Selection of Patients for Pulmonary Embolectomy

¹ Director of Medical Education, St. Joseph Hospital, Houston
² Resident Physician, Ben Taub General Hospital

1. From a review of medical writings on pulmonary embolectomy and analysis of our own experience with such cases, we caution against strict adherence to a single criterion or set of criteria for the operation.

2. Systemic arterial hypotension unresponsive to vasopressor therapy is the most frequently cited and probably the most reliable indication for pulmonary embolectomy. In some patients, however, the procedure should be done ideally before the onset of systemic arterial hypotension, particularly when hemodynamic and angiographic studies demonstrate progressive worsening despite optimal anticoagulant therapy.

3. Embolectomy may be necessary even when pressures in the pulmonary artery and right side of the heart are normal.

4. Angiography is indispensable for establishing the presence of surgically accessible pulmonary thromboemboli and should precede embolectomy in all but patients who rapidly become agonal.