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

Between 1973 and 1977 we performed 106 venous thrombectomies. 100 of these cases showed occlusion in the ilio-femoral area and 6 in the axillary area. The postoperative mortality was 2 per cent in pelvic thrombosis and 0 per cent in the Paget-von-Schroetter-Syndrome. Fatal pulmonary embolism did not occur. Seventy per cent of patients were free of complaints 6 months postoperatively. Best results were achieved by early operation. The Paget-von-Schroetter-Syndrome is frequently caused by a thoracic outlet syndrome. Therefore, the first rib has to be removed during the second operation in order to prevent recurrence.
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PMID:[The venous thrombectomy (author's transl)]. 67 50

Between 1.1.1985 and 1.1.1988, 158 patients were referred because of acute deep venous thrombosis. They were 82 women (median age 48.5) and 76 men (median age 56.5). On admission, 4 patients had already a pulmonary embolism in 3 others embolism occurred during hospitalisation. The segment involved was the isolated iliac in 10, iliofemoral in 53, isolated femoral in 7, femorotibial in 47 and isolated tibial in 41 patients. Anticoagulation and compression therapy was undertaken in 102 and mortality was 21%. At follow-up 63% had at least 1 sign of venous insufficiency, in all 16% had no sequelae and were subjectively symptom-free. Thrombolytic therapy was carried out in 25, mortality was 8%. At follow-up, 72% had at least one sign of venous insufficiency. Venous thrombectomy was performed in 31, combined in 4 with balloon dilatation of an iliac spur. Mortality was low with 3%, 58% had at least one sign of venous insufficiency at follow-up and 39% were subjectively symptom-free. Our results show that an objective assessment is insofar difficult because subjective and clinical results do not correlate; 51% with clinically verified post-therapeutic venous insufficiency had normal venous drainage in strain-gauge plethysmography, whilst 41% without subjective discomforts demonstrated an insufficient drainage. Our results show that a full restitution is seldom achieved, thrombectomy does not prevent chronic venous insufficiency. Best results were observed in isolated iliac thrombosis. We conclude that thrombectomy should be restricted to the phlegmasia caerulea dolens form of DVT, while floating thrombus and ascending thrombus extending into the vena cava should be treated with a cava filter or ligation.
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PMID:Deep venous thrombosis: results of thrombectomy versus medical therapy. Presented at the 5th European-American Symposium on Venous Diseases, Vienna, Austria, Nov. 7-11, 1990. 162 39

For the treatment of massive pulmonary embolism thrombolytic therapy is efficient in reducing late mortality and complications from chronic pulmonary hypertension. Best results are achieved if treatment is started as soon as possible. Even after days or weeks after pulmonary thromboembolism, however, thrombolytic therapy is beneficial. In life threatening conditions due to right heart failure an initial bolus of 2,000,000 U urokinase should be administered. The number of contraindications can be markedly reduced due to the well controlled thrombolysis with urokinase.
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PMID:Thrombolytic therapy in fulminant pulmonary thromboembolism. 178 41

The clinical diagnosis of deep vein thrombosis is unreliable and venography remains the best single method of investigation. In the last ten years several non-invasive procedures have been introduced in the vascular laboratories, sometime without adequate assessment of their reliability. We tested sensitivity and specificity of three different non-invasive procedures, namely phleboscintigraphy with 99Technetium, Doppler ultrasound technique and strain-gauge plethysmography in patients with clinically suspected deep vein thrombosis of lower limbs or pulmonary embolism. A total of 288 patients entered the study. Venography was used as the reference standard and was assessed independently, without knowledge of the results of non-invasive methods. In the first 36 patients phleboscintigraphy and Doppler ultrasound were evaluated: sensitivity and specificity of phleboscintigraphy resulted only a little more than 50%; the method was therefore considered unreliable and subsequently abandoned. Doppler ultrasound could be evaluated upon a total of 81 patients, showing an unsatisfactory sensitivity (63%), but a quite reliable specificity (86%). Best results were obtained with strain-gauge plethysmography, using maximal venous outflow and venous capacitance as diagnostic parameters. 209 patients entered this study, and a sensitivity of about 90% with a specificity of about 95% was observed. If we consider only acute proximal deep vein thrombosis, sensitivity approaches 97%, while it is only 60% in distal deep vein thrombosis.
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PMID:[Instrumental diagnosis of deep venous thrombosis. Prospective study with non-invasive methods]. 623 96

The indications for the use of antithrombotic therapy are evolving as new drugs become available or new indications or dosages are recommended for drugs already in use. This document reviews and updates the former one published in 1994. To that end, an exhaustive revision of the literature published in the last 15 years has been undertaken. Following the evidence based medicine dictates, and aiming to select all the relevant publications for each pathology, all studies were selected through MEDLINE, using the specified key words for each subject, and were filtered using the following steps: a) only randomized, controlled studies, meta-analysis, guidelines and review articles were chosen; b) then, the Best-Evidence and Cochrane Collaboration databases were consulted; c) finally, the evidence based medicine validation, relevance and applicability criteria were assessed for each publication. The use of antiaggregants and anticoagulants are given for the following conditions: a) prevention of deep vein thrombosis and pulmonary embolism; b) prevention of systemic emboli in patients with lone atrial fibrillation, atrial fibrillation associated or not with rheumatic heart disease, in patients with biological or mechanical cardiac valvular prostheses and in dilated cardiomyopathy; c) antithrombotic therapy in coronary heart disease and in coronary intervention; d) the interactions with oral anticoagulants and how to control these therapies are also discussed.
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PMID:[Practice guidelines of the Spanish Society of Cardiology. Recommendations for the use of antithrombotic treatment in cardiology]. 1073 66

