Pulmonary embolism ACC/AHA guidelines surgical embolectomy

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Emergency surgical embolectomy with cardiopulmonary bypass is an effective treatment strategy for
 * Massive PE patients
 * Submassive PE with right ventricular dysfunction when contraindications preclude thrombolysis.
 * Acute PE patients who require surgical excision of a right atrial thrombus or paradoxical embolism.

==ACC/AHA Guidelines- Recommendations for Catheter Embolectomy and Fragmentation (DO NOT EDIT) == {{cquote|

Class IIa
1. Depending on local expertise, either catheter embolectomy and fragmentation or surgical embolectomy is reasonable for patients with massive PE and contraindications to fibrinolysis(Level of Evidence: C).

2. Catheter embolectomy and fragmentation or surgical embolectomy is reasonable for patients with massive PE who remain unstable after receiving fibrinolysis (Level of Evidence: C)''.

3. For patients with massive PE who cannot receive fibrinolysis or who remain unstable after fibrinolysis, it is reasonable to consider transfer to an institution experienced in either catheter embolectomy or surgical embolectomy if these procedures are not available locally and safe transfer can be achieved (Level of Evidence: C)''.

Class IIb
4. Either catheter embolectomy or surgical embolectomy may be considered for patients with submassive acute PE judged to have clinical evidence of adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe RV dysfunction, or major myocardial necrosis) (Level of Evidence: C)''.

Class III
5. Catheter embolectomy and surgical thrombectomy are not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening (Level of Evidence: C)}}''.

Guidelines Resources

 * Guidelines on the management of Pulmonary embolism: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension