Findings Of Pulmonary Embolism Research Articles

PREVALENCE OF SYMPTOMATIC VENOUS THROMBOEMBOLISM IN PATIENTS WITH DIABETIC FEET TREATED IN TOTAL CONTACT CAST IN A TERTIARY REFERRAL DIABETIC FOOT UNIT

IntroductionTotal contact casting (TCC) is one of the most commonly utilized modalities in the management of diabetic feet. We undertook a retrospective review to determine the prevalence of symptomatic VTE events in patients treated in a weight bearing TCC in our diabetic foot unit, and to formulate guidelines for VTE prophylaxis.MethodsElectronic records were reviewed to identify all patients treated in a TCC between 2014 and 2021. Data collection included patient demographics, comorbidities, period of immobilization in TCC, the incidence of VTE events, and any VTE prophylaxis prescribed during their period in TCC.Results549 patients were identified who had at least one episode of TCC. Mean age was 67 years (range 28 to 94 years) and the mean duration in cast was 10.2 weeks (range 0.3–46 weeks). Only 6 patients (1.1%) were prescribed chemical thrombo-prophylaxis during their period in TCC. Mean body mass index (BMI) for these patients was 32.3 (Range 18.4–58.9). Other significant comorbidities: 81% (n-444) of patients had associated cardio-vascular comorbidities; 54 % (n-296) had renal comorbidities including 22% (n-121) having had dialysis and 4.2% (n-23) with renal transplants. Eight of the 549 patients (1.5%) had suffered a VTE event of which only 2 (0.36%) were during the period of immobilization in TCC. One was a symptomatic DVT (0.18%) and the another was an asymptomatic (incidental) finding of pulmonary embolism (PE). There was no mortality related to the VTE episodes.ConclusionNICE guidelines state that one should “Consider pharmacological VTE prophylaxis for patients with lower limb immobilization”. Our study finds that patients treated in a weight bearing TCC do not require routine pharmacological VTE prophylaxis, in spite of an extended period of lower limb immobilization and significant medical comorbidities.

Clinical characteristics and treatment of patients with central pulmonary embolism and right heart thrombus.

Right heart thrombus (RHT), also known as clot in transit, is an uncommon finding in pulmonary embolism (PE) that is associated with increased inpatient mortality. To date, there is no consensus on the management of RHT. Therefore, we aim to describe the clinical features, treatments, and outcomes of patients with simultaneous RHT and PE. This is a retrospective, cross-sectional, and single-center study of hospitalized patients with central PE who had RHT visualized on transthoracic echocardiography (TTE) from January 2012 to May 2022. We use descriptive statistics to describe their clinical features, treatments, and outcomes, including mechanical ventilation, major bleeding, inpatient mortality, length of hospital stay, and recurrent PE on follow-up. Of 433 patients with central PE who underwent TTE, nine patients (2%) had RHT. The median age was 63 years (range 29-87), most were African American (6/9), and females (5/9). All patients had evidence of RV dysfunction and received therapeutic anticoagulation. Eight patients received RHT-directed interventions, including systemic thrombolysis (2/9), catheter-directed suction embolectomy (4/9), and surgical embolectomy (2/9). Regarding outcomes, 4/9 patients were hemodynamically unstable, 8/9 were hypoxemic, and 2/9 were mechanically ventilated. The median length of hospital stay was six days (range 1-16). One patient died during hospital admission, and two patients had recurrent PE. We described the different therapeutic approaches and outcomes of patients with RHT treated in our institution. Our study adds valuable information to the literature, as there is no consensus on the treatment of RHT. Right heart thrombus (RHT) was a rare finding in central pulmonary embolism. Most patients with RHT had evidence of RV dysfunction and pulmonary hypertension. Most patients received RHT-directed therapies in addition to therapeutic anticoagulation.

Implanon and Pulmonary EmbolismAny Association?

