Clinical Signs Of Pulmonary Embolism Research Articles

Shear wave elastography values of thrombus in patients with lower extremity deep vein thrombosis for pulmonary embolism detection: the ROC analysis

Rationale: Thrombosis of the iliac (IV) and femoral veins (FV) is one of the most common causes of pulmonary embolism (PE). Modern ultrasound scanners are equipped with the technology of shear wave elastography, which gives a quantitative assessment of thrombus stiffness by Young's modulus reconstruction. However, the lack of convincing data on the role of thrombus stiffness for clinical manifestations of PE hinders the active use of shear wave elastography to diagnose the risk of embolism.
 Aim: To determine the threshold values of the venous thrombus Young’s modulus for deep venous thrombosis (DVT) of the lower extremities complicated by massive PE and/or PE with acute cor pulmonale (ACP).
 Materials and methods: This was a single center cross-sectional study in 101 patients who were hospitalized with the diagnosis of acute (duration of less than 2 weeks) or subacute (from 2 weeks to 3 months) IV and FV thrombosis. Doppler ultrasound of the lower extremity veins and echocardiography were done in all patients. Forty eight patients with clinical signs of PE had chest computed tomography. The venous thrombus stiffness was assessed by shear wave elastography with the Young's modulus reconstruction. We performed the ROC analysis for mean values of the Young's modulus for proximal segments of IV and FV thrombi in patients with DVT and massive PE and ACP.
 Results: PE was diagnosed in 40.6% (26/64) of the patients hospitalized with acute DVT and in 54.1% (20/37) of those with subacute DVT. Echocardiographic signs of ACP in massive PE were found in 47.4% (9/19) of the patients, in submassive and minor PE in 55.6% (15/27). In DVT complicated with PE, the ROC analysis of the shear wave elastography results gave the following threshold values of the mean Young’s modulus for the proximal thrombus segment: for acute IV thrombosis + PE and ACP, ≤ 16.7 kPa (AUC 0.714, sensitivity 100%, specificity 42.1%), in subacute IV thrombosis + PE and APC, ≤ 23.7 kPa (0.939, 100 and 90.9%, respectively), in acute FV thrombosis + massive PE, ≥ 9.5 kPa (0.706, 100 and 50%, respectively), in subacute FV thrombosis + massive PE, ≥ 24.4 kPa (0.550, 60.0 and 68.8%, respectively).
 Conclusion: Shear wave elastography of deep vein thrombi of the lower extremities makes it possible to identify patients with PE and ACP during acute and subacute IV thrombosis and to determine massive PE in acute FV thrombosis.

Clinical features of pulmonary embolism in patients with previous recent COVID-19 infection

BACKGROUND: Pulmonary embolism (PE) is one of the most significant thromboembolic complications of coronavirus disease 2019 (COVID-19). Several studies have demonstrated the clinical features of PE in patients in the acute phase of COVID-19. The features of the course of PE diagnosed after an acute infection have not been sufficiently studied.
 AIM: To study the clinical picture of PE that occurred within 3 months after COVID-19.
 METHODS: A retrospective study was completed. Patients were hospitalized with a diagnosis of PE between January 2020 and December 2021. Two subgroups were formed: with a history of recent (up to 3 months) COVID-19 infection and without a history of COVID-19.
 RESULTS: Of the 278 patients hospitalized with PE, 44 had anamnesis of COVID-19, and 69 had no anamnesis of infection. In the remaining 165 patients with PE, determining the presence or absence of a history of COVID-19 was impossible. In the analysis of the clinical picture and examination results of 44 patients with COVID-19, distal localization of thrombotic lung lesions was predominant, the incidence of deep vein thrombosis of the lower extremities was lower, and right heart lesions were noted. A tendency toward the presence of diabetes mellitus, anemia, and thrombocytopenia was found.
 CONCLUSION: Patients with PE and history of COVID-19 have features of clinical presentation. The identified signs are consistent with the results of studies that have evaluated the course and clinical signs of PE in the acute period of COVID-19. Similar manifestations may indicate a significant effect of COVID-19 on PE signs both during and after the acute period of COVID-19. Clinical features were determined by the severity of the previous infection.

Chemoport Fracture due to Catheter Pinch Off Syndrome: A Rare Complication of Subclavian Vein Approach Revisited.

