Pulmonary Embolism (PE) can sometimes present with subtle symptoms, shortness of breath, chest pain, or even just fatigue, making it easy to mistake for less serious conditions. But when left undiagnosed, PE can escalate, blocking blood flow to the lungs and putting a patient’s life at risk. Thanks to advances in imaging and minimally invasive techniques like mechanical embolectomy, we can now detect and treat PE more effectively and with less risk. Early intervention not only saves lives but also ensures faster recovery and improved quality of life for patients.
What is Pulmonary Embolism?
The most common cause of pulmonary embolism (PE) is a blood clot that generally originates in a deep vein in the leg and travels to the lung, blocking one of the pulmonary arteries. The result can be life-threatening.
Common Questions About Pulmonary Embolism (PE) and Mechanical Embolectomy
What is a pulmonary embolism (PE)?
A pulmonary embolism (PE) occurs when a blood clot, usually originating from a deep vein in the leg (deep vein thrombosis or DVT), travels to the lungs and blocks one or more pulmonary arteries. This can reduce blood flow to the lungs and become life-threatening if not treated promptly.
What are the symptoms of a pulmonary embolism?
Common symptoms include sudden shortness of breath, chest pain that may worsen with deep breathing, rapid heartbeat, coughing (sometimes with blood), dizziness or fainting. Symptoms vary depending on the size of the clot and should always be assessed urgently.
What is mechanical embolectomy?
Mechanical embolectomy is a minimally invasive, catheter-based procedure used to remove or break up blood clots in the pulmonary arteries. It may be considered for selected patients with moderate- to high-risk pulmonary embolism, particularly when rapid clot removal is needed or when clot-dissolving medications are unsuitable.
Is mechanical embolectomy an alternative to clot-dissolving medication?
For some patients, yes. While anticoagulants remain the main treatment for many pulmonary embolisms, selected patients may benefit from catheter-directed therapies such as mechanical embolectomy, catheter-directed thrombolysis or a combination of both. Treatment depends on the severity of the PE, bleeding risk and overall clinical condition.
How is a pulmonary embolism diagnosed?
Pulmonary embolism is typically diagnosed using CT pulmonary angiography (CTPA), blood tests such as D-dimer, ultrasound of the legs to look for DVT and other investigations depending on the patient's condition. Early diagnosis allows timely treatment and improves outcomes.
Why Speed Matters
Because a pulmonary embolism can lessen or prohibit blood flow, it can indirectly cause heart problems and even a heart attack. As such, it is essential to treat PE immediately.
While clot-dissolving medication may help, or surgery, there is a minimally invasive way to remove blood clots known as mechanical pulmonary embolectomy. This allows for faster clot removal with fewer potential bleeding risks and spending time in the ICU and hospital.
Mechanical Pulmonary Embolectomy Overview
Treatment by mechanical pulmonary embolectomy may be a physical aspiration, fragmenting, or retrieving the clot through a catheter-based procedure.
Who Needs It? Indications & Patient Selection
Patients who may need mechanical intervention include:
- Someone in shock or cardiac arrest due to PE with hemodynamic collapse.
- A patient with a sub-massive PE with worsening right heart strain despite anticoagulation.
- Someone who is not a candidate for thrombolytics.
- A patient who did not respond to previous therapy.
Causes of PE
PE is usually caused by a blood clot traveling from the leg to the lungs but other less frequent pulmonary embolism causes may be due to a fat embolus following a bone fracture, tumor fragments, air bubbles, or amniotic fluid.
Diagnosis of PE
To diagnose a pulmonary embolism, a patient will need to undergo blood and imaging tests along with a clinical evaluation by a vascular specialist in Singapore. A CT pulmonary angiogram is often recommended and an ultrasound of the legs may locate blood clots.
Treatment of PE
Today mechanical thrombectomy is often the best option for the treatment of PE because it is less invasive than surgery and more effective than thrombolytics.
However, there are severe cases when surgery may be necessary.
Step-by-Step: Inside the Cath Lab
A mechanical embolectomy is done within a catheterization lab and includes:
- Access through the right common femoral or internal jugular vein.
- Fluoroscopy with or without an intravascular ultrasound.
- Inserting and moving a large bore sheath up into the main or lobar pulmonary artery.
- Using a negative pressure vacuum to aspirate the clot which may include breaking down the clot. If needed, aspiration may be supplemented with micro-dosing of a thrombolytic.
- A hemodynamic test to assess cardiovascular function.
Benefits of the Minimally Invasive Route
The benefits of a PE procedure are clear:
- Reduction of bleeding risk due to lack of surgical incision.
- Almost immediate symptom relief with improved oxygenation.
- Intolerance of thrombolytic medications.
- Preservation of lung tissue and right-ventricular function due to the lack of invasive surgery.
- Shortened time in the ICU with many patients able to be up and able to go home within 24 hours.
- More suitable treatment for high-risk or frail patients.
Recovery & Follow-Up
During recovery, patients will be monitored by telemetry for continuous echocardiographic assessment.
Attention should be given to risk-factor modification for possible deep-vein thrombosis including weight management, mobility issues, or oral contraceptive use. Patients should be seen in two weeks following the procedure and in three months and 12 months.
There is a reduced risk of chronic thromboembolic pulmonary hypertension (CTEPH) following PE.
Why Choose Our Specialized Vascular Clinic in Singapore
The Supreme Vascular and Interventional Clinic is a comprehensive clinic offering a wide spectrum of vascular, cardiology, pulmonary, and critical care. Our Cath lab suite is furnished with the latest generation of testing equipment for minimally invasive treatment options in Singapore.
When to Consider a Vascular Specialist Assessment in Singapore
Pulmonary embolism is a medical condition that requires prompt assessment. Following emergency treatment, specialist review is important to determine the cause of the clot, reduce the risk of recurrence and evaluate whether advanced catheter-based treatment is appropriate.
Consider seeking specialist assessment if you:
- Have been diagnosed with a pulmonary embolism and would like to understand all available treatment options
- Have been told you have a moderate- or high-risk pulmonary embolism that may benefit from catheter-based treatment
- Cannot receive clot-dissolving medication because of an increased bleeding risk
- Have recurrent pulmonary embolism or deep vein thrombosis (DVT)
- Continue to experience breathlessness or reduced exercise tolerance after treatment
- Would like a second opinion regarding minimally invasive pulmonary embolism treatment or long-term follow-up
A specialist consultation includes reviewing your imaging, medical history, clot burden, underlying risk factors and recovery to develop an individualised treatment and prevention plan.
Seek emergency medical attention immediately if you experience sudden shortness of breath, severe chest pain, coughing up blood, fainting, collapse or signs of shock. These symptoms may indicate a pulmonary embolism and require urgent emergency treatment.
Contact the Supreme Vascular and Interventional Clinic
If you or a loved one is experiencing PE symptoms or any medical emergency, call 9-9-5 or go to the closest emergency room for an immediate evaluation.
For consultation in our specialized vascular clinic in Singapore with our vascular and endovascular specialist, Dr. Manish Taneja, contact us to arrange your appointment today.
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If your legs feel sore persistently, achy when standing long periods, or maybe you notice blue or purple veins even bulging in the area, chances are these symptoms of varicose veins and spider veins could lead to other serious venous diseases such as Deep Vein Thrombosis (DVT), Chronic Venous Insufficiency (CVI), or Leg Swelling due to increased pressure forming larger blood clots over time. Varicose veins are fully treatable with minimally invasive procedures and treatments offering minimal downtime and quick recovery preventing further complications. Long term effects of untreated varicose veins can hinder your daily life and impact your health.
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