Implanon is a single rod contraceptive implant, it is one of the most reliable birth control methods, highly effective with rapid onset of action and an equally rapid return of fertility once removed. Thromboembolic events are established adverse events of hormonal contraceptives; however, few cases of thromboembolic complications of implanon have been reported in the literature. A 39 year old woman, with no known risk factors for thrombus formation and no past history of thromboembolic events presented with difficulty with breathing, cough, hemoptysis, chest pain and an episode of syncopal attack. Further evaluation revealed elevated D dimer, sinus tachycardia on (ECG) and computerized tomography pulmonary angiogram (CTPA) finding of pulmonary embolism. She had implanon inserted for contraception 2 months before the event. Initiation of prompt management with anticoagulant and discontinuation of implanon led to a favourable patient outcome. In conclusion, pulmonary embolism is a possible though uncommon adverse event associated with implanon contraceptive. Therefore, women of reproductive age group requiring contraceptives should be risk stratified with the aim of identifying those with increased risk of this side effect. They should be properly guided and counseled on the appropriate choice of safe and effective contraceptive method. In addition, women on hormonal contraceptive methods (including implanon) presenting with symptoms suggestive of thromboembolic events should be promptly evaluated and treated to avoid high fatality associated with this condition.

Inferior vena cava filter thrombosis: An overview

The leading long term and undervalued impediment associated with inferior vena cava (IVC) filter placement is said to be increased risk of venous thrombosis within and below the IVC. Anticoagulation remains the mainstay treatment preference for the management of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Now and then, it is not viable due to bleeding complications or, occasionally, breakthrough PE associated with this treatment method. In these patients, the development of vena cava filters was a significant advancement in their management. Patients with IVC filters predominantly the ones placed with permanent filters are considered to be at a greater risk for the development of recurrent DVT. Cautious applications of IVC filters, along with retrieval of temporary IVC filters in good time, significantly diminishe the risk of IVC thrombosis. The proof of connection of IVC thrombosis with each of the following factors is known: Population demographics, history of or preexisting hypercoagulable states/anticoagulation, the manner in which the thrombus is assessed, and the duration since the filter employment. Most cases of IVC filter thrombosis are asymptomatic. Contrast-enhanced computed tomography is a preferred imaging modality compared to Doppler sonography. Here in this article, we attempt to discuss briefly the present ideas concerned with the indications of IVC filters along with the prevalence, risks, and management of IVC filter thrombosis.

A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach

BackgroundChoriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach.Case presentationIn a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution.ConclusionsThis was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis.

Long-term complications of inferior vena cava filters

Anticoagulation is the cornerstone for the treatment of deep venous thrombosis and pulmonary embolism. On occasion, this is not possible because of bleeding complications or, rarely, breakthrough pulmonary embolism associated with this treatment method. The development of vena cava interruption in the 1970s was a critical advance in the treatment of these patients. Placement of inferior vena cava (IVC) filters has been steadily increasing since their introduction. Nonetheless, the incidence of complications associated with placement of these devices is largely unknown. Most of the evidence regarding IVC filter complications relies on case reports, with scarce data coming from larger randomized controlled trials. We aimed to present a summary addressing long-term complications of IVC filters as published in recent articles addressing problems such as IVC thrombosis and IVC filter migration, perforation, fracture, embolization, and tilting. We performed a PubMed search and Google Scholar search using different combinations of “long term,” “complications,” “IVC filter,” and “vena cava filter.” We reviewed the available English publications and reported the findings in this summary.

Outcomes of the TrapEase inferior vena cava filter over 10 years at a single health care system

PurposeTo retrospectively investigate the safety, efficacy, and complications associated with TrapEase inferior vena cava filters. MethodsAll patients who received a TrapEase filter at a single institution between April 2003 and January 2013 were identified, and outcomes were reviewed and analyzed. ResultsDuring the study period, 594 patients (278 women; mean age, 68.9 ± 13.6 years; range, 19.2-96.3 years) received a TrapEase filter. The duration of this study was 88 months, with a median clinical follow-up of 3.6 months (range, 0-148.3 months). During follow-up, 489 of 594 patients (82.3%) died and 105 remained alive with filters in situ. Nine cases of breakthrough pulmonary embolism occurred among the 582 patients with clinical follow-up (1.5%). Among 128 patients with imaging that contained the filter, there were 17 cases of filter fracture (13.3%). Of the 39 patients with available computed tomography scans, eight had filling defects within the filter suggestive of thrombus or embolus (20.5%), including two patients with complete caval occlusion. Recurrent deep vein thrombosis occurred in 109 out of 582 patients (18.7%) with clinical follow-up. ConclusionsMost patients who received TrapEase filters died during follow-up, possibly because operators chose to implant a permanent filter in patients with known terminal illnesses. The filter fracture rate seemed to be high, but there were no instances of free fracture fragment or distant migration. Although the filter may theoretically be effective in preventing thrombus migration owing to the double basket design, pulmonary embolism breakthrough rates were comparable with rates seen with other filters.

Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation.

IntroductionEmergency department (ED) patients with acute pulmonary embolism (PE) despite therapeutic anticoagulation at the time of diagnosis are uncommonly encountered and present a diagnostic and management challenge. Their characterization and outcomes are poorly described. We sought to describe the prevalence and characteristics of therapeutically anticoagulated patients among a population of patients with acute PE in a community setting and to describe treatment changes and 30-day outcomes.MethodsFrom a large retrospective cohort of adults with acute, objectively-confirmed PE across 21 EDs between 01/2013 and 04/2015, we identified patients who arrived on direct oral or injectable anticoagulants, or warfarin with an initial ED international normalized ratio (INR) value ≥2.0. Patients were excluded from the larger cohort if they had received a diagnosis of venous thromboembolism (VTE) in the prior 30 days. We gathered demographic and clinical variables from electronic health records and structured manual chart review. We report discharge anticoagulation regimens and major 30-day adverse outcomes.ResultsAmong 2,996 PE patients, 36 (1.2%) met study criteria. Mean age was 63 years. Eleven patients (31%) had active cancer and 25 (69%) were high risk on the PE Severity Index (Classes III–V), comparable to the larger cohort (p>0.1). Reasons for pre-arrival anticoagulation were VTE treatment or prevention (n=21), and atrial fibrillation or flutter (n=15). All patients arrived on warfarin and one was also on enoxaparin: 32 had a therapeutic INR (2.0–3.0) and four had a supratherapeutic INR (>3.0). Fifteen patients (42%) had at least one subtherapeutic INR (<2.0) in the 14 days preceding their diagnostic visit. Two patients died during hospitalization. Of the 34 ultimately discharged, 22 underwent a change in anticoagulation drug or dosing, 19 of whom received injectables, either to replace or to supplement warfarin. Four patients also received inferior vena cava filters. Thirty-day outcomes included one major hemorrhage and one additional death. No patients experienced recurrent or worsening VTE.ConclusionWe found a low prevalence of therapeutic anticoagulation at the time of acute PE diagnosis. Most patients with breakthrough PE underwent a change in therapy, though management varied widely. Subtherapeutic anticoagulation levels in the preceding weeks were common and support the importance of anticoagulation adherence.

Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications.

To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval. A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016. A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n=6270; 56.3%) and prophylactic (n=4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6±47.3days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively. Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

Objective: This study aimed to prospectively evaluate the incidence, characteristics, and risk factors of venous thromboembolism (VTE) development, and the diagnostic value of blood coagulation markers in patients receiving surgery for malignant bone and soft tissue tumor of lower extremity. Methods: A prospective study of 20 patients who were examined using ultrasonography. Serum soluble fibrin monomer complex (SFMC) and D-dimer were measured in the perioperative period. VTE incidence, VTE development time, change in blood coagulation markers, and effect of each risk factor were evaluated. Results: VTE was found in 8 of 20 patients. Four of these 8 patients had the finding of pulmonary embolism (PE) without symptom. Onset time of VTE was from day 1 to 7 after surgery. The cutoff value of SFMC was <3 μg/mL at any measurement point and D-dimer was approximately 2 g/mL in receiver operating characteristic analysis. Body mass index was the only significant risk factor. Conclusion: VTE showed high incidence and often occurred in the early period in only physical prophylaxis after surgery. SFMC or D-dimer was not always useful to detect VTE development. With regard to rehabilitation intervention, risk management is required until 1 week after surgery.

Complications and retrieval characteristics of Celect Platinum inferior vena cava filters.

The purpose of this study was to retrospectively assess the retrieval characteristics and rate of filter-related complications associated with use of the Celect Platinum (Cook Medical, Bloomington, Ind) inferior vena cava filter (IVCF). A single-center, retrospective review was conducted to identify patients who received a Celect Platinum IVCF between June 2013 and February 2016. The patients' charts and imaging records (computed tomography [CT] and cavography) associated with filter placement, follow-up, and filter retrieval procedures were assessed for attempted and successful retrieval rates and filter-related complications. During the review period, 562 Celect Platinum filters were placed in 556 patients. Outcome and evaluable imaging data (CT and cavography) were available from 335 patients, with median CT follow-up time of 45days (average, 126days) and median cavography follow-up time of 90days (average, 102days). IVCF leg perforation of the inferior vena cava wall >3mm was identified in 65 cases (19.4%) on follow-up imaging (64 cases). In addition, filter tilt >15 degrees was identified in 4 filters (1.2%), filter migration >2cm in 1 filter (0.3%), and occlusive filter or inferior vena cava or iliac vein thrombus in 11 filters; no filter fracture was observed. One case of breakthrough pulmonary embolism and two additional indeterminate cases were identified on follow-up CT pulmonary angiography (2.6%-7.7%). Retrieval was successful in 155 of 155 patients (median indwell time, 90days; range, 1-445days); an advanced retrieval technique was used in 11 retrievals. The outcomes for the Celect Platinum filter were comparable to those previously reported for the first-generation Celect filter in all categories assessed.

