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

Endovenous techniques such as radiofrequency ablation (RFA) and endovenous laser therapy (ELT) have emerged as percutaneous minimally invasive procedures for ablation of incompetent great saphenous veins in patients with varicosity and venous insufficiency. Early reports showed safety and efficacy of both techniques, with excellent technical success rates and few major complications, such as deep vein thrombosis or pulmonary embolism. During our initial experience with ELT in 56 limbs of 41 patients, 39 underwent postoperative duplex scanning. We encountered three cases (7.7%) with thrombus extension into the common femoral vein. All three patients were anticoagulated, and a temporary inferior vena cava filter was placed in one. All remained asymptomatic. The thrombus resolved by 1 month in all three patients. Review of the literature revealed that the incidence of thrombus extension into the common femoral vein or deep vein thrombosis in published clinical series is 0.3% after ELT and 2.1% after RFA. This possibility warrants routine postoperative duplex scanning, more alertness during these procedures, and patient education on this possible complication.
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PMID:Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. 1601 76

Current evidence indicates that prolonged air travel predisposes to venous thrombosis and pulmonary embolism. An effect is seen once travel duration exceeds 6 to 9 hours and becomes obvious in long-haul passengers traveling for 12 or more hours. A recent records linkage study found that increase in thrombosis rate among arriving passengers peaked during the first week and was no longer apparent after 2 weeks. Medium- to long-distance travelers have a 2- to 4-fold increase in relative thrombosis risk compared with nontravelers, but the averaged absolute risk is small (approximately one symptomatic event per 2 million arrivals, with a case-fatality rate of approximately 2%) and there is no evidence that thrombosis is more likely in economy class than in business- or first-class passengers. It remains uncertain whether and to what extent thrombosis risk is increased by short-distance air travel or prolonged travel by motorcar, train, or other means. Most travelers who develop venous thrombosis or pulmonary embolism also have one or more other predisposing risk factors that may include older age, obesity, recent injury or surgery, previous thrombosis, venous insufficiency, malignancy, hormonal therapies, or pregnancy. Limited (though theoretically plausible) evidence suggests that factor V Leiden and the prothrombin gene mutation predispose to thrombosis in otherwise healthy travelers. Given that very many passengers with such predispositions do not develop thrombosis, and a lack of prospective studies to link predisposition with disease, it is not now possible to allocate absolute thrombosis risk among intending passengers or to estimate benefit-to-risk ratios or benefit-to-cost ratios for prophylaxis. Randomized comparisons using ultrasound imaging indicate a measurable incidence of subclinical leg vein thrombosis after prolonged air travel, which appears to increase with travel duration and is reduced by graded pressure elastic support stockings. Whether this surrogate outcome measure translates into clinical benefit remains unknown, but support stockings are likely to be more effective and have less adverse effects than the use of aspirin.
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PMID:Travel, venous thromboembolism, and thrombophilia. 1570 80

Significant spontaneous thrombus disintegration in deep venous thrombosis (DVT) occurs very infrequently. On the contrary, these thrombi are prone to appositional growth and migration into the pulmonary arteries. The development of chronic venous insufficiency due to postthrombotic syndrome is a frequent consequence of DVT. Therapeutic options in DVT include anticoagulation and recanalising procedures such as thrombolysis and thrombectomy. After appropriate indication assessment, the interventional radiologist can offer an efficacy-proven minimally-invasive vessel restitution approach by performing locoregional thrombolysis, pharmacomechanical therapy or, particularly in iliocaval thrombosis, mechanical thrombectomy. These methods not only serve to restitute of vessel patency, but also allow preserving venous valve function. In DVT with recurrent pulmonary embolism, retrievable filters with extended implantation duration can be deployed. In chronic proximal venous flow obstruction or in case of significant residual stenosis after thrombolysis, balloon angioplasty with stent implantation is the treatment modality of choice. Consequently, the radiologist can adopt an important role in the treatment of extensive venous disease. In this article, the treatment modalities concerning iliofemoral and iliocaval thrombosis are demonstrated and illustrated.
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PMID:[Iliofemoral and iliocaval interventions in deep venous thrombosis]. 1587 Oct 82

