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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our objective was to investigate possible factors implicated in either early death from or scintigraphic resolution of pulmonary embolism. To that end we conducted a retrospective study of 116 patients with either a high likelihood of pulmonary thromboembolism (PTE) diagnosed by scintiscan or with a fair probability of PTE by scintiscan accompanied by a positive phlebograph. The images were taken upon admission, at 7 days, 10 days and 6 months. The factors analyzed were age, sex, trauma, immobility, surgery, obesity, hemiplegia, venous insufficiency, cardiopulmonary disease, neoplasia, chest X-ray and ECG alterations, D(A-a)O2 and size of perfusion defects upon admission and 7 to 10 days later. We performed single-variable analyses and multiple logical regression analyses using perfusion defect at 6 months as the dependent variable. The early mortality rate (13%) was higher in patients with neoplasms, a larger alveolar-arterial index and greater perfusion defects upon admission. Scintiscans became normal in 28%. Multivariate analysis to predict total or partial resolution at 6 months showed that size of perfusion defects at 7 to 10 days was the best predictive factor. A cutoff point was calculated by analyzing the ROC for this factor. Thus, when the defect at 7 to 10 days was equal to or greater than 1 segment, the probability of residual defects remaining after 6 months was twice as great (sensitivity 83%, specificity 57%). In conclusion, early death was more likely in PTE patients with neoplasms, larger defects upon admission and greater alveolar-arterial difference. Scintigrams showed resolution 6 months after admission in 28%. The size of perfusion defects 7 to 10 days after admission was the factor that best predicted total of partial resolution at 6 months.
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PMID:[The prognostic factors for early mortality and for total or partial gammagraphic resolution in venous thromboembolic disease]. 925 67

We report the results of surgical treatment of iliofemoral vein thrombosis in 49 pregnant women in a seven years period. The patients mean age was 26.5 years (range 18-41 years). Isolated descending pelvic vein thrombosis (PVT) occurred between the 20th and 36th week of pregnancy and was located predominantly left sided. 89.8% of PVT developed in the late period of gestation, three cases of pelvic vein thrombosis were diagnosed after vaginal delivery. An iliac vein spur in one patient and an AT-III deficiency in two cases were registered as additional risk factors. After venous catheter thrombectomy an arteriovenous fistula between the superficial femoral artery and the femoral vein was performed to increase blood flow and velocity in the pelvic veins. Abdominal delivery was performed simultaneously, if thrombosis occurred after the 34th week of pregnancy. Late re-thrombosis was registered in 4 patients (9.0%) after a mean follow-up of 42 months. We have seen symptoms of mild, not life threatening pulmonary embolism in two patients on the first postoperative day (complication rate 4.0%). Re-occlusion rate was high (3/5) after surgical thrombectomy carried out between the 20th and 26th week of gestation. Risk factors were an AT III deficiency in two cases and the continued compression syndrome of the pelvic veins caused by the enlarging uterus. In the late period of gestation surgical thrombectomy of PVT is the preferential method of treatment in selected patients with good therapeutical results. The operation reduces the risk of future venous insufficiency and post-thrombotic syndrome in the young female patients.
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PMID:[Results of surgical treatment of pregnancy-associated pelvic vein thrombosis]. 930 88

Defects as evaluated by lung perfusion scans may persist even 6 months after pulmonary embolism (PE), when treatment is withdrawn. The aim of this study was to evaluate the effect of several potential factors on the resolution of lung perfusion defects, both during the first days and at 6 months, when patients were discharged. In a retrospective follow-up cohort study we included 102 patients with PE, diagnosed lung from a ventilation/perfusion (V'/Q') scan, following Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) criteria, together with a phlebographic study of lower extremities or angiography. Lung perfusion scan was performed at diagnosis, and in two follow-up evaluations, at 7-10 days and at 6 months. Potential factors studied were: age; sex; presence of underlying cardiac or pulmonary disease; venous insufficiency; alveolar-arterial pressure difference for oxygen; delay in diagnosis; abnormalities in electrocardiogram or chest radiograph; and the size of defects as shown in lung perfusion scans. All factors were studied with regards to the size of the defects at the two follow-up evaluations, through a univariate statistical analysis and two multiple stepwise regression analysis. Multivariate statistical analysis selected four factors: size of defects at diagnosis; prior cardiopulmonary disease; delay in diagnosis; and sex, as synergistic variables to predict defect size at 7-10 days. On the other hand, the defect size at 7-10 days was the only variable selected as a predictor of the size of defects at 6 months. Resolution of pulmonary defects during the first days after diagnosis of pulmonary embolism is influenced by the initial defect size, prior cardiopulmonary diseases and sex. The size of residual defects at 6 months depends mainly on the size of defects at 7-10 days.
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PMID:Prognostic factors in restoration of pulmonary flow after submassive pulmonary embolism: a multiple regression analysis. 959 2

