Pulmonary Artery Thromboembolism Research Articles

Predictors of Chronic Thromboembolic Pulmonary Hypertension

to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). We included in this study 210 patients hospitalized withdiagnosis ofsubmassive and massive PTE from 2013 to 2017. In 1to3years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity ofpulmonary artery vascular bed involvement was assessed bymultislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Intheprocess of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable- shin veins, popliteal, and common femoral veins, unfavorable- superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated orlow molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic oranticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post-infarction cardiosclerosis. Ontheother hand, age, gender, degree of severity at the time of admission, presence ofinfarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history oftrauma and malignancies, cardiac arrhythmias produced nosignificant impact on the development of CTEPH.

DIFFICULTIES AND PECULIARITIES OF EARLY DIAGNOSTICS OF PULMONARY EMBOLISM

The retrospective analysis of 22 patients’ clinical records with the verified pulmonary artery thromboembolism (PE) with various outcomes of a disease is carried out. Hypodiagnostics of PE at a pre-hospital stage is revealed, the predictive importance of Revised Geneva Score scale is shown, predictors of a lethal outcome at a PE are defined: arterial hypotension, tachycardia, McGinn-White syndrome (SI-QIII phenomenon).

КОМПЛЕКСНИЙ ПІДХІД ДО РОЗМЕЖУВАННЯ ПЕРВИННОГО ТА ВТОРИННОГО ВАРІАНТІВ ІПОХОНДРИЧНИХ СТАНІВ В ОСІБ З СЕРЦЕВО-СУДИННОЮ ПАТОЛОГІЄЮ

З метою систематизувати клініко-анамнестичні, клініко-психологічні та психопатологічні дані щодо розмежування первинного та вторинного варіантів іпохондричних станів в осіб що перенесли кардіоваскулярні катастрофи, було оглянуто 100 хворих на кардіологічну патологію із проявами іпохондричної симптоматики, що перенесли інфаркт міокарду, тромбоемболію легеневої артерії тощо. Хворих було розділено на групи за ознакою варіанту іпохондричних симптомів, що було презентовано. Для встановлення рівнів та структури проявів іпохондричної симптоматики у контингенті дослідження, а також для встановлення патоперсонологічних характеристик хворих, особливостей внутрішньої картини хвороби, спектра реакцій на психогенні фактори у структурі захворювання були використані: «Опитувальник соціальної значущості хвороби Сердюка», опитувальник «Самопочуття, активність, настрій», «Опросник совладания со стрессом» (Версія Рассказовой - Гордеевой - Осина). Для дослідження психоптологічних проявів іпохондричного стану використовувалась клінічна шкала загальних психопатологічних симптомів (GPS) у складі PANSS. За результатами дослідження систематизовано клініко-анамнестичні, клініко-психологічні та психопатологічні дані щодо розмежування первинного та вторинного варіантів іпохондричних станів в осіб що перенесли кардіоваскулярні катастрофи. &nbsp

Pulmonary Thromboembolism in Behcet’s Disease: A Case Report

Behcet’s disease is a vasculitis which presents as recurrent oral and genital aphthous ulceration, uveitis and skin lesions. Unlike other types of vasculitis, venous system involvement is a common manifestation of Behcet’s disease. Despite the high incidence of deep vein thrombosis in Behcet’s disease, pulmonary artery thromboembolism (PTE) is a rare complication. In this article, we report on a 44-year old man who experienced recurring painful oral ulcers, bilateral panuveitis, superficial phlebitis and positive pathergy which had led to a diagnosis of Behcet’s disease 12 years earlier. He developed sudden onset dyspnea, pleuritic chest pain and hemoptysis two days before admission. The patient had tachypnea and mild respiratory distress at the time of admission. CT angiography showed filling defects in the inter-lobar arteries of both lungs with sub-segmental consolidation. A lung perfusion scan showed multiple segmental and sub-segmental perfusion defects in both lungs which did not match the ventilation scan. A diagnosis of PTE was made and anticoagulation with enoxaparin and warfarin was begun. The tachypnea, chest pain and hemoptysis disappeared after three days and he was discharged after 10 days with warfarin. His disease was in complete remission at eight months after discharge.