Chemoports are routinely used for administering chemotherapeutic agents, drugs, blood, and blood products. Chemoport insertion is associated with inherent complications. Fracture of chemoport due to pinch off syndrome is a rare life-threatening complication. We report our experience of fracture chemoport in patients with carcinoma breast and its management. We also present a detailed review of literature about this complication, clinical features, warning signs, diagnostic workup, management, and prevention. From a prospectively maintained database of chemoport insertion patients, a retrospective analysis was done from 2017 to 2020. During this period, the incidence of fracture chemoport was evaluated and their management. Out of 560 chemoport insertions, there were 3 patients with chemoport fracture, with an incidence of 0.5%. All the three patients were hemodynamically stable, with no clinical signs of pulmonary embolism. The chemoports were non-functional and on radiologic evaluation fracture of chemoport with embolization of distal segment was demonstrated. All the patients were managed by retrieval of the embolized catheters by a snare and removal of port chambers under local anesthesia. Choose internal jugular vein over subclavian vein for placing central venous access devices. When subclavian vein is chosen, point of entry should be lateral part of costochondral space. The incidence of chemoport fractures is 0.5% which present as non-functioning chemoports. Identify pinch off sign, especially with an upright check X-ray after chemoport placement. Consider repositioning of chemoport if pinch off sign is present.

Clinical and paraclinical patterns of presentation, and sensitivity of diagnostic scores for pulmonary embolism at the emergencies: retrospective study on the impact of age at the University hospitals of Strasbourg (France).

In retrospect, all patients discharged with a documented diagnosis of pulmonary embolism from the adult emergency service of the Regional university hospital of Strasbourg (France) over a year were considered. According to 4 age categories (<70, 70-74, 75-80 and >80 years) the data from the medical records were analyzed and compared. Diagnostic scores of Wells and modified Geneva were calculated. 117 patients met the inclusion criteria (mean age 71.8±13.8 years, women 54%). Chest pain was less common after 80 years; no difference was observed for syncope or dyspnea although the oxygen saturation is lower in old age. For diagnosis, 25% of patients had a lung scintigraphy with an increased recourse with age (<70 years: 10%, >80 years: 41%). Thoracic computed tomography angiography concerned 79% of patients with a significant decrease of his use in older. The sensitivity of the diagnostic scores was low but increased with age when the strong and intermediate probabilities of pulmonary embolism were combined. This study confirms the low specificity of the clinical signs of pulmonary embolism, whatever the age. It also shows the low sensitivity of the diagnostic scores in the 70 years or older.

Pulmonary Embolism in Children

Unlike in adults, pulmonary embolism (PE) is an infrequent event in children. It has a marked bimodal distribution during the paediatric years, occurring predominantly in neonates and adolescents. The most important predisposing factors to PE in children are the presence of a central venous line (CVL), infection, and congenital heart disease. Clinical signs of PE are non-specific in children or can be masked by underlying conditions. Diagnostic testing is necessary in children, especially with the lack of clinical prediction rules. Recommendations for tests are derived from adult studies with ventilation/perfusion (V/Q) scintigraphy being well established. There exists an increasing role for computerised tomography pulmonary angiography (CTPA) and magnetic resonance pulmonary angiography (MRPA). Thrombotic events in children are initially treated with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). For the extended anticoagulant therapy LMWH or vitamin K antagonists can be used with duration of treatment recommendations extrapolated from adult data. Mortality rates for PE in children are reported to be around 10%, with death usually related to the underlying disease processes. Exact data about recurrence risk in children is unknown. Because of the difference in aetiology, presentation, diagnostic methods and treatment between adults and children further research is necessary to assess the validity of recommendations for children.

Parenchymal and pleural findings in pulmonary embolism visualized by multi-channel detector computed tomography

