Is it good to place a filter for pulmonary embolism or not?

Written by Yuan Qing
Pulmonology
Updated on September 03, 2024
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Whether it is good or not to place a filter for pulmonary embolism mainly depends on the cause of the pulmonary embolism and whether there are indications for placing a filter.

Generally speaking, if pulmonary embolism is caused by the formation of blood clots in the lower limbs or the inferior vena cava, placing a filter can generally be beneficial. However, not all cases of lower limb venous thrombosis require a filter. Filters are usually only used for deep or large vein thromboses that are not suitable for thrombectomy or thrombolysis treatments. If a filter is placed under other conditions, it is very likely that thrombosis will re-form on the surface of the filter, potentially leading to some recurrent pulmonary embolisms or iatrogenic pulmonary embolisms. Therefore, the decision to place a filter is complex and requires a doctor to weigh the pros and cons before deciding whether or not to proceed.

Other Voices

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Written by Wang Li Bing
Intensive Care Medicine Department
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What are the symptoms of a pulmonary embolism warning sign?

Pulmonary embolism is also very common in clinical settings, mainly seen in patients who have been bedridden for a long time, undergone various major surgeries, suffered from long bone fractures, pregnancy, etc. In the early stages of pulmonary embolism, patients generally experience varying degrees of chest pain, hemoptysis, and difficulty breathing, among others. If pulmonary embolism is suspected and the patient's condition permits, a pulmonary artery CTA scan should be immediately carried out to further confirm the diagnosis of pulmonary embolism. If the pulmonary embolism has already caused circulatory disturbances, thrombolytic therapy should then be considered.

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Written by Li Qiang
Intensive Care Unit
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Can pulmonary embolism result in a vegetative state?

After a pulmonary embolism, if it is an acute and extensive embolism and not treated promptly, it can lead to severe hypoxemia. If hypoxemia is not addressed quickly and persists, it will affect the oxygen supply to vital organs throughout the body, including the brain. The brain is the organ most vulnerable to oxygen deprivation. If there is complete lack of oxygen for just four minutes, irreversible damage occurs to the cerebral cortex, and the patient will not wake up, leading to a vegetative state. Therefore, in cases of acute extensive pulmonary embolism, if treatment is delayed, there is a significant risk of the patient entering a vegetative state, and the mortality rate is also very high. Many patients may experience sudden death.

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Written by Wei Shi Liang
Intensive Care Unit
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Pulmonary Embolism Interventional Treatment Methods

Interventional treatment for pulmonary embolism is mainly used for large pulmonary embolisms in the main trunk or major branches of the pulmonary artery. It is applicable in the following scenarios: contraindications to thrombolysis and anticoagulation therapy, inefficacy after thrombolysis or aggressive medical treatment, or lack of surgical conditions. Interventional therapy for pulmonary embolism can involve removing the embolus or breaking it into fragments, allowing it to move to the distal pulmonary arteries, thereby opening the central pulmonary arteries, rapidly reducing pulmonary artery resistance, significantly increasing total pulmonary blood flow, improving cardiopulmonary hemodynamics, and right ventricular function. The treatment involves catheter fragmentation and suction of large clots in the pulmonary artery or performing balloon angioplasty, and it also enables local administration of small-dose thrombolysis. These are the primary methods of interventional treatment for pulmonary embolism.

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Written by Li Qiang
Intensive Care Unit
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Why does pulmonary embolism cause cardiac arrest?

The mechanisms causing cardiac arrest due to acute pulmonary embolism mainly encompass several aspects. One is a large-scale acute extensive pulmonary embolism, which prevents the blood from being ejected from the right heart, potentially leading to acute right heart failure. At this time, the entire body's blood circulation will encounter issues. Another scenario is that following the pulmonary embolism, it causes severe hypoxia. This hypoxia can lead to oxygen deficiency in all organs of the body, including the heart. The coronary arteries that supply nutrients to the heart can also become ischemic. Both of these factors can cause the heartbeat to lead to sudden cardiac arrest. These are the primary mechanisms that can cause a sudden stop in the heartbeat.

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Written by Yuan Qing
Pulmonology
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Why should one lie flat for acute pulmonary embolism?

When acute pulmonary embolism occurs, it is primarily due to a thrombus from the venous system being carried by the venous blood flow back to the right heart, and then due to the ejection from the right heart, this thrombus gets lodged in the pulmonary artery, forming a pulmonary embolism. After the onset of pulmonary embolism, the primary treatment measure is to have the patient lie down and remain still. The reason is mainly that if the patient is standing or moving, it is very likely that the thrombus in the venous system could continue to detach and move within the venous system. This can worsen the symptoms of pulmonary embolism or lead to new embolic sites, so the treatment for the patient involves immobilization and lying down to avoid further movement, making this the most basic approach to treatment.