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

Twenty-five cases of extraluminal and 47 of intraluminal inferior vena caval (IVC) occlusion for management of pulmonary embolism were reviewed. A comparison of results obtained with both methods suggests that the IVC umbrella filter provides the safer, more reliable means of IVC interruption in patients whose condition fulfills the criteria for caval occlusion. The simplicity of this technique and the fact that it can be performed under local anesthesia justify its consideration as the procedure of choice for IVC occlusion and permit its use in severely ill patients. On the basis of our positive findings, we now recommend that extraluminal occlusion be reserved for patients in whom insertion of the IVC umbrella is technically impossible.
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PMID:Extraluminal or intraluminal inferior vena cava occlusion in pulmonary embolism. 66 9

Besides anticoagulants and thrombolytic drugs, surgery should be included among the therapeutical means to prevent deep phlebitis of the lower limbs. Early phlebography, thoroughly innocuous, is necessary to any coherent therapy. The prevention of pulmonary embolism which can be done by a ligature of the inferior vena cava or by the fitting of an umbrella-shaped filtre, is performed most of the time with a clamp of Adams and de Weese. Its reliability is satisfactory as the percentage of embolic recurrences does not exceed 5%. Early venous thrombectomy prevents in 60 to 80% of cases the post-phlebitic incidents; but its indication must be reserved to young patients.
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PMID:[Role of surgery in the treatment of deep venous thrombosis of the lower limbs and prevention of pulmonary embolism]. 74 28

The authors have carried out phlebograms on 50 patients with recent pulmonary emboli. In the majority of cases (44 out of 50) they found thrombosis in the veins of the lower limbs: in 35 cases, these were situated proximally, ending in the femoro-ilio-caval segment; in 9 cases they were confined to the suropopliteal veins. These facts have led us to modify our treatment plan for pulmonary embolism. Thrombolytic treatment seems to be justified in cases where the prebitis is high up, even if the pulmonary embolus is benign. Heparin is reserved for those cases of benign pulmonary emboli which are secondary to suro-popliteal phlebitis. The question of interrupting the inferior vena cava must bed ecided in the light of the phlebograms.
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PMID:[Venous signs at the acute stage of pulmonary embolism]. 82 66

The natural history diagnosis and immediate treatment of patients suffering from pulmonary embolism has been discussed. Anaesthetists should use their influence to bring about a high standard of prophylactic care against deep venous thrombosis and consequently of pulmonary embolism. They are likely to be involved in the resuscitation and treatment in intensive care units of those cases who suffer from major symptoms and massive emboli and some of them will rarely be involved in anaesthetising for pulmonary embolectomy aided by cardiopulmonary by-pass and, less rarely, for IVC ligation or plication and venous disobliteration. Anticoagulant drugs appear to limit the mortality of pulmonary embolism to 5%. The mortality of IVC ligation or plication varies in different reports from 2 to 50%; it should therefore be reserved for the special indications which have been discussed. There is also an incidence of recurrent pulmonary embolism after IVC ligation and plication and leg troubles from stasis in about 30% of cases. Streptokinase is usually indicated in the immediate treatment of major pulmonary emboli which cause shock and severe distress with an immediate threat to life. In hospitals having access to cardiopulmonary by-pass, pulmonary embolectomy has a small role to play in major emboli with cardiovascular collapse, if surgery can start within 2 hours and pulmonary angiography is available. Cardiopulmonary by-pass on its own may be life-saving in supporting the circulation while the clot fragments. If cardiac arrest occurs, external cardiac massage should be undertaken as it is sometimes successful and disseminates and fragments the clot in the pulmonary artery.
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PMID:Pulmonary embolism. Prophylaxis diagnosis and treatment. 97 May 90

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.
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PMID:Nd:YAG laser treatment of colorectal malignancies: an experience of 4 1/2 years. 137 43

