Massive Lungenembolie Embolectomy - Wikipedia
Pulmonary embolism PE is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body through the bloodstream embolism. PE usually results from a blood clot in the leg that travels to the lung.
Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during periods of sitting, and the use of blood thinners after some types of surgery. Pulmonary emboli affect aboutpeople each year in Europe.
Symptoms of pulmonary embolism are typically sudden in onset and may include one or many of the following: On physical examination, the lungs are usually normal. Occasionally, massive Lungenembolie, a pleural massive Lungenembolie rub may be audible over the affected area of the lung mostly in PE with infarct.
A pleural effusion is sometimes present that is exudative, detectable by decreased percussion note, audible breath sounds, and massive Lungenembolie resonance. As smaller pulmonary emboli tend to lodge in more peripheral areas without collateral circulation they are more likely to cause lung infarction and small effusions both of which are painfulbut not hypoxia, dyspnea or hemodynamic instability such as tachycardia.
Larger PEs, which tend to lodge centrally, typically cause dyspnea, hypoxia, low blood pressurefast heart rate and faintingbut are often painless because there is no lung infarction due to collateral massive Lungenembolie. The classic presentation for PE with pleuritic pain, dyspnea and tachycardia is likely caused by a large fragmented embolism causing both large and small PEs.
Thus, small PEs are often missed because they cause pleuritic pain alone without any other findings and large PEs often missed because they are painless and mimic other conditions often causing ECG changes and small rises in troponin and BNP levels. PEs are sometimes described as massive, submassive and nonmassive depending on the clinical signs and symptoms.
Massive Lungenembolie the exact definitions of these are unclear, an accepted definition of massive PE is one in which there is hemodynamic instability such as sustained low blood pressure, slowed heart rateor pulselessness.
The massive Lungenembolie are generally regarded as a continuum termed venous thromboembolism VTE. The development of thrombosis is classically due to a group of causes named Virchow's triad alterations in blood flow, massive Lungenembolie, factors in the vessel wall and factors affecting the properties of the blood.
Often, more than one risk factor is present. After a first PE, the search for secondary causes is usually brief. Only when a second PE occurs, and especially when this happens while still under anticoagulant therapy, a further search for underlying conditions is undertaken.
This will include testing "thrombophilia screen" for Factor V Leiden mutationantiphospholipid antibodies, protein C and S and antithrombin levels, and later prothrombin mutation, MTHFR mutation, Factor VIII concentration and rarer inherited coagulation abnormalities. In massive Lungenembolie to diagnose a pulmonary embolism, a review of clinical criteria to determine the need for testing is recommended.
If there are concerns this is followed by testing to determine a likelihood of being able to confirm a diagnosis by massive Lungenembolie, followed by imaging if other massive Lungenembolie have shown that there is a likelihood of a PE diagnosis. The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation shortness of breathchest pain cannot be definitively differentiated from other causes of chest pain and shortness of breath.
The decision to perform medical imaging is based on clinical reasoning, that is, the medical historysymptoms and findings on massive Lungenembolie examinationfollowed by an assessment of clinical probability. The most commonly used method to predict clinical probability, the Wells score, is a clinical prediction rulewhose use is complicated by multiple versions being available. InPhilip Steven Wellsinitially developed a prediction rule based on a literature search to predict the likelihood of PE, based on clinical criteria.
There are additional prediction rules for PE, massive Lungenembolie, such as the Geneva rule. More importantly, the use of any rule is associated with reduction in recurrent thromboembolism. Traditional interpretation   .
Alternative interpretation  . The pulmonary embolism rule-out criteria PERC helps assess people in whom pulmonary embolism is suspected, but unlikely. Unlike the Wells score and Geneva scorewhich are clinical prediction rules intended to risk stratify people with suspected PE, the PERC rule is designed to rule out risk of PE in people when the physician has already stratified them into a low-risk category. People in this low risk category without any of these criteria may undergo no further diagnostic testing for PE: The rationale behind this decision is that further testing specifically CT angiogram of the chest may cause more harm from radiation exposure and contrast dye than the risk of PE.
In people with a low or moderate suspicion of PE, a normal D-dimer level shown in a blood test is enough to exclude the possibility of thrombotic PE, with a three-month risk of thromboembolic events being 0. In other words, a positive D-dimer is not synonymous with PE, but a negative D-dimer is, with a good degree of certainty, an indication of absence of a PE. When a PE is being suspected, several blood tests are done in order to exclude important secondary causes of PE.
This includes a full blood countmassive Lungenembolie, clotting status PTaPTTTTand some screening tests erythrocyte sedimentation raterenal functionliver enzymeselectrolytes. If one of these is abnormal, further investigations might be warranted. In typical people who are not known to be at high risk of PE, massive Lungenembolie, imaging is helpful to confirm or exclude a diagnosis of PE after simpler first-line tests are used.
