Pulmonary Embolism and the Indications for Embolectomy

THE RECENT increase in interest in the diagnosis and treatment of pulmonary embolism provides convincing evidence that most workers in the field do not share the view of Morrison¹ concerning the possible obsolescence of pulmonary embolectomy. Much of the renewed interest undoubtedly stems from the application of cardiopulmonary bypass to the classic Trendelenberg² operation. Since the descriptions of this modification by Sharp³ and Cooley,⁴ many surgeons have confirmed the increased success rate of embolectomy performed in this way. More successful embolectomies have been performed since 1961 than in the 37 years between Kirchner's initial success⁵ and 1961.

Once the bypass circuit has been established, the operation becomes a rather straightforward one, a far cry from the heroic maneuvers of the past. There is no doubt that the heart-lung machine has greatly improved the treatment of this catastrophic disease. Many patients with massive pulmonary embolus die