A normal computed tomography (CT) scan of the pulmonary arteries in the presence of parenchymal and pleural abnormalities may indicate a false-negative diagnosis of pulmonary embolism (PE). Multi-channel detector CT (MDCT) with thinner collimation may improve the detection of small peripheral PEs causing such abnormalities. To investigate parenchymal and pleural findings visualized by contrast-enhanced MDCT in patients with and without PE, and to identify possible predictors of PE. 129 patients with clinical signs of PE were included. In all patients an iopromide-enhanced 64-MDCT (64x0.625 mm collimation, pitch 1.375, overlapping reconstruction with a slice thickness of 0.625 mm, increment of overlapping slice reconstruction 0.43) was performed within 24 h after the onset of the symptoms. MDCT detected PE in 45 of the 129 patients (35%). PE and parenchymal/pleural findings were localized predominantly within the lower lobes. Wedge-shaped opacities were significantly associated with PE (OR =3.00; 95% confidence interval 1.13-7.91). Vascular signs were only visualized in patients with PE. Nodules, consolidations, atelectasis, or effusions were not predictive of PE. The present MDCT study verified that parenchymal and pleural findings can be found in patients with or without PE. Wedge-shaped opacities and vascular signs were significantly associated with PE and therefore can be potential predictors of PE.

Combined magnetic resonance imaging of deep venous thrombosis and pulmonary arteries after a single injection of a blood pool contrast agent

Agreement rate between magnetic resonance imaging (MRI) and Doppler ultrasound (DUS) for the detection of deep vein thrombosis (DVT) in the lower extremities was attempted by using the intravascular MRI contrast agent gadofosveset trisodium. The potential of this method to detect pulmonary embolism (PE) was also evaluated. Forty-three consecutive inpatients with ultrasound-confirmed DVT but no clinical signs of PE were prospectively enrolled in this feasibility study. MRI was performed after a single injection of gadofosveset trisodium. The pulmonary arteries were imaged using a 3D Fast Low Angle Shot (FLASH) gradient recalled echo sequence. Additionally, pulmonary arteries, abdominal veins, pelvic and leg veins were imaged using a fat-suppressed 3D gradient echo Volume Interpolated Breath-hold Examination (VIBE FS). Gadofosveset trisodium-enhanced MRI detected more thrombi in the pelvic region, upper leg and lower leg than the initial DUS. In addition, PE was detected in 16 of the 43 DVT patients (37%). This study shows the feasibility of a combined protocol for the MRI diagnosis of DVT and PE using gadofosveset trisodium. This procedure is not only more sensitive in detecting DVT compared to standard DUS, but is also able to detect PE in asymptomatic patients.

Radial Arterial Approach with Adjunctive Urokinase for Treating Occluded Autogenous Radial-Cephalic Fistulas

There are no data regarding the feasibility and safety of a radial arterial approach with adjunctive urokinase for treating occluded autogenous radial-cephalic fistulas. We retrospectively examined 54 transradial interventions performed to treat occluded autogenous radial-cephalic fistulas within 72 h of occurrence. Urokinase was used in patients with a large thrombus burden. A total of 92 lesions in 54 consecutive patients (27 males, 27 females; mean age, 61.8+/-12.3 years) were treated via radial access. All radial punctures were successful except in one patient. Most thrombotic lesions were located within 1 cm of the radiocephalic anastomosis (79.6%). The mean length of treated thrombotic lesions was 10.3+/-5.4 cm (range, 4-32 cm). Twenty-five patients (46.3%) received urokinase (mean dose, 96,000+/-30,000 U). After transradial intervention, systolic, diastolic, and mean pressures in the radial artery decreased from 179+/-41, 77+/-17, and 111+/-22 mm Hg to 71+/-29, 36+/-15, and 48+/-19 mm Hg (all p's\0.001), respectively. Four radial interventions were unsuccessful. The anatomic and clinical success rates of the radial approach were both 92.6%; postinterventional primary patency rates were 65% at 6 months and 40% at 12 months. Two minor vascular complications were noted, one caused by guidewire-induced contrast extravasation and the other by balloon-induced contrast extravasation. No patient developed clinical signs of pulmonary embolism. In conclusion, the radial approach with adjunctive urokinase is an effective and safe approach to treat occluded autogenous radial-cephalic fistulas.

Paradoxical Peripheral Embolism – a Rare and Underestimated Event

We present a case of paradoxical peripheral embolism related to a patent foramen ovale (PFO) in a young female with clinical signs of pulmonary embolism and simultaneous left hand acute ischaemia. A PFO associated with a right-to-left pressure gradient was revealed by trans-oesophageal echocardiography. She underwent a successful bilateral brachial thrombo-embolectomy with cerebral protection by clamping of the right common carotid and simultaneous proximal right common carotid thrombo-embolectomy, according to prior angiographic study. Paradoxical embolism is still rarely considered as a possible cause of acute limb ischaemia and may be underestimated.

Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography

The aim of our study is to investigate prospectively the quantitative relationship between deep venous thrombosis (DVT) and acute pulmonary embolism (PE). 110 patients clinically suspected of having venous thromboembolic disease underwent combined CT pulmonary angiography (CTPA) and venography of lower limb veins. 44 patients presented with clinical signs of DVT and positive ultrasonography or ascending venography, but no clinical sign of PE (Group 1). 66 patients presented with clinical signs of PE and positive CTPA (Group 2). Clot load in lower limb veins and pulmonary arteries were scored by two independent readers, each using two separate systems for DVT and two for PE. 27 (61%) patients in Group 1 also had PE, and 55 (83%) patients in Group 2 also had DVT. Correlations between PE and DVT scores were weak but statistically significant in Group 2 (r(s) ranging from 0.470-0.520; p< or =0.001), but only some were significant in Group 1 (r(s) ranging from 0.253-0.318; p-values ranging from 0.035-0.097). In conclusion, although PE occurs in a majority of patients with DVT, and vice versa, the amount/burden of clot load in one condition does not necessarily indicate - or indicates only weakly - the degree of burden in the other condition.

Lungenembolie

The annual incidence of pulmonary embolism (PE) in western industrial nations is about 1 to 1.5 cases per 1,000 citizens. For the prognosis of the patients it is important to consider PE early as a differential diagnosis. The clinical disorders are non-specific and varied. The most frequent clinical signs of PE are dyspnoea, tachypnoea, tachycardia and chest pain. Diagnostic algorithms are available for the diagnosis of PE. There is a cardinal difference in diagnostic procedure between clinically stable and instable patients. The criteria for stability are mainly hemodynamic values. In hemodynamically instable patients echocardiography is the most important diagnostic tool. Therapeutical goals depend on the severity of PE and include hemodynamic stabilisation, prevention of the growth of the thrombus, recanalisation of pulmonal arterial vessels, removal of hypoxemia, and prophylaxis of recurrence. Anticoagulation is the only therapy of choice in stable patient of risk classification I. Interventions like thrombolysis and embolectomy are mainly indicated in hemodynamically instable patients.

Lung sonographic findings in patients with suspected pulmonary embolism.

To assess the feasibility and diagnostic performance of lung transthoracic sonography in patients with suspected pulmonary embolism. In a prospective clinical study we compared sonographic findings of the peripheral lung with various scintigraphic gradings and D-dimer plasma concentrations. One hundred and nineteen consecutive patients with clinical signs of pulmonary embolism were investigated within 24 hours of the onset of symptoms. Seventy patients with suspected pulmonary embolism (59%) had sonographic lesions, which were echo poor, homogeneous and rounded or wedge-shaped with a hyperechoic reflexion in the centre. Of the patients with high-probability scintigraphic scans 86% had such sonographic lesions as had 79% with intermediate, 64% with low-probability and 33% with normal scintigraphic scans. Of the patients with positive sonographic findings and normal or low-probability scans only a minority (14%) had negative D-dimer tests. We found a high rate of specific sonographic lesions in patients with suspected pulmonary embolism when investigating the peripheral lung with ultrasound.

Gammagrafía pulmonar y tomografía computarizada helicoidal en el diagnóstico de embolia pulmonar en España. Datos del Sistema Nacional de Salud y el Registro RIETE

To analyze the trends in the utilization of ventilation/perfusion pulmonary scintigraphy (V/QSc), spiral CT (sCT) and pulmonary angiography for diagnosis of pulmonary embolism (PE) in Spain, taking in account the information from the National System of Health (NSH) and RIETE Registry. To examine the diagnostic conformities of V/QSc and sCT in RIETE, with special reference to V/QSc of intermediate/indeterminate probability (V/QScIP). We examined annual trends of diagnostic imaging for PE in 5,678 Spanish patients included in RIETE (period 2001-2005) and in those of the NHS Databases (1999-2003 period). In RIETE the agreement between diagnostics was compared in cases with both V/QSc and sCT and angiography and V/QSc or sCT. We observed an increasing trend in sTC use, which overcame to V/QSc in 2002 (RIETE) and 2003 (NHS). In 732 cases with both techniques there was a diagnostic conformity of 53%. In 116 cases with V/QScIP a concomitant sTC was + for PE in 87%. If clinical signs of PE were present, then sTC was + in 95% of cases. In 29 cases with sCT and angiography agreement was 83% and in 31 cases with angiography and V/QSc was 77%. Nowadays in Spain the sTC is the most utilized method to diagnose EP. However, V/QSc studies are also broadly used. In studies V/QScIP it is advisable to look for deep venous thrombosis and, if present, the results of RIETE allow to assure EP coexistence in 87-95% of cases.