Deep Vein Thrombosis Interventions in Cancer Patients.

The presence of cancer increases the risk of deep vein thrombosis (DVT), DVT recurrence, and treatment-related bleeding, and therefore offers distinctive clinical considerations when planning treatment. Anticoagulation with a low-molecular-weight heparin is the preferred initial and long-term therapy in cancer patients. Inferior vena cava filters may be used judiciously for patients with cancer-related DVT who have contraindications to anticoagulation or who exhibit breakthrough pulmonary embolism (PE) despite anticoagulation, but should be removed when the PE risk is felt to subside. Because moderate-quality evidence suggests that the use of catheter-directed thrombolysis (CDT) can prevent the postthrombotic syndrome, cancer patients with acute iliofemoral DVT, low expected bleeding risk, and good functional status may reasonably be considered for CDT if DVT-related sequelae are likely to be a dominant contributor to the patient's clinical condition, functional status, and quality of life. In selected patients who have chronic venous symptoms from mass/nodal compression of the pelvic veins, endovascular stent placement may provide symptom relief. As current recommendations are based on very limited data, further studies would be welcome to better delineate the most appropriate use of endovascular therapies in patients with cancer.

Indwelling and Retrieval Complications of Denali and Celect Infrarenal Vena Cava Filters

PurposeTo compare indwelling and retrieval complications of Denali and Celect filters placed in the infrarenal inferior vena cava (IVC). Materials and MethodsA retrospective study was conducted over 2 years at a single institution in which 171 Denali and 162 Celect filters were placed in 333 patients with a mean age of 62.3 years ± 15.7 (161 men; 48.3%). Filter indications included venous thromboembolic disease (n = 320; 96.1%) and surgical prophylaxis (n = 13; 3.9%). A jugular approach was used to place 303 filters (91.0%). Computed tomography (CT) follow-up, complications, and retrieval data were obtained. ResultsFollow-up CT imaging was performed on 58 filters from each group with lower incidences of caval strut penetration (one vs 12) and filter tilt (one vs 15) in the Denali filter group (P = .002 and P < .001, respectively). There was no difference in incidences of breakthrough pulmonary embolism (P = .68). Retrieval attempts were performed on 43 Denali and 53 Celect filters with mean indwelling times at retrieval of 128.2 and 144.1 days, respectively (P = .40). Mean fluoroscopy time at retrieval was lower in the Denali group (3.1 min vs 6.0 min; P = .01). There were fewer cases of complex retrieval in the Denali group (n = 2 vs 10; P = .06). Tilt, fluoroscopy time, and air kerma were associated with complex retrieval (P = .04, P < .001, and P < .001, respectively). There was one Denali filter deployment complication that led to retrieval failure. ConclusionsThis study suggests that Denali filters are associated with lower incidences of strut penetration and filter tilt as well as shorter fluoroscopy time at retrieval compared with Celect filters when placed in the infrarenal IVC.

Retrospective Review of 516 Implantations of Option Inferior Vena Cava Filters at a Single Health Care System

