THROMBOENDARTERECTOMY FOR CHRONIC PULMONARY THROMBOEMBOLISM

Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec- tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.

Non-selective pulmonary angiography for venous thromboembolism diagnosis, a better choice?

Objective: To evaluate the efficiency of non-selective pulmonary angiography for pulmonary embolism diagnosis. Methods: 105 consecutive subjects diagnosed with limb deep venous thrombosis (DVT) by lower limb phlebography underwent non-selective pulmonary angiography. Results: 52.38% patients were diagnosed with pulmonary embolism, 21.9% with inferior vena cava thromboembolism, and 9.52% with pulmonary embolism combined with inferior vena cava thrombosis. Images obtained by non-selective pulmonary angiography had a good correlation with selective pulmonary angiography. Conclusion: The non-selective pulmonary angiography was a simplified, efficient and safe method for pulmonary embolism diagnosis. Large clinical trials are still needed to further evaluate the accuracy and safety of the non-selective method.

Simple mechanical thrombectomy with intrapulmonary arterial thrombolysis in pulmonary thromboembolism： a small case series

Pulmonary thromboembolism （PTE） is a life-threatening condition with a high early mortality rate caused by acute right ventricular failure and cardiogenic shock. We report a series of three patients who presented with acute and subacute submassive PTE. They were suc-cessfully treated by simple catheter-based mechanical thrombectomy and intrapulmonary arterial thrombolysis. Mechanical fragmentation and aspiration of thrombus was performed by commonly used J-wire, multi-purpose and Judkin Right guiding catheters and this obviated the need of specific thrombectomy devices.

Trauma and pulmonary thromboembolism:an experimenta study on their correlation

Objective： To investigate the correlation between trauma and pulmonary thromboembolism. Methods： Comminuted fractures and extensive soft- tissue contusion at both hind limbs were made by a falling weight from a height in 16 rabbits. Lung perfnsion scanning was performed to obtain the radioactivity counts before trauma, at 1 h, 48 h and 96 h after trauma. All the data were divided into 4 groups based on the above 4 time points. The rabbits were sacrificed when positive findings on the pulmonary perfnsion scanning appeared. Their lungs were harvested to be paraffln-embedded and stained with hematoxylin-erosin method for histological examination of thrombocmbolism. The randomized block design ANOVA and the method of least significant difference （LSD） were used for statistical analysis of the radioactivity counts. Results： The histological findings showed that pulmonary embolism developed in 6 of the 16 rabbits （37.5%）. Five of the 6 pulmonary embolism rabbits presented neither clinical symptoms nor positive pulmonary embolism manifestations in the lung perfnsion scanning. A significant difference was found in lung perfusion radioactivity between the pre-traumatic, post-traumatic lh groups and post-traumatic 48 b and 96 b groups （P 〈 0. 05）. Conclusions ： Fractures of the bind limbs accompanied with extensive soft-tissue contusion may cause pulmonary micro-embolism that is not sensitive to lung perfnsion scanning and tends to have no clinical symptoms. Pulmonary embofism development may take more than two days after trauma.