Endovascular treatment of acute pulmonary embolism

Thromboembolism of pulmonary artery is life-threatening condition due to acute right ventricle failure and cardiogenic shock. System thrombolysis is the main way of reperfusion in massive pulmonary embolism with a very high risk of fatal hemorrhage complications. There is a popular revascularization method in two last decades such as endovascular treatment. It allows to recover the blood flow into occluded pulmonary arteries up to three weeks after confirmed embolism episode and to decrease major bleeding risks. Now trials corroborate the high efficacy and safety of interventional treatment the usage of which would allow to improve prognosis in massive pulmonary embolism.

The Added Value of Multislice CT Venography in Pre-Operative Assessment of the Deep Venous System of Both Lower Limbs; Correlation with the Doppler/US Findings

AbstractBackground: Deep venous thrombosis is very common disease affecting the public health, so proper assessment and treatment improve the quality of patient's life. In addition DVT may cause pulmonary arterial thrombo-embolism.Aims of the Study: To assess the value of CT venography in detailed assessment of the lower extremities deep venous system in comparison with the Doppler US findings for patients with swollen limbs referred from vascular clinics.Patients and Methods: The study was carried over sixty patients (19 males and 41 females, age range 21-56 year old) from November 2016 to December 2017. Detailed evaluation of all examined patients was done using Doppler/US by experienced sonologist and multislice CT venography with calculation of the body mass index for each patient.Results: Sixty patients (19 males and 41 females, age range 21-56 year old), body mass index range (20-34), Doppler findings showed that 54 patients were free of deep venous thrombosis and 6 patients with chronic deep venous thrombosis. However, multislice CT venography showed that 48 patients were free of deep venous thrombosis and 12 patients with chronic deep venous thrombosis. Also according to these results patients are classified as primary and secondary varicose veins.Conclusion: Based on our results, multislice CT venog-raphy is a non operator dependant technique adding great clinical value in assessment of the patency and detailed delineation of the deep venous system, especially the abdominal and pelvic veins.

CLINICAL ANALYSIS OF A PATIENT WITH ANTIPHOSPHOLIPID SYNDROME AND SUB-MASSIVE PULMONARY EMBOLISM

The article presents a clinical analysis of the patient with a newly developed unprovoked episode of venous thromboembolic events. It discusses the challenges in the diagnosis of pulmonary embolism, the need for thrombolytic therapy in patients with pulmonary arterial thromboembolism of medium risk. The guidelines for diagnosis of antiphospholipid syndrome in accordance with modern principles are provided. It also considers the issues of anticoagulant treatment.

COMORBID PATHOLOGY IN PATIENTS WITH ATRIAL FIBRILLATION AND PULMONARY EMBOLISM

Aims. Based on the data of the Register of new cases of pulmonary arterial thromboembolism (PE) in Tomsk hospitals (2003–2012), to study the development of thromboembolism in patients with atrial fibrillation (AF). Results. The database of the Register of new cases of hospital PE included data from patients with PE (751 people) who died in the city’s hospitals and underwent autopsy. Among them, 238 patients were identified who had AF before the development of PE (in 185 patients — a permanent form of AF, in 53 — paroxysmal and persistent). Among metabolic disorders, 25% of patients showed obesity of various degrees and 27% had type 2 diabetes. Chronic heart failure 2 stages in the phase of decompensation was diagnosed in 41% of patients. The number of verified cases of PE in persons with AF did not differ significantly from patients without fibrillation and was 40%. According to autopsy data, pulmonary embolism is recognized as the main cause of death in more than half of people with AF (in 131 cases). A massive volume of pulmonary artery disease was detected in 109 patients with AF (46%). Among patients with thromboembolism from the right heart chambers, AF as a whole (regardless of form) was found in 56% of cases, that is, significantly more often than in patients with a source of embolism in the inferior vena cava (14.3%, p=0.005), veins of the lower limbs (27%, p<0.001) and veins of the pelvis (2.6%, p=0.014). Similar relationships were found in persons with chronic AF. For the paroxysmal form of differences between groups with different sources of embolism, it was not possible to identify. According to autopsy data, in patients with atrial fibrillation, the right heart was the source of PE in 121 patients (48%), 85% of them in the right atrial appendage.

