Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

PURPOSE: Acute limb ischemia is not only a limb-threatening but also a life-threatening condition. Despite the use of surgical and/or thrombolytic therapy for this urgent treatment -requiring condition, it is still reported to carry high morbidity and mortality rates. METHODS: We analyzed the treatment outcomes of 118 limbs (11 upper limbs, 107 lower limb) with acute limb ischemia treated for 103 patients (age, median: 64, male 89 female 14) at the Department of Surgery, Kyungpook National University Hospital, from March 1993 to March 1999. The underlying causes of acute limb ischemia included 62 limbs with acute arterial embolism in 51 patients, 39 limbs with acute arterial thrombosis in 37 patients, 15 limbs with graft occlusion in 14 patients, and 2 limbs of undetermined cause of limb ischemia in 1 patient. The retrospective, nonrandomized study was done. RESULTS: The underlying causes of acute limb ischemia were arterial embolism in 52.5%, arterial thrombosis in 33.1%, bypass graft occlusion 12.7%, and undetermined cause in 1.7%. Severity of ischemia according to the SVS/ISCVS classification, 107 limbs (90.7%) were classified as category II and 9 limbs (7.6%) were in category III. For the limbs with embolisms, 47 embolectomies (including 6 cases treated with adjuvant thrombolytic therapy) and 10 arterial bypasses were performed. For the limbs with thromboses, 23 arterial bypasses, 5 thrombectomies, and 4 catheter directed thrombolytic therapies were performed. For the patients with acute graft occusion, 8 redo bypasses, 4 thrombolytic therapies, and 2 thrombectomies were performed. We experienced major limb amputations in 8.1%, hospital mortality in 13.7% and recurrence of ischemic symptoms in 16.1% during the follow-up period in the embolism patients and limb amputations in 2.7%, hospital mortality in 14.3%, and recurrence of ischemic symptoms in 8.3% of the thrombosis patients. Of the patients with category II ischemia, major limb amputation and hospital mortality rates were 4.7% and 9.2%, respectively. CONCLUSION: In dealing with acute limb ischemia, prompt and appropriate selection of treatment modalities, if needed in combined modes, is critically important in improving the treatment outcomes.
Amputation ; Catheters ; Classification ; Embolectomy ; Embolism ; Extremities* ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Hospital Mortality ; Humans ; Ischemia* ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Transplants ; Upper Extremity

PURPOSE: We retrospectively analyzed open pulmonary thromboembolectomy in patients with acute and chronic pulmonary thromboembolism. MATERIALS AND METHODS: Between August 1990 and May 2005, 12 consecutive patients with acute and chronic pulmonary thromboembolism underwent open pulmonary thromboembolectomy at Yonsei Cardiovascular Center. Their mean age was 47.5 years, and 7 of the patients were female. Among 12 patients, 5 had acute onset, and 7 had chronic disease, and 9 patients were associated with deep venous thrombosis. Extent of pulmonary embolism was massive in 3 patients with hemodynamic instability, and submassive in 8 patients. Preoperative echocardiogram revealed elevated right ventricular pressure in all patients, and 7 patients were in NYHA functional class III or IV. Pulmonary thromboembolectomy was performed in all patients under total circulatory arrest. RESULTS: There were 2 hospital deaths (16.7%). Among the patients who survived, mean right ventricular pressure was decreased significantly from 64.3mmHg to 34.0mmHg with improvement of NYHA functional class. CONCLUSION: Open pulmonary thromboembolectomy is thought to be an immediate and definitive treatment for massive pulmonary embolism with optimal results. Even though operative mortality is still high, early diagnosis and immediate surgical intervention in highly selective patients may improve the clinical outcome.
Adult ; Aged ; *Embolectomy/mortality ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism/mortality/physiopathology/*surgery ; Retrospective Studies ; Vena Cava Filters

Mortality rate for pulmonary embolectomy in critically ill patients still ranges from 30% to 45%. The causes of death in these patients are persistent pulmonary hypertension, pulmonary edema, and massive pulmonary hemorrhage. Residual thrombus and air trapping in peripheral pulmonary artery during pulmonary embolectomy can cause intractable right heart failure and persistent pulmonary hypertension. We report a successful extraction of residual thrombus and air bubbles during pulmonary embolectomy by retrograde pulmonary perfusion. Use of this technique could decrease morbidity and mortality from persistent right heart failure after pulmonary embolectomy in critically ill patients.
Cause of Death ; Critical Illness ; Embolectomy* ; Heart Failure ; Hemorrhage ; Humans ; Hypertension, Pulmonary ; Mortality ; Perfusion* ; Pulmonary Artery ; Pulmonary Edema ; Pulmonary Embolism* ; Thoracic Surgery ; Thrombosis