PurposeTo retrospectively evaluate the safety, efficacy, and retrievability of Option inferior vena cava (IVC) filters. Materials and MethodsAll patients (N = 516; 247 women; mean age, 67.1 y ± 15.1; range, 19.5–101.6 y) who received an Option filter between August 2009 and March 2015 at a single health care system were analyzed. ResultsThe study duration was 68 months, with median clinical follow-up of 7.1 months (range, 1 d to 61.8 mo). During follow-up, 73 of 83 patients (88.0%) underwent successful filter retrieval, 153 died (including three after successful retrieval), and 293 remained alive with filters in situ. Seventeen cases of breakthrough pulmonary embolism (PE) occurred (3.4%). Among 323 patients with direct filter imaging, there were two cases of tilt > 15°, one case of filter deformity, 16 cases of intracaval migration > 2 cm, and no cases of filter fracture. There were six cases of caval occlusion, nine cases of thrombus trapped inside the filter, and 57 cases of limb penetration on computed tomography scans or radiographs of the IVC. Retrieval failures were attributed to filter tilt or tip embedment in the caval wall (n = 4), complete IVC thrombosis (n = 3), thrombus inside the filter (n = 2), or inability to disengage filter legs (n = 1). Recurrent deep vein thrombosis occurred in 34 patients, including 32 with filters in situ and two whose filters had been removed. ConclusionsMost Option filters were left in situ for permanent indications. Rates of successful retrieval, device-related complications, and breakthrough PE were similar to those associated with other retrievable filters.

Acute Refractory Hypotension 24 Hours Post-Inferior Vena Cave Filter Insertion Complicated by Early Phlegmasia Cerulea Dolens

We present a case of a 67-year-old man with T4aN3bM0 gastric adenocarcinoma who developed refractory hypotension 24 hours post-inferior vena cave filter (IVCF) insertion for a new finding of pulmonary embolism (PE) and ongoing melena stool. After 18 hours of aggressive 20 L intravenous fluid resuscitation in the ICU followed by vasopressors and intravenous antibiotics, a point-of-care echocardiography did not reveal right ventricular strain and a non-contrast CT scan of the abdominal and pelvis was reported as not remarkable. But his lower limbs became progressively edematous and swollen while his upper limb maintained its normal circumference. At 24 hours post-ICU admission, his lower limbs had worsened with severe pain and pallor. The compartmental pressure measurements were in the high normal ranges. At morning rounds, the complete occlusion of the IVCF causing severe hypovolemic shock was considered and re-review of the non-contrast CT abdomen and pelvis showed complete collapsed IVC above the IVCF. The IVC below the IVCF was distended, as were the common and external iliac veins bilaterally concerning for extensive venous thrombosis and early phlegmasia cerulea dolens (PCD). The patient was treated with local catheter-directed thrombolysis with thrombus maceration and aspiration followed by localized direct tissue plasminogen activator (tPA) infusion and systemic heparin infusion. The patient’s refractory hypotension resolved quickly and had surgery to remove his gastric tumor 8 days post-IVCF insertion. The placement of IVCF in a patient with known malignancy can greatly increase the risk for additional thrombus formation. But in our patient the speed is unprecedented, in which complete vena cava thrombosis (VCT) occurred at the site of the IVCF and below and its mechanism of causing refractory hypotension is rare. The consideration of PCD in a patient with refractory hypovolemic shock post-IVCF insertion followed by aggressive fluid resuscitation and worsening lower limb pain and discoloration remains a rare but important differential diagnosis. J Med Cases. 2015;6(8):353-357 doi: https://doi.org/10.14740/jmc2204w

Strut Penetration: Local Complications, Breakthrough Pulmonary Embolism, and Retrieval Failure in Patients with Celect Vena Cava Filters

PurposeTo investigate strut penetration in patients with Celect filters, specifically local complications and association with breakthrough pulmonary embolism (PE) or retrieval failure. Materials and MethodsA retrospective single-center study was conducted to evaluate patients who received Celect filters between January 2007 and May 2013. A total of 595 filters were placed during the study period. Primary indications included thromboembolic disease (93%) and primary surgical prophylaxis (7%). Complications and retrieval data were assessed by computed tomography (CT) and electronic medical records. ResultsA total of 193 patients underwent follow-up abdominal CT at a mean follow-up interval of 176.2 days (range, 0–1,739 d). The rate of strut penetration more than 3 mm outside the caval wall was 28.5% (n = 55). One patient had CT evidence of clinically major strut penetration (1.8%) with strut compression of the right ureter causing hydronephrosis. Indwelling filter time longer than 100 days was associated with strut penetration (P < .001). Age, sex, and history of thromboembolic disease were not associated with strut penetration (P = .51, P = .81, and P = .89). Sixty-three patients presented for follow-up CT pulmonary angiography at a mean of 128.1 days (range, 1–895 d). The rate of breakthrough PE was 12.7%. The overall retrieval success rate was 96.7% (n = 150). Strut penetration was not associated with breakthrough PE or retrieval failure (P = .49 and P = .22). ConclusionsAlthough strut penetration is a common complication with Celect filters, there is no association with breakthrough PE or retrieval failure. CT evidence of local complications associated with strut penetration is rare.

