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Thomas W. Wakefield - One of the best experts on this subject based on the ideXlab platform.
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long term experience with transvenous catheter pulmonary Embolectomy
Journal of Vascular Surgery, 1993Co-Authors: Lazar J. Greenfield, Mary C. Proctor, David M. Williams, Thomas W. WakefieldAbstract:Abstract Purpose: Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary Embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open Embolectomy on cardiopulmonary bypass. Methods: The indication for Embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. Results: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min ( p = 0.003) after Embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). Conclusions: Successful Embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) ( p p
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Long-term experience with transvenous catheter pulmonary Embolectomy
Journal of vascular surgery, 1993Co-Authors: Lazar J. Greenfield, Mary C. Proctor, David M. Williams, Thomas W. WakefieldAbstract:Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary Embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open Embolectomy on cardiopulmonary bypass. The indication for Embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after Embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). Successful Embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful Embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the series (range 1 to 237 months). Catheter pulmonary Embolectomy by surgeon and radiologist is of maximal benefit for major or massive PE but less likely to benefit patients with chronic recurrent PE.
Ikuo Fukuda - One of the best experts on this subject based on the ideXlab platform.
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outcome of pulmonary Embolectomy for acute pulmonary thromboembolism analysis of 32 patients from a multicentre registry in japan
Interactive Cardiovascular and Thoracic Surgery, 2012Co-Authors: Satoshi Taniguchi, Ikuo Fukuda, Wakako Fukuda, Kenichi Watanabe, Yoshiaki Saito, Mashio Nakamura, Masahito SakumaAbstract:OBJECTIVE: Massive pulmonary embolism is relatively rare but a potentially life-threatening condition. The purpose of this study was to analyse the outcome of pulmonary Embolectomy in registered data from the Japanese Society of Pulmonary Embolism Research (JaSPER). METHODS: From 1994 to 2006, 1661 cases of acute pulmonary embolism were registered in the JaSPER database. Retrospective analysis of 32 patients undergoing pulmonary Embolectomy was conducted. The overall incidence of pulmonary Embolectomy was 1.9% [95% confidence interval (CI): 1.8–3.2%]. The mean age of patients was 57 years and 66% were female. RESULTS: Overall mortality of pulmonary Embolectomy was 18.8% [95% CI: 5.2–25.6%]. Most of the patients had massive or submassive pulmonary thromboembolism, and three patients experienced cardiopulmonary arrest before Embolectomy. Ten patients received preoperative percutaneous cardiopulmonary bypass, and mortality was 30% in this subgroup. CONCLUSIONS: Pulmonary Embolectomy is an effective therapeutic option for patients with massive or submassive pulmonary embolism. Prompt triage of patients with haemodynamic instability is important.
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improved outcome of surgical pulmonary Embolectomy by aggressive intervention for critically ill patients
The Annals of Thoracic Surgery, 2011Co-Authors: Ikuo Fukuda, Satoshi Taniguchi, Kozo Fukui, Masahito Minakawa, Kazuyuki Daitoku, Yasuyuki SuzukiAbstract:Background Acute massive pulmonary thromboembolism is a life-threatening disorder, and prompt treatment is necessary. We analyzed the outcome of pulmonary Embolectomy for massive pulmonary embolism. Methods Nineteen patients who underwent pulmonary Embolectomy were retrospectively investigated. Average age of patients was 59 years, and 79% were female. Most patients had massive or submassive pulmonary thromboemboli dislodging into the main pulmonary trunk or bilateral main pulmonary arteries. Hemodynamics of most patients were unstable. Two patients required percutaneous cardiopulmonary support before Embolectomy, and 4 required cardiopulmonary resuscitation. In 6 patients, thrombolysis was ineffective. Results All patients underwent emergent pulmonary Embolectomy. Operative mortality was 5.3%. No patients exhibited newly developed neurologic damage. Ten-year survival rate was 83.5% ± 8.7%. Conclusions Pulmonary Embolectomy saves critically ill patients having acute massive pulmonary thromboembolism. We must evaluate pulmonary embolism patients with an algorithm that includes surgical Embolectomy as one of several therapeutic options.