THE CLINICAL-PHYSIOLOGICAL INDICES OF APPLICATION OF INTERRUPTED PNEUMO-COMPRESSION IN PREVENTION OF THROMBOSIS OF DEEP VEINS AND THROMBOEMBOLISM OF PULMONARY ARTERIES

The review presents analysis and generalization of studies concerning therapeutic effect of interrupted pneumo-compression. The physiological differences underlining mechanisms of effecting of ascending and descending pneumo-compression are emphasized. The comparison with static pneumo-compression is carried out. The various technical approaches to application of pneumo-compression and molecular aspects of involvement of fibrinolytic mechanisms into effects of interrupted pneumo-compression are analyzed. The review uses both national and foreign scientific studies and monographs and tutorials. This comprehensive approach permits to analyze sufficiently wide specter of data confirming efficiency of preventive application of interrupted pneumo-compression for preventing thrombosis of deep veins and thromboembolism of pulmonary arteries.

Pulmonary Artery Intimal Sarcoma versus Pulmonary Artery Thromboembolism: CT and Clinical Findings.

ObjectiveTo describe CT and clinical findings of pulmonary artery intimal sarcoma (PAIS) compared with those of pulmonary thromboembolism (PTE), to investigate MRI and positron emission tomography (PET)-CT findings of PAIS, and to evaluate the effect of delayed diagnosis of PAIS on survival outcomes.Materials and MethodsTwenty-six patients with PAIS were retrospectively identified and matched for sex, with patients with PTE at a ratio of 1:2. CT and clinical findings of the two groups were compared using Student's t test or chi-square test. The effect of delayed diagnosis on survival was investigated using Kaplan-Meier analysis.ResultsThe most common tumor pattern in PAIS was tumoral impaction. Heterogeneous attenuation, wall eclipse signs, intratumoral vessels, acute interphase angles, single location, presence of lung ischemia, and central location were significantly more common in PAIS than in PTE (all p < 0.01). Levels of D-dimers and brain natriuretic peptide were lower in PAIS than in PTE (p < 0.05). In three patients of PAIS, long inversion time sequence MRI showed intermingled dark signal intensity foci suggestive of intermingled thrombi. All nine patients who had undergone PET-CT displayed hypermetabolism. Diagnosis was delayed in 42.3% of the PAIS patients and those patients had a significantly shorter overall survival than patients whose diagnosis was not delayed (p < 0.05).ConclusionThe characteristic CT and clinical findings of PAIS may help achieve early diagnosis of PAIS and make better survival outcomes of patients. MRI and PET-CT can be used as second-line imaging modalities and could help distinguish PAIS from PTE and to plan clinical management.

Levels of antithrombin III and D-dimers as predictors of pulmonary artery thromboembolism in patients with deep vein thrombosis

Aim. Search for predictors of pulmonary artery thromboembolism in patients with deep vein thrombosis among the indicators of hemostasis system. Methods. Retrospective analysis of indicators of hemostasis system was performed in 23 patients with defined pulmonary artery thromboembolism, 30 patients with deep vein thrombosis and 20 healthy volunteers. Values of platelet aggregation by Born method, concentration of circulating thrombocytic aggregates by Kohanna method, values of thromboelastometry, as well as blood levels of D-dimers and antitrombin III in arterial and venous blood were measured. Results. It was established that in patients from both thrombosis groups, haemostasis system changes are similar in nature: (1) a high value of Wu-Hoak is registered - more than 15 times higher in both arterial and venous blood compared to the control group; (2) platelet aggregation rates demonstrate hyperaggregation with all inductors, both in arterial and venous blood; (3) thromboelastography results are characterized by increased activity of thrombocytic hemostasis, prolonged clotting time, heightened clot strength compared to control in both arterial and venous blood flow. However, the difference was revealed between groups with and without pulmonary thromboembolism in venous blood levels of D-dimers and activity of antithrombin III. A function to predict pulmonary thromboembolism was constructed depending on the level of D-dimers and activity of antithrombin III in patients with deep vein thrombosis. Conclusion. The developed function for prediction of pulmonary artery thromboembolism can objectively assess the likelihood of pulmonary thromboembolism, which in turn allows minimizing risk and timely assessing the effectiveness of taken preventive measures.

