A catheter also can insert a filter into your body's main vein — the inferior vena cava — leading from your legs to the right side of your heart, to prevent clots from getting into your lungs. This procedure is an alternative for people who can't tolerate anticoagulant drugs or for when the drugs don't work well enough or quickly enough. The catheter containing the filter in its tip is usually inserted in a vein in the neck, then into the vena cava. Some filters can be removed when no longer necessary. Using the filter may prevent fatal or nonfatal recurrent PE, but does not dissolve an existing clot.
Risk factors include:
- Heart disease
- Surgery, especially hip and knee replacements
- Multiple medical comorbidities
- Family history of inherited disorders causing venous blood clots or pulmonary embolism
- Being overweight
- Supplemental estrogen
Most people who have a type of surgery that puts them at risk for DVT will be given medication pre- and post-surgery to prevent clot formation.
Pulmonary embolism can be life-threatening; a third of people with undiagnosed and untreated pulmonary embolism don't survive.