CT pulmonary angiography is the recommended first line diagnostic imaging test in most people. Historically, massive Lungenembolie, the gold standard for diagnosis was pulmonary angiographybut this has fallen into disuse with the increased availability of non-invasive techniques. CT pulmonary angiography CTPA is a pulmonary angiogram obtained using computed tomography CT with radiocontrast rather than right heart catheterization. Its advantages are clinical equivalence, its non-invasive nature, its greater availability massive Lungenembolie people, and the possibility of identifying other lung disorders from the massive Lungenembolie diagnosis in case there is no pulmonary embolism.
On CT scanmassive Lungenembolie, pulmonary emboli can be classified according to level along the arterial tree.
CT pulmonary angiography showing a "saddle embolus" at the bifurcation of the main pulmonary artery and thrombus burden in the lobar arteries on both sides. Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT MDCT machines. However, this study's results may be biased due to possible incorporation bias, since the CT scan was the final diagnostic tool in people with pulmonary embolism.
The authors noted that a negative single slice CT scan is insufficient to rule out massive Lungenembolie embolism on its own. This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results. It is particularly useful in people who have an allergy to iodinated contrastimpaired renal function, massive Lungenembolie, or are von Krampfadern hilft Salbe due to its lower radiation exposure as compared to CT.
Tests that are frequently done that are not sensitive for PE, massive Lungenembolie, but can be diagnostic. The primary use of the ECG is to rule out other causes of chest pain.
While certain ECG changes may occur with PE, none are specific enough to confirm or sensitive enough to rule out the diagnosis. The most commonly seen signs in the ECG are sinus tachycardiaright axis deviation, and right bundle branch block. In massive and submassive PE, dysfunction of the right side of the heart may be seen on echocardiographyan indication that the pulmonary artery is severely obstructed and the right ventriclea low-pressure pump, is unable to match the pressure.
Some studies see below suggest that this finding may be an indication for thrombolysis. Not every person with a suspected pulmonary embolism requires an echocardiogram, but elevations in cardiac troponins or brain natriuretic peptide may indicate heart strain and warrant an echocardiogram,  and be important in prognosis.
The specific appearance of the right ventricle on echocardiography is referred to as the McConnell's sign. This is the finding of akinesia of the mid-free wall but a normal motion of the apex. Ultrasound of the heart showing signs of PE .
Pulmonary embolism may be preventable in those with risk factors. People admitted to hospital massive Lungenembolie receive preventative medication, Kaki und Krampfadern unfractionated heparinlow molecular weight heparin LMWHor fondaparinuxand anti-thrombosis stockings to reduce the risk of a DVT in the leg that could dislodge and migrate to the lungs.
Following the completion of warfarin in those with prior PE, long-term aspirin is useful to prevent recurrence. Anticoagulant therapy is the mainstay of treatment, massive Lungenembolie.
Acutely, supportive treatments, such as oxygen or analgesiamay be required, massive Lungenembolie. People massive Lungenembolie often admitted to hospital in the early stages of treatment, and tend to massive Lungenembolie under inpatient care until the INR has reached therapeutic levels.
Increasingly, however, massive Lungenembolie, low-risk cases are massive Lungenembolie at home in a fashion already common in the treatment of DVT. Usually, anticoagulant therapy is the mainstay of treatment. Unfractionated heparin UFHlow molecular weight heparin LMWHor massive Lungenembolie is administered initially, massive Lungenembolie, while warfarinacenocoumarolor phenprocoumon therapy is commenced this may take several days, usually while the patient is in the hospital.
LMWH may reduce bleeding among people with pulmonary embolism as compared to UFH according to a systematic review of randomized controlled trials by the Cochrane Collaboration. There massive Lungenembolie no difference in overall mortality between participants treated with LMWH and those treated with unfractionated heparin. Warfarin therapy often requires a frequent dose adjustment and monitoring of the international normalized ratio INR, massive Lungenembolie.
In patients with an underlying malignancy, massive Lungenembolie, therapy with a course of LMWH is favored over warfarin; it is continued for massive Lungenembolie months, at Varizen Davos point a decision should be reached whether ongoing treatment is required. Similarly, pregnant massive Lungenembolie are often maintained on low molecular weight heparin until Thrombophlebitis der unteren Extremitäten trophischen Geschwüren least six weeks after delivery to avoid the known teratogenic effects of warfarin, especially in the early stages of massive Lungenembolie. Thrombophlebitis, arterielle Symptome therapy is usually continued for 3—6 months, or "lifelong" if there have been previous DVTs or PEs, or none of the usual risk factors is present.
An abnormal D-dimer level at the end of treatment might signal the need for continued treatment among patients with a first unprovoked pulmonary embolus. In this situation, it is the best available treatment in those without contraindications and is supported by clinical guidelines. Catheter-directed thrombolysis CDT is a new technique found to be relatively safe and effective for massive PEs.
This involves accessing the venous system by placing a catheter into a vein in the groin and guiding it through the veins by using massive Lungenembolie imaging until it is located next to the PE in the lung circulation. Medication that breaks up blood clots is released through the catheter so that its highest concentration is directly next to the massive Lungenembolie embolus.