Venous thromboembolism (VTE) is a costly complication of hospitalization. The sequelae make it a concern for public health planners. The Nationwide Inpatient Sample (NIS) contains data for hospital discharges in the United States. These data were reviewed to determine their suitability for health policy planning. International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE were applied to the NIS data. The sample was queried for demographic information, mortality, length of hospital stay, diagnosis, and treatment. The rates were standardized for geographic region and disease acuity. Statistical analysis included descriptive reporting of means and event rates; analysis of variance and logistic regression were used for regional effects and modeling of mortality. Between 1993 and 2000, 636,814 discharges involved VTE (1.2%). This rate was consistent over time and within regions. Regional differences existed in the acceptance of new technology and hospital charges. Mortality varied from 6.3% (Midwest) to 7.9% (Northeast) and was associated with admission type, comorbidities, pulmonary embolism, and discharge from the Northeast region. White race, chronic venous insufficiency, and female gender were protective variables. The NIS data report a consistent mortality rate despite improved therapy. Regional diagnostic, treatment, and economic differences exist. The data are useful for the purposes of public health care planning and stimulating clinical trial questions.
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PMID:Venous thromboembolism: regional differences in the nationwide inpatient sample, 1993 to 2000. 1589 61

Pulmonary thromboembolism in the early postoperative period is rare. We present 2 cases of massive embolism that occurred soon after gastric bypass surgery. The first patient was a 32-year-old man, a smoker with a body mass index (BMI) of 52 kg/m2, obstructive sleep apnea-hypopnea syndrome and venous insufficiency in the lower extremities. Fatal cardiorespiratory arrest occurred 22 hours after surgery. Autopsy confirmed massive pulmonary thromboembolism. The second patient was a 48-year-old woman with a BMI of 40 kg/m2 who had undergone abdominal hysterectomy 2 months earlier. She survived cardiorespiratory arrest occurring 11 hours after surgery. There were no sequelae. The diagnosis of pulmonary thromboembolism was confirmed by transesophageal echocardiography. These patients undoubtedly had asymptomatic deep vein thrombosis before the operations. Prevention of pulmonary embolism is essential in high risk patients. The prophylactic measures usually applied are administration of low molecular weight heparin to prevent thrombosis, early ambulation, and the use of elastic compression stockings or intermittent pneumatic compression.
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PMID:[Two cases of early postoperative massive pulmonary thromboembolism after gastric bypass surgery]. 1751 75

Background. Total hip arthroplasty (THA) is today one of the most frequently performed major surgical operations in orthopedics. Although it is the standard method of treatment for advanced degenerative changes in the joint, the operation is accompanied by a high risk of thromboembolic complications. Material and methods. The present study is a retrospective analysis of two groups of THA patients. Group I consisted of 80 patients (average age 62) operated 1980-1983, for whom no prophylaxis was applied. In Group II, low molecular weight heparin (LMWH) was applied pre- and postoperatively. This group consisted of 94 patients (average age 63.5) operated in the year 1998. Thromboembolic complications were diagnosed on the basis of reported symptoms, physical examinations and additional tests (chest x-ray, EKG, gasometry). Results. In Group I there were 11 complications (13.75%), including 10 cases (91%) of deep venous thromboembolic disease of the lower extremities (DVT) and 1 case (9%) of pulmonary embolism (PE), while in Group II there were only 2 complications (2.1%), 1 DVT and 1 PE. The difference between groups was statistically significant. The risk factors for venous thromboembolic disease were analyzed. In both study groups, the predominant risk factors were prolonged duration of surgery and diabetes accompanied by venous insufficiency. Conclusions. The results of our analysis showed that the use of DVT prophylaxis with low-molecular heparin in the preoperative and postoperative period reduced the occurrence of thromboembolic complications.
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PMID:Thromboembolic complications after total hip arthroplasty and prevention of thrombosis: own experience. 1767 66