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Embolectomy for acute pulmonary thromboembolism: From Trendelenburg’s procedure to the contemporary surgical approach
Surgery Today, 2011Co-Authors: Ikuo Fukuda, Satoshi TaniguchiAbstract:Acute pulmonary thromboembolism (APTE) is a potentially catastrophic event after surgery. We reviewed the literature on surgical pulmonary Embolectomy to elucidate its place in emergency management. Although pulmonary Embolectomy is invasive, prompt removal of the emboli decreases the right ventricular load and promotes quick recovery of cardiopulmonary function. Conversely, fibrinolytic therapy places additional burden on patients at risk of potential hemorrhagic complication. Surgical Embolectomy is an effective procedure with a low risk of hemorrhage because anticoagulant therapy is needed for only a short time.
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Embolectomy for acute pulmonary thromboembolism from trendelenburg s procedure to the contemporary surgical approach
Surgery Today, 2011Co-Authors: Ikuo Fukuda, Satoshi TaniguchiAbstract:Acute pulmonary thromboembolism (APTE) is a potentially catastrophic event after surgery. We reviewed the literature on surgical pulmonary Embolectomy to elucidate its place in emergency management. Although pulmonary Embolectomy is invasive, prompt removal of the emboli decreases the right ventricular load and promotes quick recovery of cardiopulmonary function. Conversely, fibrinolytic therapy places additional burden on patients at risk of potential hemorrhagic complication. Surgical Embolectomy is an effective procedure with a low risk of hemorrhage because anticoagulant therapy is needed for only a short time.
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Rescue surgical Embolectomy for fatal pulmonary embolism in patient with intracranial hemorrhage.
The Annals of thoracic surgery, 2006Co-Authors: Ikuo Fukuda, Kozo Fukui, Masahito Minakawa, Masayuki Koyama, Ikko Ichinoseki, Yasuyuki SuzukiAbstract:The incidence of pulmonary embolism is relatively high in stroke patients due to prolonged bed rest, paralysis of the lower extremities, and dehydration. We herein report three cases of pulmonary Embolectomy for patients with intracranial hemorrhage. All patients had massive central pulmonary embolism and were in deep shock. The interval between the onset of intracranial bleeding and surgical Embolectomy was 7 to 16 days. All patients underwent emergent pulmonary Embolectomy using cardiopulmonary bypass and survived without any neurologic exacerbation. Surgical pulmonary Embolectomy is a treatment of choice to save patients with massive pulmonary embolism after intracranial hemorrhage.
Lazar J. Greenfield - One of the best experts on this subject based on the ideXlab platform.
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long term experience with transvenous catheter pulmonary Embolectomy
Journal of Vascular Surgery, 1993Co-Authors: Lazar J. Greenfield, Mary C. Proctor, David M. Williams, Thomas W. WakefieldAbstract:Abstract Purpose: Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary Embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open Embolectomy on cardiopulmonary bypass. Methods: The indication for Embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. Results: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min ( p = 0.003) after Embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). Conclusions: Successful Embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) ( p p
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Long-term experience with transvenous catheter pulmonary Embolectomy
Journal of vascular surgery, 1993Co-Authors: Lazar J. Greenfield, Mary C. Proctor, David M. Williams, Thomas W. WakefieldAbstract:Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary Embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open Embolectomy on cardiopulmonary bypass. The indication for Embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after Embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). Successful Embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful Embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the series (range 1 to 237 months). Catheter pulmonary Embolectomy by surgeon and radiologist is of maximal benefit for major or massive PE but less likely to benefit patients with chronic recurrent PE.
Paul D Stein - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Embolectomy in elderly patients.