Despite the fact that the balloon catheter has greatly improved the technique of embolectomy, limb loss and mortality rates still remain high in some patients. The natural clinical course of a peripheral arterial embolism depends upon the location of the occlusion, the completeness of the luminal obliteration, the extent of secondary thrombosis, and the degree of spontaneous restoration of the collateral circulation. Surgeons should get accustomed to managing this disease appropriately. We wanted to know how to analyze the factors of amputation and operative mortality in those patients. For this study, we selected 46 cases of arterial embolectomies due to arterial embolisms of the lower extremity which were performed at Korea University Hospital between 1990 to 1996. Among the 46 cases, 39 cases were male and 9 cases were female. The etiologies of arterial embolism were 28 due to atrial fibrillation, 9 due to valvular heart disease. In the interval to therapy, 1) there were 7 cases severe ischemia and 3 cases amputations in a group for whom the embolectomy was done within 48 hours in 34 cases. 2) there were 5 cases of severe ischemia and 2 cases of amputations in a group for whom embolectomy was done after 48 hours. Popliteal artery occlusions were associated with severe ischemia and high amputation rates of 42.9%, and 28.6%, respectively. There were 6 cases of collateral circulation in the preoperative angiogram, one amputation was performed. Collateral circulation was not shown in 32 cases, but amputation was performed in 4 cases. In conclusion, this study shows that the prognosis of arterial embolism of the lower extremity can be improved by early detection, an early embolectomy, and the involvement of a qualified vascular surgeon. For a late arterial embolectomy, i.e., one beyond 48 hours after onset, indications are that even if the operation is performed one or several days beyond the accepted operation time, complete or adequate restoration of arterial flow to the limb may be achieved.
Amputation ; Atrial Fibrillation ; Catheters ; Collateral Circulation ; Embolectomy ; Embolism* ; Extremities ; Female ; Heart Valve Diseases ; Humans ; Ischemia ; Korea ; Lower Extremity* ; Male ; Mortality ; Phenobarbital ; Popliteal Artery ; Prognosis ; Thromboembolism ; Thrombosis

BACKGROUND: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of 6.8±5.4 years (4.2 years). METHODS: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade. RESULTS: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial bleeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5–78.5) to 31.0 (25.7–37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63–2.00) to 0.50 (0.50–1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up. CONCLUSION: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.
Acute Kidney Injury ; Blood Pressure ; Cardiopulmonary Bypass ; Echocardiography ; Embolectomy ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypoxia, Brain ; Mortality ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies ; Survivors ; Tricuspid Valve Insufficiency

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries ; Behcet Syndrome ; Celiac Artery ; Diagnosis ; Embolectomy ; Emergency Service, Hospital ; Female ; Humans ; Mesenteric Artery, Superior ; Mortality ; Transplants ; Vasculitis ; Weight Loss

In the past 60 years the maternal mortality rate has declined rnarkedly. Nevertheless, death associated with childbirth is still a major public health problem. For women delivered of live infants, the leading causes of mortality are acute pulmonary embolism(mostly thromboembolic), pregnancy-induced hypertension, hemorrhage, and infection. Currently, the common cause of maternal rnortality are pulmonary embolisrn. Though acute pulmonary embolism is a potentially fatal disorder, when properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death. However, the diagnosis of acute pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features. Pulmonary angiography, admittedly the 'gold standard' technique for this diagnosis, is costly, invasive, and not universally available. Noninvasive procedures such as lung scan has certainly simplified the diagnostic approach. However, lung scan is diagnostic in only 30 to 50% of patients, and many institutions lack nuclear medicine facilities. Thus, alternative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism. Echocradiography is rapid, practical and sensitive technique for the identification of right ventricular overload following acute pulmonary embolism. Echocardiographic identification of patients with right ventricular dysfunction is important because aggressive intervention with thrombolytics, certain inotropic and vasoactive agents, or embolectomy may improve outcome. We report herein two cases of acute pulmonary embolism after cesarean section. Certain clinical findings, hemodynamic values, and particularly, echocardiographic signs can indentify right ventricular dysfunction after pulmonary embolisrn. The patients was immediately treated mth intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters.
Angiography ; Cause of Death ; Cesarean Section* ; Diagnosis ; Echocardiography* ; Embolectomy ; Female ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Lung ; Maternal Mortality ; Mortality ; Nuclear Medicine ; Parturition ; Pregnancy ; Public Health ; Pulmonary Embolism* ; Ventricular Dysfunction, Right

Pulmonary embolism is not a frequent cause of morbidity and mortality in patients with or without malignancies. Pulmonary embolism should be ruled out when sudden tachypnea and pulmonary hypertension develop in leukemic children, and chest radiograph shows no or minimal abnormalities. A 14-year-old girl with acute lymphoblastic leukemia was admitted due to neutropenic fever and dyspnea. Chest computed tomography and ventilation/perfusion scan showed pulmonary embolism, and embolectomy revealed aspergillosis. Invasive aspergillosis is the major opportunistic fungal pathogen in neutropenic patient and an important cause of death. The critical elements of successful management of invasive aspergillosis complicating neutropenia and pulmonary embolism are early diagnosis, initiation of aggressive doses of amphotericin B, reversal of immune suppression and feasible surgical resection of the lesions. To the best of our knowledge, this is the first report of pulmonary embolism caused by Aspergillus in an immunocompromised setting in Korea and we present a case report with a brief review.
Adolescent ; Amphotericin B ; Aspergillosis ; Aspergillus* ; Cause of Death ; Child* ; Dyspnea ; Early Diagnosis ; Embolectomy ; Female ; Fever ; Humans ; Hypertension, Pulmonary ; Korea ; Mortality ; Neutropenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Embolism* ; Radiography, Thoracic ; Tachypnea ; Thorax

Background: Even though there were developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Meterial and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%. All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96.3% of the cases. Mortality rate was 5.6% and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 GI bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.
Acute Kidney Injury ; Amputation ; Compartment Syndromes ; Early Diagnosis ; Embolectomy ; Embolism ; Extremities* ; Female ; Heart Diseases ; Hemorrhage ; Humans ; Hypertension ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies ; Smoke ; Smoking ; Stroke ; Thromboembolism ; Thrombosis ; Transplants ; Vascular Diseases ; Wound Infection