Surgical, post-surgical deep vein thrombosis (DVT), or thromboembolism is common and potentially catastrophic. Surgical DVT may lead to either immediate post-surgical morbidity or long-term morbidity by way of post-phlebitic syndrome and chronic venous insufficiency. In addition, surgery-associated pulmonary embolism (PE) may lead to significant morbidity or post-surgical mortality. As this surgical complication is so common, both the North American Consensus Conference Committee, sponsored by the American College of Chest Physicians, and the International Consensus Conference Committee, sponsored by the International Society of Angiology, have convened periodically during the past two decades to analyze the highest-quality published studies and publish clear standards and guidelines for prevention and treatment of surgical DVT and thromboembolism. The latest North American Recommendations were published in 2004 and the latest International Committee recommendations were released in 2006. These recommendations are summarized in this chapter, which offers the clinician the latest guidelines for prevention and treatment of surgery-associated DVT and thromboembolism.
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PMID:Prevention and treatment of surgical thrombosis and thromboembolism. 1880 82

Venous thrombosis is one of the most common vascular diseases. Without treatment, pulmonary embolism is a potentially life-threatening complication. Long-term complications are chronic venous insufficiency and post-thrombotic syndrome. Medical anticoagulation is currently the standard therapy, since it prevents appositional thrombus growth although it usually can not prevent the development of post-thrombotic syndrome. The structure of the thrombotic material often leads to partial recanalisation with residual stenosis. Early and sufficient systemic thrombolysis with adequate concentration may achieve disintegration of the thrombus and preservation of venous valve function. Supplementary to conservative therapy, local catheter thrombolysis is possible even in cases with contraindications for a systemic thrombolysis therapy. Additional interventional techniques reduce the required concentration of the thrombolytic. Venous stenosis can be treated by balloon angioplasty and stent implantation. This article reviews the different percutaneous treatment options as well as their application and usefulness in thrombosis of the lower torso.
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PMID:[Venous interventions--part 1: techniques and lower torso thromboses]. 1898 52

Deep venous thrombosis and pulmonary embolism are major health problems with potential serious outcomes. Acutely, pulmonary embolism may be fatal. In the long term, pulmonary hypertension can develop from recurrent pulmonary embolism. Often overlooked is post-thrombotic chronic venous insufficiency occurring as a result of deep venous thrombosis causing deep venous reflux or obstruction with skin changes and ulceration with adverse impact on quality of life and escalation of health care costs. Almost all hospitalized patients have at least one risk factor for venous thrombosis and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep venous thrombosis is approximately 10 to 40% among medical or general surgical patients and 40 to 60% following major orthopedic surgery. Abundant data from metaanalysis and blinded, randomized clinical trials have demonstrated strong evidence that primary thromboprophylaxis reduces deep venous thrombosis and pulmonary embolism and little or no increase in the rates of clinically important bleeding with prophylactic doses of low-dose unfractionated heparin, low-molecular-weight heparin or fondaparinuxem.
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PMID:[Prevention of venous thromboembolism in surgery, laparoscopic surgery and urology]. 1937 46

Pulmonary embolism is a well-known and feared complication of deep venous thrombosis (DVT). Patients who present with acute DVT are treated with anticoagulation therapy whenever possible. Nonetheless, anticoagulation therapy does not actually treat DVT by dissolution of thrombus but instead prevents the propagation of the existing acute DVT. Unfortunately, a significant number of patients, particularly those with femoral or iliofemoral DVT, will develop the postthrombotic syndrome (PTS), despite receiving anticoagulation therapy. PTS is clinically manifested by leg pain, swelling, skin discoloration, and venous claudication; venous ulceration is the most severe form of PTS. The natural course of DVT is that of recanalization of the thrombosed segment, which may ultimately lead to venous insufficiency and/or reflux because of damage to the venous valves. Venous insufficiency, valvular incompetence, and reflux following DVT are known to play a major role in the development of PTS. Catheter-directed venous thrombolysis has been proposed as a means of reducing the risk of PTS, as this will actually dissolve the acute thrombus, restore venous patency, and, most importantly, restore venous valve function. This review examines the different techniques of thrombolysis and thrombectomy.
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PMID:Acute deep vein thrombosis and thrombolysis. 1985 32


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