Sometimes it depends on the DNA. Mutations of specific genes that come into play in the normal coagulation process set in motion mechanisms capable of facilitating the formation of clots within the vessels. In other cases it arises from the stasis of the venous circulation of the legs, perhaps because one remains in bed for days after a fracture of the femur. Or again due to disturbances in the normal flow of blood.
If to all this we add other risk elements such as smoking, obesity, trauma, surgery and long air travel with relative stasis of the vessels of the legs, as well as chronic diseases such as tumors, here is the picture of those who are more likely of experiencing pulmonary embolism.
This condition occurs when a blood clot from the peripheral venous circulation comes to occlude a pulmonary vessel. It represents the third most frequent cardiovascular emergency, after heart attack and stroke, and can also frequently affect young people and women.
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Symptoms of pulmonary embolism vary from case to case
We are facing a complex picture, which presents itself with over 65,000 patients every year in Italy. but pulmonary embolisme she can also be sudbola, with very variable symptoms. Sometimes it causes almost imperceptible disturbances, perhaps because the more peripheral branches of the pulmonary artery are initially affected.
In other cases it is nearly explosive with chest pain, coughing, rapid heartbeat and severe breathing difficulties. In the most severe forms, with rapid impairment of circulation in the larger branches of the main pulmonary artery, it can also quickly lead to death.
For the cure, the important thing is to arrive early. And it’s not just drugs. There are also tailor-made cures for the people for whom the treatments are thrombolysiswhich dissolve the clot, can increase the risk of bleeding and are therefore unmanageable.
What can be done? It works to remove the thrombus and not to dissolve it. This result can be achieved not only with surgery, but also percutaneously. To remember it are the experts of the Italian Society of Interventional Cardiology (Gise), at a congress in Milan.
Tailored care
Thrombolysis serves to dissolve the thrombus by freeing the blocked vessel. However, in Italy about 1200 high-risk patients per year can experience dangerous bleeding with this type of approach and cannot undergo thrombolysis. It must be said that the clot can be removed with a classic surgery, with an operation that is however very complex.
And then? “In cases with contraindications to thrombolysis, the catheter approach has proven to be effective and if you intervene promptly, mortality can be reduced – he explains. Giovanni Esposito, president of Gise and director of the Uoc of Cardiology, Hemodynamics and UTIC of the Federico II University Hospital of Naples. However, it is necessary to create specific diagnostic-therapeutic paths for pulmonary thromboembolism, whose therapy requires a multidisciplinary approach given the possibility of intervening with drugs, surgery or with an interventional procedure; above all, it is necessary to create a network of centers that are able to provide all possible therapies in order to manage each case in the best way “.
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Not just scalpels
With percutaneous thrombectomy, as in the case of heart attack surgery, the circulation is accessed via a catheter through peripheral vessels, to reach the site of the thrombus and eliminate it mechanically. In practice, this procedure allows the thrombus to be reduced to very small pieces, which can then be aspirated and taken out of the blood vessel.
According to the Gise data, this approach could be used in high-risk patients with contraindications to drugs, approx 1200 a yearand could be of benefit in at least 10,000 intermediate-to-high-risk patients per year.
Among the alternatives, for selected patients, it is also possible to place a sort of “sieve” of the blood that filters it and can prevent the emboli from moving towards the pulmonary arterial system.
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