Pulmonary Embolism Interventional Treatment Methods

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 13, 2024
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Interventional treatment for pulmonary embolism is mainly used for large pulmonary embolisms in the main trunk or major branches of the pulmonary artery. It is applicable in the following scenarios: contraindications to thrombolysis and anticoagulation therapy, inefficacy after thrombolysis or aggressive medical treatment, or lack of surgical conditions. Interventional therapy for pulmonary embolism can involve removing the embolus or breaking it into fragments, allowing it to move to the distal pulmonary arteries, thereby opening the central pulmonary arteries, rapidly reducing pulmonary artery resistance, significantly increasing total pulmonary blood flow, improving cardiopulmonary hemodynamics, and right ventricular function. The treatment involves catheter fragmentation and suction of large clots in the pulmonary artery or performing balloon angioplasty, and it also enables local administration of small-dose thrombolysis. These are the primary methods of interventional treatment for pulmonary embolism.

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Written by Wei Shi Liang
Intensive Care Unit
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Can a pulmonary embolism be detected by a CT scan?

CT can detect acute pulmonary embolism, using CT angiography, which is the preferred imaging method for diagnosing pulmonary embolisms. It mainly shows central filling defects, as well as eccentric and abdominal wall filling defects, and complete filling defects. A diagnosis of pulmonary embolism can be made through the visualization of these filling defects on a CT scan. Additionally, some indirect signs, such as pulmonary hypertension, right ventricular enlargement, and the common mosaic sign, can also be observed. These are characteristic CT manifestations of acute pulmonary embolism.

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Written by Wang Chun Mei
Pulmonology
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Why can't patients with pulmonary embolism get out of bed?

Pulmonary embolism is a relatively common clinical disease, with many and complex inducing factors. The most common cause of pulmonary embolism in patients is due primarily to thrombi dislodging from the veins of the lower limbs or the pelvic deep veins, traveling through the bloodstream to the pulmonary arteries, thus causing the disease. Therefore, bed rest is essential during the acute phase of pulmonary embolism. The purpose of bed rest is to prevent further embolisms, to avoid the dislodging of pelvic or lower limb deep vein thrombi, which could lead to the formation of new thrombi. Therefore, for patients with pulmonary embolism, it is crucial to provide timely treatments such as thrombolysis to control the clinical symptoms caused by the pulmonary embolism effectively.

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Written by Yuan Qing
Pulmonology
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Is it good to place a filter for pulmonary embolism or not?

Whether it is good or not to place a filter for pulmonary embolism mainly depends on the cause of the pulmonary embolism and whether there are indications for placing a filter. Generally speaking, if pulmonary embolism is caused by the formation of blood clots in the lower limbs or the inferior vena cava, placing a filter can generally be beneficial. However, not all cases of lower limb venous thrombosis require a filter. Filters are usually only used for deep or large vein thromboses that are not suitable for thrombectomy or thrombolysis treatments. If a filter is placed under other conditions, it is very likely that thrombosis will re-form on the surface of the filter, potentially leading to some recurrent pulmonary embolisms or iatrogenic pulmonary embolisms. Therefore, the decision to place a filter is complex and requires a doctor to weigh the pros and cons before deciding whether or not to proceed.

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Written by Wang Chun Mei
Pulmonology
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Will acute pulmonary embolism get better in two days?

Acute pulmonary embolism is a type of disease with very many and complex inducing factors. Clinically, acute pulmonary embolism has a very sudden onset, and patients often present with unexplained symptoms such as pale complexion, chest tightness, chest pain, and difficulty breathing. During the acute phase of pulmonary embolism, immediate and effective anti-shock and other symptomatic resuscitation are essential upon arrival at the hospital. Generally, after timely and effective resuscitation, the patient's condition may be somewhat controlled. Usually, the first 1-3 days after the onset of pulmonary embolism are the most dangerous; therefore, continuous monitoring of the patient's vital signs is crucial during this time, followed by anti-shock and anticoagulation treatment as needed. Therefore, acute pulmonary embolism will not improve by the second day, although some of the patient's clinical symptoms may slightly improve after treatment.

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Written by Yuan Qing
Pulmonology
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How to determine if a pulmonary embolism is acute or chronic?

Pulmonary embolism can be distinguished between acute and chronic based on the duration of the patient's illness, symptoms, and supplemental examinations. Typically, patients with acute pulmonary embolism have no prior similar symptoms and suddenly experience severe symptoms such as chest pain, difficulty breathing, and coughing up blood. Additionally, through supplemental examinations like blood tests, abdominal ultrasound, and pulmonary artery CT angiography, it is possible to determine whether the thrombus is fresh or old. In contrast, chronic pulmonary embolism often presents with prolonged symptoms. Patients usually do not experience chest pain or cough, and the main issue is chronic breathing difficulty. In severe cases, pulmonary heart disease may occur, and patients may have swelling in the face and limbs. Ultrasound and pulmonary artery CT angiography can reveal the characteristics of the thrombus, which differ from those seen in acute pulmonary embolism. Thus, these examinations can help determine whether the condition is acute or chronic.