Acute Pulmonary Thromboembolism: Systematic review on the management of the disease and new perspectives in surgical intervention in severe patients

Pulmonary thromboembolism has high morbidity and mortality when not diagnosed and treated quickly. Because it presents a nonspecific clinical picture, it can be confused with numerous pathologies and, in this sense, for its proper diagnosis, PTE should always be considered in patients with cardiorespiratory symptoms and those with risk factors. Thus, based on clinical suspicion, numerous complementary exams have been called to help confirm the diagnosis, with computed tomography angiography (CT angiography) currently considered the gold standard. However, other tools can help in the diagnosis, such as the WELLs score, D-Dimer measurement and Doppler ultrasound of the lower limbs. Furthermore, the disease can be stratified, depending on its severity, into massive, submassive and mild PE; in this sense, depending on the stratification, different treatments are instituted. Currently, submassive PTE has generated numerous discussions regarding which treatment to institute: intensive management -through surgical intervention or fibrinolysis -or conservative -even treatment of mild PTE. However, for the management of massive PE, surgical intervention has gained space, since in many circumstances there are contraindications to the use of fibrinolysis as a therapeutic measure. Finally, for mild PE, supportive therapy and the use of oral anticoagulants are recommended. (author)