Coagulation-related complications are a frequent cause of death following hip replacement surgery. Venographically-proven deep vein thrombosis (DVT) is found in a high frequency. Most cases have no symptoms. Fatal pulmonary embolism (PE) may develop from subclinical thrombi. In addition, arterial thromboses may induce serious cardiovascular events and an unknown number of patients may develop cardiorespiratory insufficiency, due to non-fatal venous PE. Finally, several patients may develop venous insufficiency. Recent prospective double-blind studies have shown that the frequency of deep vein thrombosis increased after hospital discharge in patients undergoing hip replacement surgery. Prolonged thrombo-prophylaxis with low-molecular-weight heparin (dalteparin or enoxaparin) is recommended for at least 5 weeks after the operation.
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PMID:Thromboprophylaxis in hip arthroplasty. New frontiers and future strategy. 1137 55

Streptokinase, urokinase, tissue plasminogen activator and similar drugs can all cause lysis of venous thrombi and pulmonary emboli, but there is small evidence that accelerated lysis achieves a significantly better clinical outcome, on average, in the shorter or longer term, than heparin alone. Thrombolytic therapy for deep leg vein thrombosis aims to restore flow and to preserve venous valves, and so to prevent chronic post-phlebitic disability, but no trial has convincingly demonstrated that the last can be achieved in more than a few patients. Only a small minority of people with extensive proximal thrombosis develop disabling post-phlebitic venous insufficiency, and there are no good clinical predictors of this outcome. As a result, any widespread use of thrombolytics would bring an immediate risk of major bleeding to many people who will never be destined to develop a clinically important problem. Thrombolytic therapy after venous thrombosis should be avoided except, perhaps, in a few carefully selected patients with severe obstruction. The case for using thrombolytics after recent pulmonary embolism is strongest in the limited number of patients with ongoing hypoxia, respiratory distress, pulmonary hypertension and right heart failure, because thrombolytic therapy often achieves an impressive and almost immediate clinical benefit in this clinical setting. Whether early relief from pulmonary artery obstruction translates into longer-term advantage over heparin remains uncertain, however, because no comparative trial has ever shown these drugs to reduce mortality after pulmonary embolism. In all cases, both the physician and the patient must balance the certainty of an immediate bleeding risk against the uncertainty of a better than marginal real benefit.
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PMID:Thrombolytic therapy for venous thrombosis and pulmonary embolism. 1033 Oct 98

Deep venous thrombosis is an uncommon but feared complication in pregnancy. The treatment of choice in most centers is heparin and compression stockings, which effectively prevents pulmonary embolism, but the incidence of chronic venous insufficiency with skin change and ulcers after such treatment is reported to be up to 65%. In the period 1985-93, thirty-nine pregnant women were treated for femoroiliacal venous thrombosis (FIVT) with operative thrombectomy, arteriovenous fistula and anticoagulant therapy. The aim of this study was to examine those of the women who subsequently had been pregnant again. The pregnancy and delivery were closely monitored and the frequency of clinically detected as well as objectively measured venous insufficiency was recorded. Nineteen of the women subsequently became pregnant again, resulting in 25 deliveries. They were investigated at the Coagulation Laboratory and treated with phenendione or low molecularweight heparin. All pregnancies proceeded successfully. None showed clinical signs of rethrombosis during the subsequent pregnancy. At follow up 11 patients had dilated or varicose veins, nine had a closed iliaca at ultrasound examination, none had skin changes or ulcers. We conclude that women treated for FIVT in pregnancy with thrombectomy followed by anticoagulant therapy may undergo a new pregnancy with low risk of obstetrical complications and with a low risk of developing rethrombosis or chronic venous insufficiency.
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PMID:[Venous thrombectomy in pregnancy. A follow-up study]. 1056 39

