Acute Pulmonary Embolism: Treatment Options and Success Rates

Q: Acute Pulmonary Embolism: Treatment Options and Success Rates

Hello： Surgical intervention for pulmonary embolism typically involves thoracotomy in more urgent situations, such as cardiogenic shock. <br>Although the procedure is not difficult for cardiac surgeons, the severity of the patient's condition in emergency settings has led to a re

Acute Pulmonary Embolism

During my hospitalization, I received the first medication that was supposed to be administered for five days, but it was completely ineffective for me.
Later, I opted for a catheter, but the doctor said my right leg was filled with blood clots and remained swollen, and those clots could not be removed.
Eventually, the catheter was inserted from the left side, and it only managed to eliminate a small amount in the pulmonary artery.
I have been on medication for three weeks, but I still experience chest tightness and pain.
After walking for 20 minutes, I feel very fatigued, and my heart rate can reach 130 beats per minute.
The doctor mentioned that my condition is serious and recommended a costly injection for my leg, priced at 120,000, but there is no guarantee of its effectiveness.
Continuous monitoring of my condition is necessary, and if there is no improvement, I may need to undergo open-heart surgery.
What is the approximate success rate for that procedure?

Hsieh Hsin-Yi, 40~49 year old female. Ask Date: 2022/05/19

Dr. Huang Yinghe reply Cardiology

Hello: Surgical intervention for pulmonary embolism typically involves thoracotomy in more urgent situations, such as cardiogenic shock.
Although the procedure is not difficult for cardiac surgeons, the severity of the patient's condition in emergency settings has led to a reported mortality rate for thoracotomy due to pulmonary embolism ranging from 3.6% to 27.2% in various studies.
For patients, recovery after thoracotomy usually requires a hospital stay of one to two weeks, resulting in a longer recovery period.
Therefore, thoracotomy is only considered when pharmacological and catheter-based treatments are ineffective, and there is a significant burden of pulmonary artery thrombosis causing severe symptoms.
Additionally, oral anticoagulant therapy remains essential, as large thrombus burdens may take several months to gradually dissolve and be absorbed.
Deep vein thrombosis in the lower extremities is likely the source of your pulmonary embolism, and it also requires anticoagulant treatment, which necessitates time and patience.
Please continue to follow up and cooperate with your physician for ongoing monitoring and treatment.

Reply Date: 2022/05/19

More Info

Acute pulmonary embolism (PE) is a serious condition that occurs when a blood clot blocks one or more pulmonary arteries in the lungs. This can lead to severe complications, including reduced oxygen levels in the blood, heart strain, and even death. The treatment options for acute PE vary depending on the severity of the condition, the patient's overall health, and the presence of any underlying conditions.

In your case, it appears that you have undergone initial treatment with anticoagulants, which are the standard first-line therapy for PE. These medications help to prevent further clotting and allow the body to gradually dissolve existing clots. However, as you mentioned, the initial treatment did not provide relief, and you subsequently opted for catheter-directed therapy. This approach can be effective in cases where large clots are present, but it may not always result in complete resolution of the obstruction, especially if the clots are extensive or if there are complications such as significant swelling in the affected limb.

The persistence of symptoms such as chest pain, shortness of breath, and elevated heart rate indicates that your condition may still be serious. The recommendation for a costly medication to treat the blood clots in your leg, despite the lack of guaranteed effectiveness, reflects the challenging nature of your situation. It is essential to weigh the potential benefits against the risks and costs involved.

Regarding the potential for surgical intervention, open-chest surgery for PE, known as pulmonary embolectomy, is typically reserved for cases where other treatments have failed and the patient is in a critical condition, such as experiencing cardiogenic shock. The success rates for this type of surgery can vary widely, with reported mortality rates ranging from 3.6% to 27.2%, depending on various factors, including the patient's overall health, the extent of the embolism, and the presence of other medical conditions. While the procedure can be lifesaving, it also carries significant risks and requires a careful assessment of the patient's condition.

It is crucial to continue monitoring your symptoms and follow up with your healthcare provider regularly. The management of PE often requires a multidisciplinary approach, including cardiologists, pulmonologists, and hematologists, to ensure comprehensive care. If your symptoms do not improve with ongoing treatment, your healthcare team may consider additional imaging studies or alternative therapies to address the underlying issues.

In summary, the treatment of acute pulmonary embolism involves a combination of anticoagulation therapy, potential catheter-directed interventions, and, in severe cases, surgical options. The success of these treatments depends on various factors, including the extent of the embolism, the patient's overall health, and the response to initial therapies. It is essential to maintain open communication with your healthcare team to navigate the complexities of your condition and make informed decisions about your treatment options.

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