Acute deep venous thrombosis (DVT) of the lower extremities is a serious and potentially fatal disorder which often complicates the course of severely ill, hospitalized patients but may also affect ambulatory and otherwise healthy people. It is uncommon in young individuals and becomes more frequent with advancing age. The clinically important problems associated with DVT are death from pulmonary embolism (PE), morbidity resulting from the acute event, the post-thrombotic syndrome, and the inconvenience and side-effects of investigations and treatment. Furthermore, an often underemphasized problem is the anxiety that may occur in those patients who have suffered a thrombotic episode.
Baillieres Best Pract Res Clin Haematol 1999 Sep
PMID:Deep-vein thrombosis of the lower limbs: diagnosis and management. 1085 84

Suspected or confirmed venous thromboembolism (VTE) (deep-vein thrombosis and pulmonary embolism) in non-pregnant patients are common clinical problems with ample clinical research upon which diagnostic and treatment recommendations are based. Unfortunately, the level of complexity is increased in the diagnostic and therapeutic management of pregnancy-associated VTE by evolving physiological changes in expectant mothers, the effects of diagnostic and therapeutic management on the unborn child and the lack of validation of these management strategies in pregnancy. This chapter considers the epidemiology, pathogenesis, diagnosis and treatment of pregnancy-associated VTE. It highlights the poverty of research upon which to base clinical recommendations for this common problem yet offers practical but conservative approaches to patients with suspected and confirmed pregnancy-associated VTE.
Best Pract Res Clin Haematol 2003 Jun
PMID:Diagnosis and treatment of venous thromboembolism in pregnancy. 1276 92

The most important causes of acute collapse in pregnancy are pulmonary embolism, amniotic fluid embolism, acute coronary syndrome, thrombosed mechanical prosthetic heart valves, acute aortic dissection, cerebrovascular incidents and anaesthetic complications like failed intubation, anaphylaxis, and problems relating to regional or local anaesthetic agents. The management is based on supporting the different organ systems that are affected. The diagnosis of pulmonary embolism is based on a clinical suspicion supported by certain diagnostic test. Tests like D-dimers have their limitations and cannot be used alone to exclude the diagnosis especially when there is a high clinical suspicion. The choice of the best diagnostic tool is based upon weighing long-term risks to both mother and foetus on the one side and delaying the diagnosis on the other side. The management of acute coronary syndrome is based on immediate angiography and percutaneous coronary intervention. Although there are reports of the use of clopidrogel in pregnancy, there are few data on its effect on the foetus. There is no clinical evidence for fibrinolytic therapy as a reperfusion strategy in pregnancy and it is best avoided as the risk of haemorrhage outweighs the possible benefit of treatment. Patients with a prosthetic heart valve that present with a disappearance of the prosthetic heart sounds or a new murmur should get an urgent cardiac ultrasound to rule out a thrombosed prosthetic valve. Anaesthesia-related causes are an increasing cause of maternal morbidity and mortality.
Best Pract Res Clin Obstet Gynaecol 2009 Jun
PMID:Managing acute collapse in pregnant women. 1923 Jul 79

One of the greatest disappointments associated with a successful surgical procedure is a thrombotic or thrombo-embolic complication in the postoperative period. Morbidity and mortality of the perioperative period are related, to a relevant degree, to perioperative thrombo-embolic events. Ranging from simple deep venous thrombosis to pulmonary embolism or arterial thrombosis, this class of complication invariably increases length of hospital stay or may result in mortality. The purpose of this review is to identify the procedures and patient populations noted to have thrombophilia in the postoperative period, link the changes in circulating and in situ haematological/biochemical substrates most likely responsible for morbidity, identify the clinical diagnostic modalities that detect recent/impending thrombosis and, lastly, consider the rational therapeutic approaches recommended for minimising postoperative thrombotic complications.
Best Pract Res Clin Anaesthesiol 2010 Mar
PMID:Hypercoagulability in the perioperative period. 2040 76

Pulmonary embolism is the third most common cardiovascular disease after myocardial infarction and stroke. The death rate from pulmonary embolism exceeds the death rate from myocardial infarction, because myocardial infarction is much easier to detect and to treat. Among survivors of pulmonary embolism, chronic thromboembolic pulmonary hypertension occurs in 2-4 of every 100 patients. Post-thrombotic syndrome of the legs, characterized by chronic venous insufficiency, occurs in up to half of patients who suffer deep vein thrombosis or pulmonary embolism. We have effective pharmacological regimens using fixed low dose unfractionated or low molecular weight heparin to prevent venous thromboembolism among hospitalized patients. There remains the problem of low rates of utilization of pharmacological prophylaxis. The biggest change in our understanding of the epidemiology of venous thromboembolism is that we now believe that deep vein thrombosis and pulmonary embolism share similar risk factors and pathophysiology with atherothrombosis and coronary artery disease.
Best Pract Res Clin Haematol 2012 Sep
PMID:Venous thromboembolism: epidemiology and magnitude of the problem. 2295 40


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