Surgery for Pulmonary Embolism
NYU Langone doctors first treat most people who have pulmonary embolism with anticoagulant and thrombolytic medications, which thin the blood and break up clots. However, when a very large blood clot is blocking the arteries in the lungs, surgery is sometimes necessary.
If you have a large clot in a lung, an NYU Langone vascular surgeon may perform a minimally invasive surgery to remove or destroy it.
Your doctor locates the clot using an imaging test such as a CT angiogram of the chest.
Most people having this procedure are given local anesthesia. General anesthesia may be required if there are multiple blood clots or if the imaging test doesn’t clearly reveal the location of the clot or clots.
NYU Langone specialists use several of the latest minimally invasive techniques employing catheters to retrieve or break up a clot or clots. Doctors pass the catheter—a thin, flexible tube—through the artery in the lungs and position it next to the clot, so they can break it up and remove it.
One procedure uses a catheter with holes at the tip. A jet of saline is sprayed through these holes and into the clot, dissolving it. Then the surgeon pulls the clot into the catheter tip and removes it from the body along with the catheter.
The artery is then flushed with a thrombolytic medication to prevent further clotting.
Recovery time depends on the size and seriousness of the clot, your general health, and your health history. Your doctor may prescribe blood thinners for six months or longer to prevent additional clots from forming.
If you have a life-threatening pulmonary embolism, our surgeons may need to perform an open embolectomy using general anesthesia. During this open heart procedure, surgeons make an incision through the sternum, or breastbone. They may cut or divide the sternum in order to access the heart, lungs, and nearby blood vessels as quickly as possible.
Next, doctors place you on a heart–lung machine, which keeps your heart beating and lungs functioning during surgery. This allows surgeons to open the pulmonary artery—the main artery that carries blood from the heart to the lungs—and remove the clots that are creating the blockage.
After the clots are removed and you can breathe safely again, our doctors disconnect the heart–lung machine. Then they repair the sternum and close the incision with sutures or staples.
This surgery generally takes one to four hours. It may take several months to recover fully from the procedure, including healing of the sternum and regaining strength.
People treated with open embolectomy often require rehabilitation after surgery. Some people may also benefit from rehabilitation after a percutaneous embolectomy.
Rehabilitation after surgery begins in the surgical recovery rooms. Our goal is to return you to full strength as quickly as possible, so you can go home.
After an evaluation by a Rusk Rehabilitation specialist, one or more of our rehabilitation therapists visits you in the hospital and begins treatment. Therapy focuses on strength and mobility training, as well as breathing exercises to minimize weakness and shortness of breath due to pulmonary embolism.
You can prevent progressive weakness and minimize the chance that another blood clot may form by getting up and moving around after surgery as soon as it is safe to do so. Some people may require further inpatient rehabilitation at Rusk Rehabilitation, depending on their medical and functional progress, before they’re ready to go home.
After you leave the hospital and return home, a community care agency can coordinate your ongoing rehabilitation. This may be followed by outpatient care at Rusk Rehabilitation to help you achieve full independence and to help you return to your regular activities.