Whether it is thrombolysis or not, thrombectomy or other measures, all need to wait for the angiography results before considering.
Pulmonary artery emboli generally occur in the left and right main pulmonary arteries and their lower branches. Refractory distal pulmonary embolism is rare. Because the thrombus in the terminal circulation of the pulmonary artery has a strong ability to autolyse, small terminal thrombus can be completely autolyzed by human blood vessels, and there is no need for doctors to excessively dissolve thrombolysis. The doctor only needs to open up the main artery.
With this idea as a guide, it is like performing a coronary angiography on the root of the main blood vessel. The doctor wants the contrast agent to reach the pulmonary artery at the root of the left pulmonary aorta and the right pulmonary aorta, usually in the inferior vena cava.
The inferior vena cava collects systemic venous blood into the right atrium. The venous blood from the right atrium is pumped into the right ventricle, and the venous blood is output from the right ventricle to the pulmonary artery, from the pulmonary artery to the left and right pulmonary trunks to the lungs, where gas exchange occurs, turning the venous blood into arterial blood, and then the pulmonary veins return to the left atrium. The left ventricle pumps blood throughout the body in a cycle called the pulmonary circulation.
The pulmonary artery carries venous blood, not arterial blood, and the pulmonary veins carry arterial blood. The veins in the systemic circulation carry venous blood, and the arteries carry arterial blood. This is the most common thing for laypeople to misunderstand. Therefore, pulmonary artery thrombolysis dissolves venous thrombi and penetrates the femoral vein rather than the femoral artery. This is different from coronary angiography.
It is enough to illustrate the complexity and variety of interventional surgeries.
The doctors in the control room watched the imaging results through the lead glass with the surgeons in the operating room and witnessed the real-time progress of the operation.
After the imaging machine is started, you can see a thin wire tube coming to the lower end of the lung. Similar to coronary angiography again, the doctor must find a way to prevent the catheter from slipping out at the end of the catheter, such as wrapping it with a small hook. Today is not a practice session for a young doctor. The deputy senior surgeon performs the surgery himself. It is obviously different. The speed is super fast. During the process, there will be no hesitation due to unskilled exploration of the anatomy of the human body.
Most people don’t see clearly what the process is. Ta da, the contrast agent has been injected into the blood vessels for imaging.
The principle is exactly the same as other interventional surgeries. Where the blood vessels are blocked and the contrast agent cannot pass through, the contrast will be missing and appear as a blank space, that is, it will not be black but white. In the pulmonary artery, the left and right pulmonary trunks are blocked by thrombus and the lack of pulmonary artery imaging may be a unilateral pulmonary artery that is completely dim. The visual effect of this on the display is amazing, and may be more shocking than the coronary angiogram.
The first thing to say is that under normal imaging of blood vessels, the pulmonary vascular system is the same as the blood vessels distributed in other human organs, just like the branches of a big tree, but the size and number are different.
Having said that, the difference in the visual effect given to the doctor after the contrast agent is injected is very obvious. You can see on the screen that the black threads that look like feather dusters coming out of the blood vessel heads on the left and right of the two large-diameter sewer pipes are the pulmonary artery system. The blood vessel distribution map produced by cardiac coronary angiography does not have such terrible density.
Normal angiography is like this. Once blockage occurs, if it is an active blockage on one side of the lung, it is not surprising that the feather duster on one side will be completely dimmed. It is enough for medical students to feel educated after seeing it. This may not look like coronary angiography. The missing blood vessels shown in coronary angiography are like blank sections of wire tubes during the last surgery.
