In this article, we report a case of clinically severe PE following RFA surgically treated with extracorporeal membrane oxygenation (ECMO).
In a meta-analysis including 8,223 patients, only three patients had PE and none of them was lifethreatening.[6] However, O'Donnell et al.[7] investigated thrombotic complications in varicose vein treatment in a real-world setting and concluded that the number of PE could be underestimated than those reported in clinical trials.
A total of 5 to 10% of all PE cases after varicose vein surgery have an unstable hemodynamic condition, leading to shock and these patients have a 15 to 60%-times higher mortality rate, compared to those with a stable condition.[8] According to the guidelines, in patients with suspected PE presenting with shock or hypotension, if CT angiography reveals positive PE imaging, thrombolysis, surgical embolectomy or catheter-directed treatment modalities can be performed.[9] Moreover, ECMO bridging and pulmonary embolectomy can be life-saving interventions in high-risk PE cases.[10] With the use of CPR and ECMO, thrombolysis can induce bleeding and worsen the clinical situation. In more stable patients, thrombolysis is an effective method to lyse the thrombus in the pulmonary artery with improved clinical status in varicose vein surgery.[11] However, in the literature, such patients were discharged from hospital after the operation and PE usually developed between the postoperative second and fifth days during the home rest. In our case, PE developed very early, 12 h after the operation.
In conclusion, early recognition of deep vein thrombosis and pulmonary embolism and prompt treatment can be life-saving and reduce potential death events. In addition, all sorts of venous interventions should be performed in or in close of the cardiovascular centers, including non-invasive lab procedures.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to
the authorship and/or publication of this article.
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