Case report: Re-emerging significance of surgical embolectomy in pulmonary embolism

INTRODUCTION: Massive pulmonary embolus (PE) is associated with a high mortality if not treated aggressively. Treatment classically includes thrombolysis, catheter embolectomy, or open surgical embolectomy. This is the case report of a 38-year-old female presenting with massive PE three weeks status post gastric sleeve resection. PRESENTATION OF CASE: 38-year-old female status post gastric sleeve resection presented to the emergency department with acute onset shortness of breath and dizziness. Computed Tomography (CT) chest angiography showed extensive PE with pulmonary artery saddle embolus, and an enlarged right ventricle suggesting strain. Her treatment consisted of anticoagulation, AngioVac suction embolectomy, EKOS catheter thrombolysis, fragmentation with catheter, extracorporeal membrane oxygenation (ECMO), and lastly surgical embolectomy due to refractory clinical course. DISCUSSION: This case report details the natural history of a complex massive pulmonary embolism presentation requiring multiple catheter-based measures, ECMO initiation, and subsequent surgical embolectomy. CONCLUSION: This case report should serve as encouragement for early adoption of surgical therapy in pulmonary embolism cases where patients present with a complex presentation.