The VenaTech LP Permanent Caval Filter: Effectiveness and Safety in the Prevention of Pulmonary Embolism—A European Multicenter Study

To evaluate (i) the appropriateness, safety, and patient outcomes after placement of the VenaTech LP caval filter and (ii) the success of filter insertion through various venous access routes. An open multicenter prospective observational study was conducted in 12 European centers, including an initial part limited to four centers. Patients with common indications were eligible for inclusion after approval by an independent ethics committee. Over a 42-month period, 106 patients (46 men [43.4%], 60 women [56.6%]), 72.2 years +/- 13.3 of age (range, 37-97 y), with poor prognoses were included. Patients were examined 2-5 days after the procedure, then at 30 days +/- 5 and 90 days +/- 15 for clinical follow-up and filter assessment. Evaluation criteria were based on occurrence of pulmonary embolism (PE), adverse events, death, filter position, and caval patency. Data were available in 101 case report forms at days 2-5, in 75 at day 30 +/- 5, and in 60 at day 90 +/- 15. Two patients (1.9%) were lost to follow-up. The overall mortality rate was 20.8%. PE was present in 71 patients (67.0%). History of venous thromboembolic disease (VTED) was noted in 32 patients (30.2%), and recently diagnosed VTED was present in 101 patients (95.3%). Partial caval thrombosis was present before the procedure. Filter tilting of 10-45 degrees was seen in 3.9% of cases at days 2-5, 4.3% of cases at day 30 +/- 5, and 1.9% of cases at day 90 +/- 15. Follow-up evidenced neither clinical signs of PE nor significant device-related events. In a prospective patient cohort with a projected 3-month mortality rate of nearly 21.0% as a result of severe prognoses, the success of insertion via various venous access routes and the appropriateness and safety of the VenaTech LP caval filter were assessed. Findings at 90-day follow-up were free of symptomatic PE and device-related adverse effects.

Sonographische Befunde bei Varikophlebitis der Vena saphena magna: Dokumentation von Thrombuswachstum und -ablösung mit asymptomatischer Lungenembolie

In five women (mean age 58 [31-74] years) with clinically diagnosed varicose phlebitis of the long saphenous vein appositional thrombus growth was demonstrated by serial ultrasonography (B-mode compression and colour-coded duplex sonography). In one patient the appositional thrombus was found to be free-floating as far as the common femoral vein, but this was not seen by phlebography. During therapeutic heparinization there was ultrasonographic evidence of softening and partial liquefaction of thrombus material in a cranial direction. There were no clinical signs of pulmonary embolism, but pulmonary perfusion scintigraphy demonstrated perfusion deficit characteristic of emboli. Four of the five patients had a surgical crossectomy and partial saphenous vein resection. The congruence between ultrasonographic and macro- as well as micropathological findings demonstrates the great value of B-mode and duplex ultrasound examination in the area of the epifascial veins. Ultrasonography should be performed in every case of varicose phlebitis of the large veins to exclude the presence of apposition thrombi.

La clinique de l'embolie pulmonaire: décidément difficile

Clinical signs of pulmonary embolism are neither sensitive nor specific enough to rule in or out the diagnosis in suspected patients. As an example, a chest pain that is reproducible at palpation in suspected patients was recently shown not to be associated with a lower proportion of confirmed cases of pulmonary embolism. However, clinical evaluation of patients with suspected pulmonary embolism is important, because it allows the physician to assess the clinical probability of pulmonary embolism, a mandatory step in diagnostic strategies for this disease. In elderly patients, the diagnosis of pulmonary embolism is particularly challenging. Indeed, the diagnostic value of symptoms and clinical signs of pulmonary embolism is reduced, the evaluation of the clinical probability is more difficult, and performances of some diagnostic tests are diminished with increasing age. The diminution of the proportion of confirmed cases among suspected patients is a new challenge for physicians, and raises the question of what is a clinical suspicion of pulmonary embolism.