The American journal of medicine, 2013Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Objective The relation of age to case fatality rate in patients undergoing pulmonary Embolectomy has not been reported. In view of the importance of age in the selection of patients who may be candidates for pulmonary Embolectomy, we explored the database of the Nationwide Inpatient Sample to determine the impact of age on the case fatality rate. Methods Patients with pulmonary embolism who underwent pulmonary Embolectomy in short-stay hospitals throughout the United States, 1999-2008, were identified from the Nationwide Inpatient Sample. In-hospital all-cause case fatality rate was assessed according to age. Results The proportion of patients who underwent pulmonary Embolectomy decreased with age among both stable and unstable patients. Case fatality rate with pulmonary Embolectomy in stable patients increased with age beginning at age 51 to 60 years. Among patients aged 51 to 60 years, the case fatality rate was 100 of 575 (17.4%). This rate increased to 60 of 130 (46.2%) among patients aged more than 80 years ( P Conclusions The case fatality rate with pulmonary Embolectomy in stable patients increases with age greater than 51 to 60 years and is high among the elderly. The case fatality rate with pulmonary Embolectomy in unstable patients does not seem to be related to age.
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case fatality rate with pulmonary Embolectomy for acute pulmonary embolism
The American Journal of Medicine, 2012Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background There are insufficient data to assess the potential role of pulmonary Embolectomy in patients with acute pulmonary embolism. Methods In-hospital all-cause case fatality rate with pulmonary Embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. Results Among unstable patients (in shock or ventilator-dependent), case fatality rate with Embolectomy was 380 of 950 (40%). Among stable patients, case fatality rate was lower: 690 of 2820 (24%) ( P P =.01). Case fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case fatality rate. Conclusions Case fatality rate in unstable patients who underwent pulmonary Embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case fatality rate.
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Outcome of pulmonary Embolectomy.
The American journal of cardiology, 2006Co-Authors: Paul D Stein, Majd Alnas, Afzal Beemath, Nikunj R. PatelAbstract:In view of the importance of pulmonary Embolectomy as a possible treatment option in highly compromised patients with acute pulmonary embolism, a systematic review of immediate surgical outcomes was performed. Pooled data from 46 reported case series of patients operated from 1961 to 2006 showed an average mortality of 389 of 1,300 patients (30%). In patients operated on before 1985, the average mortality was 32%, compared with 20% in patients operated from 1985 to 2005. In patients who experienced cardiac arrest before pulmonary Embolectomy, the operative mortality was 59% compared with 29% in patients who did not have preoperative cardiac arrest. In conclusion, despite generally high mortality in patients who undergo pulmonary Embolectomy, it may have life-saving potential in some instances.
Azimeh Azimifar - One of the best experts on this subject based on the ideXlab platform.
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short term results of retrograde pulmonary Embolectomy in massive and submassive pulmonary embolism a single center study of 30 patients
European Journal of Cardio-Thoracic Surgery, 2011Co-Authors: Khalil Zarrabi, Abdolali Zolghadrasli, Mohammad Ali Ostovan, Azimeh AzimifarAbstract:Objective: Surgical pulmonary Embolectomy is usually reserved for critically ill patients with pulmonary embolism. The conventional antegrade technique of Embolectomy may miss peripheral clots, rendering the patient amenable to developing pulmonary hypertension. Here, we present our experience with a new retrograde pulmonary Embolectomy supplementing the current antegrade technique. Methods: From January 2004 through December 2010, 30 consecutive patients underwent pulmonary Embolectomy in our center. The study included 15 men and 15 women whose age ranged from 28 to 80 years, with mean age of 58 ± 15 years. All the patients except one were taken to the operating room with at least one imaging modality confirming the presence of a large thrombus in pulmonary-arterial vasculature. Results: The most common presenting symptoms of patients was dyspnea (n = 27, 90%). The major indications for surgery were severe hemodynamic or respiratory compromise (n = 11, 36%). After performing antegrade Embolectomy, retrograde flushing of the pulmonary veins was done. The in-hospital mortality in our study was 6.6% (2/30). Mean intubation time for the patients was 52.7 ± 36.5 h, with a range of 12―120 h. Mean intensive care unit (ICU) admission for the patients was 7 days with a range of 2―60 days. Conclusions: As far as we know, this is the largest series of cases published so far regarding the immediate results of retrograde pulmonary Embolectomy. This technique can successfulty dislodge the remaining clots in distal pulmonary vasculature not directly visualized. Surgical pulmonary Embolectomy is a safe method and should not be used as a last resort for patients with pulmonary embolism.