Deep vein thrombosis (DVT) is of clinical importance and carries the short-term risk of pulmonary embolism. Patients undergoing orthopedic surgery are at particular risk of DVT. Pharmacological prophylaxis to prevent thromboembolic events has become standard practice in this patient group. However, DVT may also lead to long-term venous insufficiency, causing disabling symptoms of swelling, chronic pain, and skin ulceration, imposing substantial health-care costs. Prevention of these long-term sequelae of DVT, termed post-thrombotic syndrome (PTS), may be of equal or even greater clinical, economic, and medicolegal significance than avoidance of the short-term effects. Surveys suggest that PTS is present in 30%-70% of patients, 5 years after an initial symptomatic or asymptomatic, proximal or distal DVT. Post-thrombotic syndrome is not reliably prevented by treatment of the initial DVT with anticoagulant therapy or thrombolysis. Therefore, prevention of DVT is the only effective approach to PTS prevention. Pharmacological thromboprophylaxis prevents venographically proven DVT in patients following orthopedic surgery, and is now recommended by North American and European consensus statements. Uncertainties remain, however, regarding the optimal duration of postsurgical prophylaxis.
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PMID:Deep vein thrombosis: beyond the operating table. 1087 26

Prophylaxis for venous thromboembolism is an area that has received intense study in certain conditions, but less than adequate coverage in other areas. In considering who needs prophylaxis, patients are categorized into levels of risk. Clinical venous thromboembolism can be correlated to these levels of risk. Methods of prophylaxis include pharmacologic, mechanical, and combinations of these. Each category of surgical and medical patient requires specific types of prophylaxis. In certain orthopedic indications, the length of prophylaxis outlasts the inpatient hospital stay and may be as long as 1 month after discharge. Even with the best prophylaxis today, the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) is decreased by only approximately 70% to 80%. Further developments should allow for greater declines in the rates of venous thromboembolism, with its subsequent short-term consequence of pulmonary embolism and lower extremity morbidity and long-term consequence of the disabling syndrome of chronic venous insufficiency (CVI).
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PMID:Current status of pulmonary embolism and venous thrombosis prophylaxis. 1100 60

We investigated the outcome of deep-vein thrombosis (DVT) in the calf after total knee arthroplasty (TKA) in 48 patients (45 women and three men) by clinical assessment and venographic study between three and four years after surgery. The mean age of the patients was 67.2 +/- 7.7 years (52 to 85) and the mean follow-up was 42.6 +/- 2.7 months (38 to 48). The diagnosis was osteoarthritis in 47 patients and rheumatoid arthritis in one patient. There were 44 calf thrombi, four popliteal thrombi but no thrombi in the femoral or iliac regions. Of the 48 patients, 24 were clinically symptomatic and 24 were asymptomatic. Clinical examination was carried out on 41 patients, of whom 37 underwent ascending venography. Seven were evaluated by telephone interview. No patient had the symptoms or signs of recurrent DVT, venous insufficiency in the affected leg, or a history of pulmonary embolism. No patient had been treated for complications of their DVT. Thirty-six of the 37 venographic studies were negative for either old or new DVT in the affected leg. One patient had residual thrombi in the muscular branches of the veins. Our study shows that deep-vein thromboses in the calf after TKA disappear spontaneously with time. No patient developed a recurrent DVT, proximal propagation or embolisation. Treatment of DVT in the calf after TKA should be based on the severity of the symptoms during the immediate postoperative period.
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PMID:Outcome of calf deep-vein thrombosis after total knee arthroplasty. 1293 2

Deep vein thrombosis (DVT) occurs in one-quarter of a million individuals annually in the United States and results in significant disability from pulmonary embolism and chronic venous insufficiency, especially when the proximal iliofemoral is involved. Treatment has centered on early institution of adequate anticoagulation to prevent thrombus propagation and embolism, but anticoagulation alone does not always restore venous patency and many patients are left with venous outflow obstruction and valvular incompetence-the anatomic underpinnings of the postthrombotic syndrome. Various strategies have been used to restore patency of thrombosed veins, including open surgical thrombectomy, pharmacological thrombolysis, and percutaneous mechanical thrombectomy. Each modality has benefits and shortcomings. Surgical thrombectomy had previously been abandoned secondary to poor long-term results. More recently, with improved techniques and better patient selection, surgical thrombectomy has regained a therapeutic role in treating acute DVT in young patients with short segment occlusions. The advent of percutaneous techniques has allowed thrombolysis, percutaneous mechanical thrombectomy, and stenting to be used in conjunction with each other-allowing for better resolution of venous clot burden than when an individual modality is used alone. Practitioners who treat patients with DVT should be familiar with all the options available to restore venous patency, preserve valvular function, and thereby minimize the risk of late postthrombotic complications.
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PMID:Invasive approaches to treatment of venous thromboembolism. 1533 78


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