Surgical embolectomy for acute massive pulmonary embolism: state of the art

Massive pulmonary embolism (PE) is a severe condition that can potentially lead to death causedby right ventricular (RV) failure and the consequent cardiogenic shock. Despite the fact thrombolysis is oftenadministrated to critical patients to increase pulmonary perfusion and to reduce RV afterload, surgical treatmentrepresents another valid option in case of failure or contraindications to thrombolytic therapy. Correct riskstratification and multidisciplinary proactive teams are critical factors to dramatically decrease the mortality of thisglobal health burden. In fact, the worldwide incidence of PE is 60–70 per 100,000, with a mortality ranging from1% for small PE to 65% for massive PE. This review provides an overview of the diagnosis and management ofthis highly lethal pathology, with a focus on the surgical approaches at the state of the art.