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thrombosis and thromboembolism phần 10

bệnh nhân (Hình 3b) và chỉ có 20% có thể là do lịch sử của thuyên tắc phổi hai chấn thương sau thần kinh chu phẫu, hai từ thuyên tắc phổi tái phát, và một do xuất huyết liên quan đến kháng đông. Bốn cái chết không rõ nguyên nhân có thể có liên quan đến thuyên tắc phổi. | Surgical Embolectomy 333 patients Fig. 3b and only 20 could be attributed to the history of pulmonary embolism two following perioperative neurological injury two from recurrent pulmonary embolism and one from anticoagulation-related hemorrhage. Four deaths from unknown causes may have been related to pulmonary embolism. The majority of deaths however were from unrelated causes mostly cancer 36 and trauma 16 . Four studies report actuarial survival data 65 66 71 85 These survival curves all show a steep initial decline reflecting the 20 to 40 operative mortality and a very flat portion thereafter reflecting the excellent mid- and long-term survival in operative survivors Fig. 4 . Medium-term 4-5 year survival was 65 to 80 65 66 71 85 and long-term 8-10 year survival was 62 to 71 65 66 . Even patients who had suffered preoperative cardiac arrest and survived to discharge had excellent long-term survival 66 . 2. Recurrent Pulmonary Embolism Clinically significant recurrent pulmonary embolism appears to be rare. Two patients noted above died from recurrent embolism. There was only one additional report of a nonfatal embolism 71 . Although these retrospective studies might underestimate the incidence they are consistent with the relatively low rate of recurrent thromboembolism in patients treated medically after pulmonary embolism 86 . In addition most but not all centers routinely performed inferior vena Figure 4 Actuarial survival after pulmonary embolectomy with and without cardiopulmonary resuscitation CPR . From Ref. 66. 334 Aklog caval interruption to protect against recurrent embolism. The three patients who did suffer recurrent embolism had not undergone inferior vena caval interruption either as a matter of policy 75 or for technical reasons 71 . 3. Functional Status Six studies document New York Heart Association functional class in 176 hospital survivors at a mean follow-up of 71 months 65 66 71 73 83 85 . Nearly all 98 were in Class I or II Fig. 5 . One .