Surgical pulmonary embolectomy for peripheral distribution of thrombus demonstrated positive outcomes in patients with either central pulmonary embolism (CPE) or peripheral pulmonary embolism (PPE), according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.
Researchers from the University of Maryland School of Medicine in Baltimore evaluated consecutive patients (n=70; median age, 53 years) undergoing surgical embolectomy at a single center from 2011 to 2016.
Computed tomographic angiography was performed in each patient, which determined CPE (74%) vs PPE (26%). CPE was defined as “any thrombus originating within the lateral pericardial borders (main or right/left pulmonary arteries), and PPE was defined as “thrombus exclusively beyond the lateral pericardial borders, involving the lobar pulmonary arteries or distal.”
Although thrombus located distal to the primary pulmonary arteries has been previously thought of as a “relative contraindication” to surgical pulmonary embolectomy, the researchers sought to compare the outcomes between submassive and massive PE in patients with CPE and PPE.
Between 2011 and 2016, the incidence of PPE for surgical embolectomy increased from 25% to 70%. The overall 90-day survival was 94%, and 100% of patients survived submassive PEs in both groups.“When physiologically warranted, surgical pulmonary embolectomy for peripheral distribution of thrombus is both technically feasible and effective,” the researchers concluded.
Pasrija C, Mohammed I, Shah A, et al. Peripheral anatomic distribution of thrombus does not adversely affect outcomes in patients undergoing surgical pulmonary embolectomy for submassive and massive pulmonary embolism. Abstract 904-06. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.