From deep venous thrombosis to pulmonary embolism

: We report our 5-year experience concerning pulmonary embolism (PE). Between 1985 and 1990, 15 consecutive patients with symptomatic acute serious PE were referred to our observation: 6 underwent urgent surgical treatment (3 with cardiogenic shock, 2 with massive PE and 1 with right atrium embolism) and 9 patients underwent thrombolytic therapy which resulted successful in 3 cases, while in the remaining 6 cases a subsequent pulmonary embolectomy was performed. Therefore 11 patients underwent pulmonary embolectomy and the operative mortality rate was 27.5% (3 cases). Lower extremity deep venous thrombosis is associated with the highest risk of PE (90%). The PE mortality rate in untreated patients is reported to be 38%. In treated patients the mortality rate is approximately 8%. In most of the cases medical treatment of the thromboembolic disease is successful but in case of early failure of anticoagulant and/or thrombolytic therapy or contraindication to, surgical treatment is required. Surgeon's role is important at any time in the natural history of the thromboembolic disease: preventive (venous thrombectomy or inferior vena caval interruption) or therapeutical surgical proceedings for manifest PE (pulmonary embolectomy in extracorporeal circulation) can be performed. The last proceeding is required in no more than 3-6% of cases, but its mortality rate is still high (11-55%) related to the clinical status of the patients whose condition worsens despite intensive medical treatment.