Acute Pulmonary Embolism Treated by Surgery and Complicated With a Pulmonary Artery Pseudoaneurysm: A Case Report

Acute pulmonary embolism (PE) remains a relatively common pathology, with a high morbidity and mortality. Recommended treatment is based on anticoagulation, and thrombolysis is reserved for patients with hemodynamic instability. However, in some cases, these treatments are contraindicated or ineffective, and then other strategies are needed. Here, we present the case of a 48-year-old female patient presenting with a submassive PE showing a highly mobile intracardiac thrombus straddling through a patent foramen ovale. Considering the high risk of systemic and cerebral embolization with pharmacologic thrombolysis or with endovascular thrombectomy, we opted for a surgical pulmonary thrombectomy (SPT). This procedure was performed successfully but complicated by a left lower pulmonary artery pseudoaneurysm, probably related to the use of a Fogarty catheter for distal embolectomy. This complication was treated by interventional radiology with an endovascular embolization. Subsequent evolution was favorable under systemic anticoagulation, and the patient was discharged home on day 19. The ambulatory follow-up showed a complete recovery after three months. Nowadays, observed postoperative mortality and complication rates with SPT in the context of acute PE are acceptable and somewhat lower than predicted ones. Considering that SPT remains rarely used nowadays, but that good outcomes are frequently reported in recent literature, we decided to perform a brief literature review to highlight recent advances in this field.