Pulmonary Embolism

What is a pulmonary embolism?

A pulmonary embolism (PE) occurs when a blood clot—or, in rare cases, substances like fat, air, or amniotic fluid—blocks blood flow in one of the lung arteries.
This life-threatening condition disrupts oxygen exchange in the body and can quickly escalate if untreated.

Most commonly, the clot originates from deep vein thrombosis (DVT) in the legs and travels to the lungs, causing what is known as pulmonary thromboembolism.
At AVC, our experienced vascular team provides comprehensive care for patients with PE in lungs, offering advanced diagnostic and treatment options tailored to each patient’s needs.

We see urgent cases within 48 business hours, ensuring timely intervention for this critical condition.

How does a pulmonary embolism occur?

The embolism definition refers to the obstruction of a blood vessel by a foreign substance or blood clot (thrombus) that travels from its site of origin.

In the case of pulmonary embolism (PE), these clots usually originate in the deep veins of the legs as deep vein thrombosis (DVT) and travel to the lungs.

This process, known as pulmonary thromboembolism, can lead to severe complications, especially in the presence of a large clot, such as a saddle embolism, which blocks the main pulmonary artery.

Rare forms of embolism, like amniotic fluid embolism or air embolism, may also result in similar blockages but are far less common.

Understanding the causes of embolism, such as prolonged immobility, surgery, or medical conditions like cancer, is crucial for reducing the risk.

Recognizing the warning signs

The signs of PE or a lung embolism can vary significantly based on the size and location of the clot and the patient’s overall health.

Common PE symptoms include:

• Shortness of breath: Often sudden and severe, even during rest.
• Chest pain: Sharp, stabbing pain that worsens with breathing or coughing.
• Lung clot symptoms, such as a persistent cough that may include blood-streaked mucus.

Additional PE signs and symptoms to watch for:

• Lightheadedness, fainting, or rapid heartbeat.
• Leg pain or swelling, often indicating PE DVT.
• Discolored or clammy skin, a hallmark of signs of embolism.

It’s critical to seek immediate medical attention if any PE signs and symptoms appear. Early intervention can save lives.

When is surgery needed for pulmonary embolism?

Surgery is typically required for pulmonary embolism (PE) in severe, life-threatening cases where other treatments, such as anticoagulants or thrombolytics, are not effective or viable.
Surgical intervention is most often considered when:

• A saddle PE blocks the main pulmonary artery, causing significant disruption to blood flow.
• The patient experiences severe PE symptoms, such as shock, dangerously low blood pressure, or cardiac instability.
• There is a high risk of recurrent clots despite anticoagulant therapy.
• Anticoagulant therapy cannot be used due to bleeding risks or medical contraindications.

Procedures such as pulmonary embolectomy (removal of the clot) or the placement of a vein filter to prevent further clots may be performed depending on the patient’s condition​. Early surgical evaluation in high-risk cases is critical to improve survival and reduce complications.

Abdominal Aortic Aneurysm (AAA): Surgery is typically recommended when the aneurysm reaches 5.5 cm in diameter for men or 5.0 cm for women.
Smaller aneurysms are usually monitored unless they grow rapidly or become symptomatic.

Thoracic Aortic Aneurysm (TAA): Surgical intervention is often considered if the aneurysm exceeds 6.0 cm in diameter.
For patients with genetic conditions like Marfan syndrome, surgery may be recommended at a smaller size (around 4.5 cm).

Peripheral Aneurysms: Intervention depends on the location and size:
Popliteal Aneurysms: Surgery is generally performed when the aneurysm is larger than 2.0 cm or causing symptoms.

Femoral Aneurysms: Surgery is advised when the size exceeds 3.0 cm or if symptoms like pain or clotting occur.

Iliac Aneurysms: Intervention is typically considered at 3.5–4.0 cm in size.

What are the symptoms of pulmonary embolism?

The symptoms of pulmonary embolism (PE) can vary widely depending on the size of the clot, the area of the lung affected, and the patient’s overall health.

Common PE symptoms include:

Shortness of breath: Sudden and persistent, often worsening with physical activity or even at rest.

Chest pain: Sharp or stabbing, typically felt when breathing deeply, coughing, or bending.

Cough: Sometimes producing bloody or blood-streaked mucus.
Additional PE signs and symptoms may include:

• Rapid or irregular heartbeat.
• Lightheadedness, dizziness, or fainting.
• Excessive sweating.
• Leg pain or swelling (from deep vein thrombosis (DVT)).
• Clammy or discolored skin (cyanosis).

These symptoms often appear suddenly and can quickly worsen. If you or someone you know experiences any of these signs, seek urgent medical attention, as a pulmonary embolism can be life-threatening.

What is the treatment for a pulmonary embolism?

The treatment for pulmonary embolism (PE) focuses on preventing the clot from growing, dissolving the existing clot, and stopping the formation of new clots.
The specific approach depends on the severity of the condition and the patient’s overall health.

1. MedicationsAnticoagulants (Blood Thinners):
   These prevent further clotting and allow the body to naturally break down existing clots.
   Common anticoagulants include heparin, which is fast-acting, and oral medications like warfarin or newer agents such as rivaroxaban and apixaban.Thrombolytics (Clot Busters):
   Used in life-threatening cases to quickly dissolve large clots.
   Administered intravenously, but reserved for severe cases due to the risk of major bleeding.
2. Surgical and Procedural Interventions
   Pulmonary Embolectomy:A surgical procedure to remove large clots, typically performed in emergencies when other treatments fail.
    Catheter-Directed Therapy:Minimally invasive techniques like Ekos pulmonary embolism therapy use ultrasound and thrombolytic medications to break up clots.
   Vein Filter:A filter placed in the inferior vena cava to prevent new clots from reaching the lungs, often used for patients who cannot take anticoagulants.
3.  Supportive Measures
   Oxygen therapy to improve oxygen levels in the blood.
   Fluids and medications to stabilize blood pressure and heart function in severe cases.
4. Long-Term Management
   Patients recovering from PE often require ongoing anticoagulant therapy to reduce the risk of recurrence.

Regular follow-ups and monitoring are essential to ensure effective management and minimize complications​.
Prompt treatment of PE in lungs is critical to reduce mortality and improve outcomes.
If you suspect PE symptoms, seek immediate medical attention.

What’s new in pulmonary embolism surgery?

In recent developments, surgeons have started using advanced techniques to treat pulmonary embolism (PE) more effectively.

One promising method is catheter-directed thrombolysis, which uses a catheter to deliver clot-busting drugs directly to the affected lung arteries.

“This technique is significant because it targets the clot more precisely, reducing the risk of bleeding compared to systemic thrombolytics,” says AVC’s Dr Jason Toniolo.

He says that this minimally invasive procedure allows for faster recovery and fewer complications than traditional open surgery for a massive pulmonary embolism.

This approach is particularly beneficial for patients who are not candidates for standard surgery due to high bleeding risks.

By improving clot removal with reduced intervention time, these advances are making a substantial difference in the treatment of pulmonary thromboembolism.