Case of successful treatment of a high risk acute tele with hypothony in a patient with polymorbid pathology

The presented article features the management of a high-risk patient with polymorbid pathology: cancer, stroke and venous thromboembolism. In spite of anticoagulant therapy with heparin, unilateral deep vein thrombosis of the lower leg was complicated by a primary episode of verified acute bilateral pulmonary artery thromboembolism of high-risk with hypotension and bilateral infarct-pneumonia. After urgent diagnosis of PE had been made, the following management of the patient in the acute phase was suggested: timely modern replacement artificial ventilation of the lungs for eight days, vasopressor support for six days, anticoagulant therapy, fluid replenishment and effective in its results, enteral nutrition. The pattern of evolving pulmonary hypertension and acute right ventricular dysfunction, coagulation disorders was tracked down. Residual thrombosis proved to linger by detection of steep D-dimer rise on the ninth day of the acute period. The signs of thrombosis persisted despite anticoagulant therapy, with the simultaneous complete disappearance of blood clots according to computed tomography. That was accompanied by severe disorders of the heart rhythm recalcitrant to antiarrhythmic and electropulse therapy. Further treatment in the settings of a specialized center revealed occult extra routes of impulse conducting that justified necessity of catheter ablation. On the ninetieth day the patient was alive and stable. Presented approach of diagnostic and therapeutic steps proved to be effective.

Инцидентность венозных тромбозов в европейской популяции: роль хирургических вмешательств

У статті розглянуто інцидентність і роль хірургічних втручань у розвитку венозних тромбозів. За даними проведеного огляду встановлено, що понад 70 % тромбозів глибоких вен нижніх кінцівок після загальнохірургічних операцій перебігають безсимптомно, при цьому фатальна тромбоемболія легеневої артерії часто є першим і єдиним проявом венозного тромбозу, посідаючи третє місце в загальній структурі причин раптової смерті. Венозні тромбоемболічні ускладнення супроводжуються поверхневим тромбофлебітом у 25 % хворих, при цьому в більшості випадків діагностується тромбоз глибоких вен, а в 3,9 % випадків виникає тромбоемболія легеневої артерії. Серед чинників хірургічного ризику венозних тромбоемболій спостерігається зв'язок із загальною анестезією, тривалістю операції більше 2 год, тромбоцитозом, наявністю асциту, хронічної серцевої недостатності, гіпоальбумінемією.

Primary pulmonary artery sarcoma masquerading as pulmonary thromboembolism: a rare diagnosis unveiled

BackgroundPrimary pulmonary artery sarcomas are rare malignant vascular tumors and carry a very poor prognosis. Due to overlapping clinical and radiological features, the differentiation between pulmonary artery thromboembolism and pulmonary artery sarcoma can be challenging.Case presentationWe herein present clinical, radiological and pathological features of primary pulmonary artery high grade sarcoma (angiosarcoma) in a 59-year-old male. The patient presented with a history of breathlessness on exertion of 2-months duration and was misdiagnosed as massive pulmonary thromboembolism on initial CT imaging.ConclusionGreat similarity with significant degree of overlap in clinical and radiologic presentation makes differentiation of pulmonary artery sarcomas and thromboembolism a diagnostic challenge. Even though they are exceptionally rare, one should always consider it as differential diagnosis especially in cases with atypical clinical or imaging presentation.

Homocysteine and D-dimer levels and multilayer computed tomography for diagnosing pulmonary artery thromboembolism

Vessel Plus is an open acccess journal, which publishes articles related to vascular diseases, including acute respiratory distress syndrome, aneurysm, atherosclerosis, hypertension, stroke, peripheral vascular or pulmonary vascular diseases, etc.

The disorders of hemostasis system and thrombotic complications in oncologic patients having liver operation.

The surgical interventions in patients with malignant tumors of liver cause a development of various forms of syndrome of disseminated intravascular coagulation (DIC) with significant increasing of concentration of markers of intravascular blood coagulation against the background of dramatic decreasing of activity of factors of prothrombin complex, level of natural anti-coagulants and components of fibrinolytic system. The thrombosis of veins of various localization developed in 12 patients with subacute form of DIC. The application of low-molecular heparin in combination with concentrate of anti-thrombin III and freshly frozen plasma decreases intensity of intra-vascular blood coagulation and results in reduction of factors of coagulation and is an efficient and adequate method of treatment of thrombosis and thromboembolism of pulmonary artery in oncologic patients. The significant increasing of level of D-dimer, von Willebrand factor against the background of dramatic decreasing of prothrombin activity, content of antithrombin III and level of plasminogen are hemostasiologic factors of development of severe liver insufficiency. The corresponding timely diagnostic and correction permits to ameliorate results of surgical treatment of patients with malignant tumors of liver.