Comparision of Clinical Findings with CTPA Findings in Pulmonary Embolism

Comparision of Clinical Findings with CTPA Findings in Pulmonary Embolism

The clinical application of combined dual-energy CT pulmonary angiography and indirect venography

Objective To assess the usefulness of combined dual-energy CT pulmonary angiography (DE-CTPA) and indirect CT venography (CTV) in the diagnosis of venous thromboembolism (VTE) . Methods Forty-nine patients with leg swelling suspected of pulmonary embolism (PE) underwent both DE-CTPA combined with CTV and lower extremity venous ultrasound (US) in 1—2 days prior to CT.Image quality of CTPA and dual energy lung perfusion image (DEPI) was rated using a 5-point scale and the coherence between CTPA and DEPI was analyzed by Kap pa statistics.The ability of CTV and US in the diagnosis of deep venous thrombosis (DVT) was compared by Chi-square test. Results Twenty-nine of 49 patients were identified with PE by DE-CTPA,including 28 patients identified by CTPA and one more by DEPI,and 21 patients were found to have both PE and DVT.Both DE-CTPA and DEPI had positive findings for pulmonary embolism in 19 patients and both had negative findings in 18 patients.There was a moderate agreement between DEPI and DE-CTPA in the assessment of PE (Kappavalue=0.7534).Thirty-eight patients with DVT were identified by US,while 35 patients were identified by CTV.Among the 35 patients with DVT identified by CTV,pelvic veins were involved in 25 patients,while the inferior vena cava was involved in 3 patients.There was no significant difference between CTV and US in the diagnosis of DVT (P=0.625).The detection rate of VTE with DE-CTPA combining CTV was 30.6% higher than that with CTPA alone. Conclusions The combined DE-CTPA and CTV achieves“one-stop”examination.It not only provides evaluation of PE and DVT and increases detection of VTE,but also depicts perfusion defect of pulmonary parenchyma that corresponds to PE. Key words: Pulmonary embolism; Venous thrombosis; Lower extremity; Phlebography; Tomography,X-ray computed

Clinical, laboratory and computed tomography results in pulmonary embolism: Retrospective evaluation of 205 patients

With this study, we aimed at evaluating demographic data, clinical, laboratory findings in pulmonary embolism (PE) and the relationship of these findings with the embolism location region and responses of the patients to the treatment of the embolism in order to contribute to the patient management in decreasing mortality. Clinical findings, accompanying diseases, risk factors, serum D-dimer and creatinine levels, imaging modalities and mortality rates of 205 patients (female: 98, male: 107) diagnosed with PE were examined retrospectively. The relationship between the qualifier variables was evaluated using Chi-square test. Average age of the patients was 61.55±14.44 years and 86 (42%) patients were above 65 years. Most common complaint was dyspnea (85%), most frequent coexisting disease was congestive heart failure (19%). Deep vein thrombosis (DVT) (30.7%) was the most frequently seen risk factor. Pulmonary embolism was mostly in the right lobe pulmonary artery (32.1%). It was observed that the higher ages of patients the more frequency of proximal located embolism was (p<0.005), especially lobar artery involvement was observed to be high (p=0.032). An early mortality rate was 4.9% and late mortality rate was 11.2%. In the patients with complaint of dyspnea who are at elder ages and have accompanying diseases, PE should be considered. PE is generally localized in the main pulmonary arteries, which emphasizes crucial importance of early diagnosis and treatment in reduction of mortality.

Echocardiographic findings in pulmonary embolism: An important guide for the management of the patient

Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most part, universally available tool for the risk stratification of patient with acute pulmonary embolism. Because of its low sensibility, an echocardiogram is best indicated in a patient in whom hypotension and or shock are suspected to be due to pulmonary embolism. Pertinent findings in the echocardiogram can justify the use of fibrinolytic therapy. Most common echocar-diographic findings in acute pulmonary embolism are: dilatation of the right ventricle, right ventricular dysfunction in some cases with preservation of the motility of the apex, dilatation of the inferior vena cava with lack of collapse during inspiration flattening of the interventricular septum suggesting right ventricular pressure overload and pulmonary hypertension based on the jet of tricuspid regurgitation if available.