Zhonghua Jie He He Hu Xi Za Zhi. 2026 Mar 12;49(3):297-306. doi: 10.3670/cma.j.cn112147-20251019-00646.
ABSTRACT
Acute pulmonary thromboembolism (PTE) is a clinical emergency caused by thrombus obstruction of the pulmonary artery. The mortality rate of high-risk PTE patients without timely intervention is as high as 10%-30%, while standardized interventional therapy can significantly reduce the mortality rate to about 3%. Although interventional therapy has been widely used in the treatment of PTE patients, there is currently a lack of standardized operating procedures for this technique, and there are significant differences among different medical institutions and operators. In order to further improve the level of interventional therapy for PTE in China and promote the standardization of interventional therapy for PTE, the Pulmonary Embolism and Pulmonary Vascular Disease Group of the Respiratory Diseases Branch of the Chinese Medical Association and the Pulmonary Embolism and Pulmonary Vascular Disease Working Group of the Respiratory Physicians Branch of the Chinese Medical Doctor Association jointly organized experts in related fields in China. Based on the latest evidence-based medical evidence and combined with China's clinical practice, they focused on the patient selection, operating procedures, and peri-operative management strategies for interventional therapy of acute PTE. After multiple rounds of discussion, they jointly formulated the "Expert Consensus on Operating Procedures for Interventional Therapy of Acute Pulmonary Thromboembolism".Recommendation 1: Interventional therapy for acute PTE should be based on risk stratification. Intermediate-risk and high-risk patients may be considered for interventional therapy under the decision-making of multidisciplinary discussion.Recommendation 2: Interventional therapy has unique advantages in the treatment of acute PTE patients, but local technical conditions should be considered, including factors such as the availability of medical devices and the experience of operators.Recommendation 3: For trans-catheter thrombus removal in acute PTE, dedicated devices are recommended to improve efficiency and safety.Recommendation 4: Interventional therapy is recommended in the following situations: high-risk acute PTE with contraindications to or failure of thrombolytic therapy; intermediate-high-risk acute PTE with contraindications to or failure of thrombolytic therapy; and intermediate-high-risk acute PTE with hemodynamic deterioration during anticoagulant therapy.Recommendation 5: The multidisciplinary teams required for interventional therapy of acute PTE include the Department of Respiratory and Critical Care Medicine, Intensive Care Unit (ICU), Department of Cardiovascular Medicine and Surgery, Department of Thoracic Surgery, Department of Radiological Interventions, etc.Recommendation 6: Pulmonary angiography should be performed before interventional therapy to clarify the location and degree of pulmonary thromboembolism, guide interventional therapy, and improve efficiency.Recommendation 7: During the operation, blood loss should be minimized, vital signs such as blood pressure and heart rate should be monitored in real time, and the patient's vital signs and subjective feelings should be paid attention to avoid serious complications such as hemorrhagic shock (It is recommended to control blood loss below 200-300 ml).Recommendation 8: The goals of interventional therapy for acute PTE are to improve oxygenation and hemodynamics, such as decreased heart rate, increased systemic blood pressure, reduction in vasoactive medications, and increased oxygen saturation, etc.Recommendation 9: Heparinization is recommended during the operation (unless strictly contraindicated), and anticoagulation should be continued after the operation.
PMID:41820036 | DOI:10.3670/cma.j.cn112147-20251019-00646