Diagnostics and treatment of inflammatory complications of thromboembolism of pulmonary arteries

Diagnostics and treatment of inflammatory complications of thromboembolism of pulmonary arteries

Possibilities of ultrasonic diagnostics of the pulmonary artery thromboembolism

Possibilities of ultrasonic diagnostics of the pulmonary artery thromboembolism

Surgical treatment of kidney cancer with extended inferior vena cava thrombosis: complications and long-term results

Objective. Analysis of factors affecting results of inferior vena cava (IVC) thrombectomy in patients with renal cell carcinoma. Materials and methods . Nephrectomy with thrombectomy from IVC was performed in 53 patients (31 (58.5 %) males and 22 (41.5 %) females) with extended thrombosis. Patient age was 35–76 years (mean age 58.7 ± 10.1 years). In 36 (68 %) patients stage Т3b was determined (mean thrombus length 5.28 ±0.32 cm), in 17 (32 %) patients – stage Т3с (mean thrombus length – 13.00 ±0.71 cm). Postoperative complications were evaluated in accordance with the Clavien–Dindo classification. Calculations were performed using statistics software SPSS Statistics 16. Results. No intraoperative complications were observed, mean blood loss was 714 (200–4000) ml. Use of the Cell Saver system allowed to perform reinfusion in the majority of patients. Blood transfusion of 200–500 ml was necessary in 15 patients. In 32 (60.3 %) patients no complications were observed. Grade I complications were observed in 2 (3.7 %) patients, grade II – in 15 (28.3 %) patients, IIIА grade – in 2 (3.7 %) patients, and grade IIIВ – in 1 (1.8 %) patient; there wasn’t any grade IV complications. Two (3.8 %) patients died of pulmonary artery thromboembolism. Correlation analysis has shown a high dependency of complications on thrombus size (r = 0.7) and blood loss volume (r = 0.6), and low dependency on tumor size (r = 0.44); complications weren’t affected by patients’ age (r = 0.1) or Karnofsky status (r = 0.0). Median overall survival was 48 months, 3-year survival was 57.1 %, median progression-free survival was 46 months, 3-year progression-free survival was 56.8 %; 90-day morbidity was absent. Three-year overall survival for рN0 was significantly higher than for рN1 (69 % vs. 25 %; р = 0.014). There was no difference in terms of survival between patients with supradiaphragmatic and subdiaphragmatic thrombi (р = 0.14). Conclusion . Results of our study show that surgical treatment of patients with renal cell carcinoma and extended IVC thrombosis is effective.

Estimation of poor prognostic factors in patients with pulmonary artery thromboembolism

To identify predictors of fatal outcome in hospitalized patients with risk factors (RF) for pulmonary artery thromboembolism (PATE) during its occurrence. To determine predictors of fatal outcome in patients with PATE, the data of a 10-year city hospital pulmonary embolism registry were used to analyze RF for PATE (according to European and Russian guidelines), complaints, medical histories, and laboratory and instrumental data, which can be identified at general surgery or general therapy hospital, as well as a nosological entity existing in the patients. According to the existing idea on thrombogenesis, RF for PATE and its fatal outcome, information about used treatment, and autopsy data, 137 parameters were selected in patients with PATE. For estimating the risk of death in patients with PATE, a logistic regression analysis was employed to make a mathematical model encompassing 10 indicators: bed rest; the presence/absence of lung diseases; chronic venous insufficiency; obesity; the symptom complex of cor pulmonale; postinfarction cardiosclerosis of the left ventricle, pericardial effusion; right atrial dilatation; right ventricular dilation; right ventricular systolic pressure >36 mm Hg as evidenced by echocardiography. The mathematical model built during the study allows the calculation of a risk for fatal outcome in the development of PATE for a specific patient in terms of its individual characteristics.