a) Define massive pulmonary embolism. (10% marks)
b) Discuss the advantages and disadvantages of thrombolysis, catheter directed clot removal and surgical embolectomy, in the treatment of massive pulmonary embolism. (90% marks)
a) Massive (or "high risk") PE is defined by the AHA guidelines (2011) as:
Catheter-directed clot removal
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Jaff, Michael R., et al. "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association." Circulation 123.16 (2011): 1788-1830.
Konstantinides, Stavros V., et al. "2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)." European heart journal 41.4 (2020): 543-603.