Transvenous management of pulmonary embolic disease.

Clinical pulmonary embolic disease was categorized into four classes according to hemodynamic and respiratory effects of the occlusion at the time of diagnosis. A new approach to management of massive embolization (Class III and IV) by transvenous catheter embolectomy was attempted in ten patients with initial success in eight. Three additional deaths occurred postoperatively, two from recurrent embolization prior to vena caval plication. In view of this preventable complication, a wire filter device was developed for insertion at the time of embolectomy. The filter has also been utilized in 15 additional patients with lesser degrees of embolization (Class II). The conal shape of the device permits preservation of flow after embolic capture and followup venacavagrams in nine patients up to 20 months postoperative shows patency in all. Complications occurred in both groups related both to the underlying disorder and to the catheter technics.