Jolly Michael, Phillips John
OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3705 Olentangy River Road, Suite 100, Columbus, OH 43214, USA.
OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3705 Olentangy River Road, Suite 100, Columbus, OH 43214, USA.
Surg Clin North Am. 2018 Apr;98(2):279-292. doi: 10.1016/j.suc.2017.11.009.
Pulmonary embolism remains a leading cause of death in the United States, with an estimated 180,000 deaths per year. Guideline-based treatment in most cases recommends oral anticoagulation for 3 months. However, in a small subset of patients, the "submassive, high-risk" by current nomenclature, with hemodynamic instability, more advanced therapeutic options are available. Treatment modalities to extract the thromboembolism and reduce pressure overload in the cardiopulmonary system include use of intravenous or catheter-directed thrombolytic agents, catheter-directed mechanical thrombectomy, and surgical embolectomy. This article discusses current minimally invasive and surgical methods for reducing embolic burden in patients with submassive, high-risk pulmonary embolism.
在美国，肺栓塞仍然是主要的死亡原因之一，估计每年有18万例死亡。在大多数情况下，基于指南的治疗建议进行3个月的口服抗凝治疗。然而，在一小部分患者中，按照目前的命名法属于“次大面积、高危”，伴有血流动力学不稳定，有更先进的治疗选择。用于清除血栓栓塞和减轻心肺系统压力负荷的治疗方式包括使用静脉或导管定向溶栓剂、导管定向机械血栓切除术和外科栓子切除术。本文讨论了目前用于减轻次大面积、高危肺栓塞患者栓塞负担的微创和手术方法。