Embolie pulmonaire récidivante malgré la présence d’un filtre cave définitif: À propos d’un cas observé au CNHU de Cotonou-Bénin

A 50-year-old man presents several clinical signs of pulmonary embolism, but this diagnosis was excluded due to the lack of venous thrombosis of the lower limbs and because the presence of a vena cava filter. The same signs reoccurred a few months later, leading to the diagnosis of venous thrombosis of the lower limbs with severe successive pulmonary embolism. This clinical case illustrates the potentially incomplete efficacy of vena cava filters for the prevention of pulmonary embolism. (J Mal Vasc 2005; 30: 59-61).

Chest Sonography in the Diagnosis of Pulmonary Embolism: A Comparison with MRI Angiography and Ventilation Perfusion Scintigraphy

To compare the diagnostic performance of chest sonography, MRI angiography and ventilation/perfusion intigraphy in pulmonary embolism (PE). In a prospective clinical study, 55 patients (41 women, 14 men, age 23 - 91 years) with clinical signs of PE were investigated within 48 hours of the onset of symptoms. The final diagnosis was made by MRI angiography (reference method). PE was diagnosed in a total of 36 patients. Chest sonography revealed rounded or wedge-shaped hypoechoic lesions in 30 patients. On ventilation/perfusion (V/P) scintigraphy, 41 patients had positive V/P scans, but only 23 were of high probability. Chest ultrasound had a positive predictive value of 97 % to diagnose PE. The sensitivity, specificity, the negative predictive value and accuracy were 81 %, 84 %, 84 % and 82 %, respectively. As 18 patients had inconclusive scans, the diagnostic performance of ventilation/perfusion scintigraphy was poor. The positive predictive value, sensitivity and specificity were 58 %, 42 % and 91 %, respectively. Patients in whom PE was excluded mainly suffered from congestive heart failure, bronchopulmonary infections or pulmonary hypertension. A negative sonographic study cannot rule out PE with certainty. However, a chest sonography is of acceptable diagnostic value in patients with suspected PE and may be used as an adjunct or guide to more established methods.

Intravascular extraction of permanent pacemaker leads.

Cardiac leads that became infected, fail, or are otherwise problematic present difficulties in the management of patients. In this report, we assess our intravascular countertraction technique. Between February 1990 and January 2001, 13 leads were removed from 11 patients using the intravascular countertraction technique. The reasons for lead extraction were pacemaker infection and lead dysfunction. In two of these patients, the ventricular leads could not be completely removed. The complete success rate was 85% and the overall success rate was 92%. There were no serious complications such as cardiac rupture, vein injury, or death, and there were no clinical signs of pulmonary embolism. In one of the patients whose ventricular leads could not be removed completely, the ventricular lead was stretched from its previous round shape, but tricuspid valve regurgitation did not occur during the 3-year follow-up period. In the other patient, the distal electrode was left in the subclavian vein. However, this residual distal electrode did not migrate, and there were no clinical signs of any recurrence of infection. The present study suggests that to remove leads successfully, the largest locking stylet that can be easily passed to the lead's tip through the coil lumen should be chosen in order to avoid valve injury, which can sometimes occur when a ventricular lead's locking stylet is left in the coil lumen.

Local venous thrombosis after cardiac catheterization.

Pulmonary embolism is a rare but life-threatening complication of cardiac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac catheterization. Patients were examined clinically and by duplex sonography with a high-resolution (5 or 7.5 MHz) transducer before and twenty-four hours after catheterization before mobilization. Duplex sonography excluded complete proximal DVT in all patients. Only partial occluding thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi were always localized at the puncture site. In 2 patients a difference was found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography, only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Phlebography was performed in 4/11 patients (36%). In 2 patients the diagnosis was confirmed; in 1 patient extravenous compression was assumed, and the other demonstrated a normal-appearing phlebography at the time of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed in addition to arterial puncture. Furthermore a 9.8 times higher risk was found if more than one venous puncture was necessary. During the follow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheterization (0/450 patients), but pDVT occurred in 2.4%. Risk factors for pDVT are the venous puncture itself and multiple puncture attempts. Clinical relevance of pDVT remains to be determined.