Avgerinos Efthymios D, Chaer Rabih A
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg. 2015 Feb;61(2):559-65. doi: 10.1016/j.jvs.2014.10.036. Epub 2014 Dec 16.
Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Systemic anticoagulation is the standard of care, and treatment can be escalated in the setting of massive or submassive PE, given the high mortality risk. A secondary consideration for intervention is the prevention of late-onset chronic thromboembolic pulmonary hypertension. Treatment options include systemic thrombolysis, catheter-directed interventions, and surgical thromboembolectomy. Whereas systemic thrombolysis seems to be beneficial in the setting of massive PE, it appears to be associated with a higher rate of major complications compared with catheter-directed thrombolysis as shown in recent randomized trials for submassive PE. The hemodynamic and clinical outcomes continue to be defined to determine the indications for and benefits of intervention. The current review summarizes contemporary evidence on the role and outcomes of catheter-directed therapies in the treatment of acute massive and submassive PE.
急性肺栓塞（PE）是心血管疾病死亡的主要原因。全身抗凝是标准治疗方法，鉴于高死亡风险，在大面积或次大面积PE的情况下可加强治疗。干预的第二个考虑因素是预防迟发性慢性血栓栓塞性肺动脉高压。治疗选择包括全身溶栓、导管定向干预和手术血栓切除术。虽然全身溶栓在大面积PE的情况下似乎有益，但与导管定向溶栓相比，它似乎与更高的主要并发症发生率相关，如最近针对次大面积PE的随机试验所示。血流动力学和临床结果仍有待确定，以明确干预的适应症和益处。本综述总结了关于导管定向治疗在急性大面积和次大面积PE治疗中的作用和结果的当代证据。
