Abstract
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide.
Systemic anticoagulation remains the recommended treatment for low-risk PE. Systemic
thrombolysis is the recommended treatment for PE with hemodynamic compromise (massive/high-risk
PE). A significant number of patients are not candidates for systemic thrombolysis
due to the bleeding risk associated with thrombolytics. Historically, surgical pulmonary
embolectomy (SPE) was recommended for massive PE with hemodynamic compromise for these
patients. In the last decade, catheter-directed thrombolysis (CDT) has largely replaced
SPE in the patient population with intermediate risk PE (submassive), defined as right
heart strain (as evidenced by right ventricle enlargement on echocardiogram and/or
computed tomography, usually along with elevation of troponin or B-type natriuretic
peptide). Use of CDT increased in the last few years due to high incidence of PE in
hospitalized patients with coronavirus disease 2019 pneumonia, and the use of mechanical
thrombectomy (initially reserved for those with contraindications to thrombolysis)
has also grown. In this article, we discuss the value of the PE response team, our
approach to management of submassive (intermediate risk) and massive (high risk) PE
with systemic thrombolytics, CDT, mechanical thrombectomy, and surgical embolectomy.
Keywords
catheter-directed thrombolysis - deep vein thrombosis - endovascular procedure - percutaneous
- thrombectomy - thrombolysis - embolectomy
