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

The frequency of pulmonary embolization seems to be increasing. Venostasis, intimal damage and hypercoagulability of blood are the more recognized causes of pulmonary thromboembolism. It is especially threatening to the elderly, obese, immobilized (for an accident or an operation) patients. Pulmonary isotopic scans or angiograms are most often relied upon to establish the diagnosis. A properly performed pulmonary angiography is necessary to establish or refute the diagnosis in almost every case. With the exception of the patients suddenly dying for a massive pulmonary embolism, the period of time between onset of symptoms and death is usually adequate for substantiating a diagnosis and promptly beginning a fit anticoagulation therapy using continuous intravenous heparin or fibrinolytic agents infusion. Although it is not proper to separate surgical and medical treatment of thromboembolism, the Authors, on the ground of their experience on 5 patients affected by massive pulmonary embolism, in 3 of whom was performed a successful embolectomy, think that heparin anticoagulation treatment is at any rate to apply for treating pulmonary embolism, but in patients in whom the shock is unresponsive to vasopressors or in whom anticoagulation therapy is controindicated, the surgical removal of pulmonary emboly, with the support of a pump oxygenator, is the treatment of choice for the acute massive pulmonary thromboembolism.
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PMID:[Massive pulmonary embolism. Clinical aspects and treatment]. 66 81

Pulmonary thromboembolism is a widespread problem and is an important cause of death in patients with a variety of medical and surgical conditions. There have been few significant advances in the understanding of the aetiology beyond additional evidence confirming the importance of Virchow's triad. An impressive list of epidemiological associations has been compiled, however. Some knowledge of the natural progression of the disease is required as an aid in the understanding of the application of the therapeutic and prophylactic measures available in the management of pulmonary embolism. It would seem that at least two-thirds of pulmonary emboli are non-fatal, and in these cases the natural resolution, even of comparatively large embolic masses, is very efficient in patients without pre-existing cardiopulmonary disease. Diagnosis may prove difficult and most ancillary investigations are of questionable value. On the other hand, pulmonary radio-isotope scanning is far more specific and pulmonary angiography is a comparatively simple and complication-free diagnostic procedure. Prophylaxis is a real and practical aim, especially following surgery or myocardial infarction. In these groups widespread clinical trials of prophylactic measures have been made possible by the objective radio-iosotope screening techniques. Mechanical means of preventing venous stasis and anticoagulation appear effective. In addition, low-dose subcutaneous heparin seems to be as useful as heparin in conventional dosage. Apart from conventional supportive therapy, there are three major approaches to the treatment of pulmonary embolism. Heparin remains the mainstay, particularly in the less severe cases, hopefully preventing propogation of thrombosis and recurrence of embolism, thus allowing resolution to take place. Thrombolytic therapy with streptokinase or urokinase is capable of producing far more rapid dissolution of pulmonary emboli with consequent theoretical advantages over heparin. No reduction in mortality has been shown using thrombolytic therapy. Patients who fail to respond satisfactorily to acute resuscitative measures may require pulmonary embolectomy.
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PMID:Pulmonary embolism: current therapeutic concepts. 77 78

Each case of pulmonary embolism associated with pregnancy or gynecology surgery which occurred over a 10-year period in a 500bed facility is reported in this retrospective study of incidence. 86 cases of pulmonary embolism were associated with all surgery over this time. 7 of these followed gynecological surgery, and 1 death occurred. 8 cases of pulmonary embolism occurred in pregnancy or postpartum patients, resulting in 1 maternal death. The paper discusses means of diagnosing and identifying patients at risk prior to surgery, but it is pointed out that in gynecological surgery especially, where deep vein thromboembolism is difficult to prove but is often the etiological factor, the incidence of embolism may be reduced but not abolished. Previously published reports on incidence of embolism postoperatively, which reviewed 3 million cases, reported .01-.87 incidence of fatal embolism. Though smaller, this series shows similar ratio of incidence. Identification of potential pulmonary thromboembolism cases includes awareness of classic symptoms of thrombophlebitis. Precipitating factors included venous stasis, trauma, hypercoagulants, and infection, especially pelvic infection. For treatment, once deep vein embolism is diagnosed, anticoagulants are indicated, and if pelvic veins are involved, so are antibiotics. The use of prophylactic anticoagulants in some pregnancy cases is discussed.
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PMID:Pulmonary thromboembolism associated with gynecologic surgery and pregnancy. 86 37

