Contemporary Surgical Management of Acute Massive Pulmonary Embolism

Pulmonary embolism (PE) is the most lethal pulmonary condition in the United States and internationally. It is also the third most common cause of death in hospitalized pa‐ tients. Since the introduction of computed tomographic pulmonary angiography (CT-PA), the estimated incidence of PE has risen from 62.1 to 112.3 cases per 100,000 [1]. Untreated, the associated mortality of PE is as high as 30% with recurrent embolism being the most common cause. Globally, systemic anticoagulation is the mainstay of treatment for both chronic and acute PE. In the case of acute massive PE (presenting with hypotension and systolic arterial pressure less than 90 mm Hg) the prognosis is much graver and associat‐ ed with a mortality of 30-60%, second only to sudden cardiac death as a cause of sudden death. This condition mandates a more aggressive and urgent algorithm for diagnosis and treatment. Prompt and appropriate treatment, which may include surgical pulmonary em‐ bolectomy, can be life-saving.