[Limited role of surgery in the treatment of pulmonary embolism]

Massive pulmonary embolism (more than 50% of the pulmonic arterial bed obstructed) has a high mortality. If the accident is not immediately fatal and if the patient is in an adequate hospital environment, the diagnosis has to be confirmed by pulmonary scan and arteriography. Immediate institution of an intensive medical support against shock combined with the induction of thrombolysis prove effective in a majority of cases. The few patients who do not favorably respond to this medical therapy must without delay undergo embolectomy under extracorporeal circulation. The risk is mainly dependent on the hemodynamic state of the patient at the moment of operation. However conditions related to time and place for optimal surgery may restrict the number of favourable results.