The role of pulmonary embolectomy in venous thromboembolism.

Embolectomy was performed by the Trendelenburg method on one patient and with cardiopulmonary bypass on 10 patients during the period 1961 to 1975. The use of cardiopulmonary bypass permitted preoperative resuscitation, cardiorespiratory support during the operation, complete embolectomies to be performed and resulted in the survival of 4 of the 10 patients. There were 5 patients who suffered cardiac arrest prior to embolectomy. Three died intraoperatively, of which two died of left ventricular failure, and two others died postoperatively of brain damage indicating the need to proceed rapidly with the accurate diagnosis and treatment of massive pulmonary embolism. Following embolectomy, partial interruption of the inferior vena cava was performed and prevented recurrent pulmonary emboli and significant post-thrombotic sequelae in four patients. Another patient underwent caval ligation with significant sequelae.