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.
Percutaneous Thrombolysis and Embolectomy
If you have a large clot in a lung, an NYU Langone interventional vascular specialist 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. Rarely, sedation may be given.
NYU Langone specialists use the latest minimally invasive techniques to retrieve or break up a clot or clots. Doctors guide a catheter—a thin, flexible tube—through a small incision either in the groin or in the neck, and into the artery in the lungs. The catheter is then positioned next to the clot, so the doctor can break it up or remove it.
Catheter-directed percutaneous thrombolysis uses a catheter with holes at the tip, which is positioned up against the clot in the lungs. The catheter is then left in place for 12 to 24 hours while a steady infusion of medicine is delivered directly into the clot to help it dissolve. The catheter is removed the next day.
Percutaneous embolectomy involves directly removing the clot through the small catheter.
Recovery time depends on the size and seriousness of the clot, your overall wellness, 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.