CDT is performed by interventional radiologistsand in medical centers that offer CDT, it may be offered massive Lungenembolie a first-line treatment, massive Lungenembolie.
The use of thrombolysis in non-massive PEs is still debated, massive Lungenembolie. There are two situations when an inferior vena cava filter is considered advantageous, and those are if anticoagulant therapy is contraindicated e. Inferior vena cava filters should be removed as soon as it becomes safe massive Lungenembolie start using anticoagulation, massive Lungenembolie. The long-term safety profile of permanently leaving a filter inside the body is not known.
Surgical management of acute pulmonary embolism massive Lungenembolie thrombectomy is uncommon and has largely been abandoned because of poor long-term outcomes. However, recently, massive Lungenembolie, it has gone through massive Lungenembolie resurgence with the revision of the surgical technique and is thought to benefit certain people.
Pulmonary emboli occur in more thanpeople in the Massive Lungenembolie States each year. There are several markers used for risk stratification and these are also independent predictors of adverse outcome. These include hypotension, cardiogenic shock, massive Lungenembolie, syncope, evidence of right heart dysfunction, and elevated cardiac enzymes.
Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to massive Lungenembolie lung can lead to pulmonary hypertension, massive Lungenembolie.
Massive Lungenembolie a massive PE, the embolus must be resolved somehow if the patient is to survive. In thrombotic PE, the blood clot may be broken down by fibrinolysisor it may be organized and recanalized so that a new channel forms through the clot. Blood flow is restored most rapidly in the first day or two after a PE, massive Lungenembolie.
There is controversy over whether small subsegmental PEs need treatment at all  and some evidence exists that patients with subsegmental PEs may do well without treatment. Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0. This figure comes from a trial published in by Barrit and Jordan,  which compared anticoagulation against placebo for the management of PE.
Barritt and Jordan performed their study in the Bristol Royal Infirmary in
Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi blood clotsmassive Lungenembolie, and is then referred to as thrombectomy, massive Lungenembolie.
Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to an organ leads to necrosis. Other involved therapeutic options are anticoagulation and massive Lungenembolie. Emboli are abnormal masses of material which can be solid, liquid or gas that are carried in the blood stream from one part of the circulation to another causing a blockage occlusion of a blood vessel that leads to lack massive Lungenembolie oxygen supply ischemia and finally infarction of tissue downstream of the embolus, massive Lungenembolie.
The most common type of emboli are a blood clot generated by thrombosis which has then broken off and is then transported in the blood stream see embolism. Surgical embolectomy for massive pulmonary embolism PE has become a rare procedure and is often viewed as a last resort. Thrombolytic therapy has become the massive Lungenembolie of choice. Surgical or catheter embolectomy is normally performed in patients with pulmonary embolism formed from venous embolisms.
Embolectomy is used for patients with persisting shock despite supportive care and who have an absolute contraindication for thrombolytic therapy. Embolectomies are performed as limb-sparing techniques for arterial embolisms in acute limb ischemia. However, there are also other options, such as catheter-directed thrombolysis and anticoagulation with observation. It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke.
Typically this is done by inserting a catheter with an inflatable balloon attached to its tip into an artery, passing the catheter tip beyond the clot, inflating the balloon, and removing the clot by withdrawing the catheter. The catheter is called Fogarty, named after its inventor Thomas J.
Possible complications of balloon embolectomy include intimal lesions, massive Lungenembolie, which can lead to another thrombosis. Catheter embolectomy is also used for aspiration embolectomy, where the thrombus is removed by suction rather than pushing with a balloon.
Surgical embolectomy is the simple surgical removal of a clot following incision into a vessel by open surgery on the massive Lungenembolie. Outcome of embolectomy varies with size and location of the embolus.
Although this is a high mortality, it may have life-saving potential in some instances. From Wikipedia, the free encyclopedia. This section needs expansion, massive Lungenembolie. You can help by adding to it. Presse Medicale in French. Journal of the Association of Physicians of India. Seminars in Vascular Surgery, massive Lungenembolie.
Surgical measures in acute ischemia of lower extremities. Pekka Aho massive Lungenembolie Pirkka Vikatmaa. American Journal of Cardiology. Ambulatory phlebectomy Laser surgery Sclerotherapy Vein stripping. Venous cutdown Arteriotomy Phlebotomy. Endovascular aneurysm repair Open aortic surgery. Cardiopulmonary bypass Cardioplegia Extracorporeal membrane oxygenation Vascular access Revascularization First rib resection Seldinger technique Vascular snare.
Digital subtraction angiography Cerebral angiography Aortography Fluorescein angiography Radionuclide angiography Magnetic resonance angiography.
Intravascular ultrasound Carotid ultrasonography. Angioscopy Ankle brachial pressure index Toe pressure Tilt table test. Retrieved from " https: Interventional radiology Vascular procedures. CS1 German-language sources de CS1 French-language sources fr Articles to be expanded from December All articles to be expanded Articles using Fleck am Bein von Krampfadern message boxes All articles with unsourced statements Articles with unsourced statements from December Views Read Edit View history.
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