A prospective double-blind study was instituted in a group of 150 general surgical patients to test the effectiveness of mini-dose heparinization in the pre- and postoperative periods. There was a 21 per cent reduction in the incidence of deep venous thrombosis in the heparin treated group. A radiopharmaceutical imaging technique with 99m-technetium macroaggregated albumin was used to evaluate the deep venous system. The procedure proved to be simple, safe, and painless; however, it was difficult to differentiate venous stasis from deep venous thrombosis. A negative study was good evidence that deep venous thrombosis did not exist. An additional benefit of this procedure was that a perfusion lung study could be obtained which provided additional information regarding pulmonary embolism without injecting additional radiopharmaceutical. Again, the negative perfusion lung study provided more information.
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PMID:Evaluation of mini-dose heparin administration as a prophylaxis against postoperative pulmonary embolism: a prospective double-blind study. 109 61

While anticoagulation remains the treatment of choice for acute pulmonary thromboembolism, vena caval interruption represents an alternative for persons with either a contraindication to or a complication of anticoagulation. The authors retrospectively reviewed their experience with vena caval interruption over a recent 5-year period. One hundred seven Greenfield filters (Medi-Tech; Watertown, MA) and 13 external vena caval clips were used in 120 patients. Indications for caval interruption were: 1) contraindication to anticoagulation (38%), 2) recurrent pulmonary embolism despite adequate anticoagulation (23%), 3) prophylaxis (22%), and 4) complications associated with anticoagulation (17%). Vena caval interruption was successfully accomplished in 98 per cent of attempts. The overall complication rate was 7 per cent, with no procedure-related major morbidity or mortality. Sixty-five patients were followed for a mean of 36 months. In that interval, there were the following: 1) one instance of venous stasis ulceration, 2) two cases of late caval thrombosis, and 3) one person with documented recurrent pulmonary emboli. Significant edema requiring support stockings was reported in 16 per cent of persons with Greenfield filters and 37 per cent of those with caval clips. Vena caval interruption by use of the Greenfield filter is a safe and effective means of protecting against pulmonary embolism with few immediate or long-term complications.
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PMID:Vena caval interruption. 155 37

Pulmonary embolism is a potentially lethal complication among patients with acetabular fractures requiring surgery. The reliability, safety, and extent of efficacy of pharmacologic as well as existing nonpharmacologic anticoagulation prophylaxis in this patient group has not been determined. A careful analysis of the myriad factors acting on these patients who have had major trauma and have undergone a major surgical procedure about the hip prompted a change in our approach to prophylaxis in this patient group. In the period from March 1984 through October 1987, 51 patients having 52 acetabular fractures underwent osteosynthesis at the Wake Forest University Medical Center. Twenty-four patients had two or more identifiable risk factors and underwent insertion of a Greenfield filter for prevention of pulmonary emboli. Filters were inserted at the time of acetabular surgery with C-arm guidance via the internal jugular vein approach. The average time for insertion was 57 min. Placements were verified by plain roentgenograms. There were no complications during filter insertion. Four patients with filters (17%) developed leg edema; in three the edema was minor, and in one the filter trapped what could have been a fatal embolus but caused lower extremity venous stasis severe enough to result in peripheral lower extremity tissue loss. There were no pulmonary emboli (by clinical criteria). The remaining 27 patients had routine medical prophylaxis and no filters. In this group, two patients had a clinically evident pulmonary embolus (7%), and one of these patients died. Two other patients (7%) had minor chronic leg edema. In one of them, a proximal deep venous thrombosis in the lower extremity was documented with venography, requiring rehospitalization and anticoagulant therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture. 160 32

Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.
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PMID:Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens. 188 10

Greenfield filters were placed bilaterally in the iliac veins in five of 250 patients undergoing percutaneous filter placements. Four of the five patients had megacava (inferior vena cava diameter greater than 28 mm). In all patients, the filters were effective in preventing pulmonary embolism. Follow-up at 9 months in two patients revealed no changes of chronic venous insufficiency or venous stasis. Iliac filtration should be considered in patients in whom a caval filter cannot be placed because of large caval size or because it is technically difficult due to iliac vein tortuosity.
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PMID:Bilateral iliac vein filtration. An effective alternative to caval filtration in patients with megacava. 199 82

During a five year period at Akron City Hospital, 165 Greenfield filters were placed in 165 patients. Of this group, 78 patients were available for long term analysis, and of these, 42 did not receive anticoagulation treatment for venous thromboembolic diseases, either acutely or on an outpatient basis. An analysis of the outcome for these 42 patients who had the Greenfield filter only as the primary mode of therapy for the disease included chart review and asking each person a standard set of questions. Leg swelling was the most common complaint, occurring in 33 per cent of patients. Venous stasis ulceration occurred in two patients and recurrent deep venous thrombosis occurred in one patient. When compared with a historical control group with venous thromboembolic disease that was treated with anticoagulation alone, the incidence of these sequelae in Greenfield-treated patients was not significantly different. Finally, in this review, the Greenfield filter is better than 95 per cent effective in the prevention of pulmonary embolism. This is no less effective than anticoagulation alone, the efficacy of which is 95 to 98 per cent. The placement of a Greenfield filter is a safe procedure that can usually be done after a local anesthetic was administered to the patient with a complication rate of less than 10 per cent. Unfortunately, major complications of anticoagulation (usually hemorrhage) are relatively common at a rate of 2 to 15 per cent, and occur more frequently in the older population. It is for reasons of safety of therapy and of an equal or better efficacy that the Greenfield filter is recommended in a broader range of clinical circumstances. In particular, it is concluded that the Greenfield filter should be used as a primary means of therapy in venous thromboembolic disease, particularly in those patients who are more than 65 years of age, when the risks of anticoagulation are most threatening.
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PMID:The Greenfield filter as the primary means of therapy in venous thromboembolic disease. 200 47

Among patients with deep vein thrombosis (DVT), the frequency of pulmonary embolism seems conditioned by the location of DVT and thrombus adherence. Consequently, patients with free-floating iliac thrombus are at high risk of life-threatening pulmonary embolism. As regards their definition, non adherent thrombus and free-floating thrombus are not synonymous. Non adherent thrombi are usual in recent DVT and have the same prognosis and treatment as common DVT. The term of free-floating thrombi should be reserved for the iliac location when a small area of the thrombus is attached to the iliac vessel wall but the rest of it does not adhere to the wall. At present, venography is the gold standard for diagnosis but duplex scanning and scanner or magnetic resonance imaging should also be evaluated for this purpose. The treatment comprises the usual anticoagulant therapy with heparin and a specific treatment for the free-floating thrombus. 1) Vena cava filter is a rapid safe solution that avoids severe pulmonary embolism, but in the case of thrombus detachment, vena cava obliteration might occur with the subsequent risk of severe bilateral venous stasis and insufficiency. The indications for such treatment might be elderly patients in a poor general condition. 2) Venous thrombectomy. Venous thrombectomy only removes the free part of the thrombus, thus preserving the contralateral iliac vein from further complications. A clip is positioned on the inferior vena cava. 3) Protected fibrinolysis. The latest catheters allow transient vena cava filter device placement. Thrombolytic therapy with rTPa might achieve thrombolysis and subsequently restore the venous circulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[What to do with a free-floating venous thrombus]. 201 Jul 10


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