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

Thirty patients with Stage III/IV cancer and thromboembolic complications between 1987-89 were reviewed. Twelve patients had a deep venous thrombosis proximal to the calf diagnosed by duplex scanning or contrast venography, 15 patients had a pulmonary embolism diagnosed by a high-probability pulmonary ventilation/perfusion scan or arteriogram, and three patients had both deep vein thrombosis and pulmonary embolism. Patients were treated primarily with anticoagulation (Group A = 20 patients) or a Greenfield filter (Group B = 10 patients). Seventy-five percent (15/20) of the Group A patients developed 19 bleeding or thrombosis-related complications: major bleeding (7), recurrent deep venous thrombosis/pulmonary embolism (4), inability to attain consistent therapeutic anticoagulation levels (3), heparin-induced thrombocytopenia (3), or progression of deep vein thrombosis (2). A Greenfield filter was eventually placed in 10 (50%) of the Group A patients without complications. Thirty percent (3/10) of the Group B patients developed progression of deep vein thrombosis that required anticoagulation. One other Group B patient died due to a guidewire-induced arrhythmia. Although patients with advanced cancers and venous thromboembolic disease have a high complication rate with either treatment, initial treatment with a Greenfield filter appears more definitive. Anticoagulation should be reserved for patients with progressive, symptomatic deep vein thromboses after placement of a filter.
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PMID:Thromboembolic complications in patients with advanced cancer: anticoagulation versus Greenfield filter placement. 201 91

The accepted role for thrombolytic therapy has until recently been limited because of its complexity and side-effects. It has generally been reserved for use systemically in a limited number of patients with acute, major pulmonary embolism or iliofemoral venous thrombosis, and locally in some patients with acute, peripheral arterial occlusion. Its indications have now been greatly expanded by the confirmation from large, multicentre trials completed within the last year that it is also effective in acute myocardial infarction, with a reduction in acute mortality of 20-25%. Moreover, administration has become greatly simplified as dosage regimens have been standardised and the need for laboratory monitoring eliminated. The standard thrombolytic agent used for nearly 3 decades has been streptokinase but within the last year recombinant, human, tissue-type plasminogen activator (the first 'third generation' thrombolytic agent) has become clinically available. This protein is the body's own chief plasminogen activator and has been produced by recombinant DNA technology. Compared with streptokinase, it appears to be both somewhat more effective and also safer (less bleeding and probably no allergic reactions). Other new thrombolytic agents are also being developed but the cost-effectiveness of the newer agents in relation to streptokinase will be for many the main practical issue.
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PMID:Thrombolytic therapy. 249 35

The aim of prophylaxis in venous thromboembolism is firstly to prevent fatal pulmonary embolism and secondly to reduce the morbidity associated with deep vein thrombosis and the post-phlebitic limb. Particularly high-risk groups are identifiable and include those over 60 years of age undergoing major surgery, patients with malignancy and those undergoing hip operations. Low-dose subcutaneous heparin (5000 U s.c. commenced two hours preoperatively and continued eight to twelve hourly until the patient is fully mobile) is unequivocally effective in preventing deep vein thrombosis in medical and surgical patients and, most importantly, significantly reduces the incidence of fatal postoperative pulmonary embolism and total mortality. Furthermore, in established deep vein thrombosis, low-dose heparin limits proximal clot propagation, which is the prelude to pulmonary embolism. Despite this, surveys have demonstrated an alarming deficiency amongst clinicians in the application of measures to prevent venous thromboembolism. Heparin prophylaxis carries a small risk of increased bleeding complications, mostly evidenced by the frequency of wound haematoma rather than major haemorrhage. Low molecular heparin fragments (e.g. Fragmin, Choay, Enoxaprin) are now emerging as useful alternative agents, having the advantage of once daily administration and yet providing similar efficacy in the prevention of deep vein thrombosis. However, protection against fatal pulmonary embolism has yet to be demonstrated. Mechanical methods of prophylaxis designed to counteract venous stasis, such as graduated elastic compression stockings, are also beneficial in protection against deep vein thrombosis but by themselves do not achieve such consistently good prophylaxis as low-dose heparin. However, clinical trials with combinations of mechanical methods and low-dose heparin indicate that this may be the optimum approach to very high-risk patients. In the presence of established acute deep vein thrombosis, anticoagulant therapy is the mainstay in preventing pulmonary embolism. Vena caval interruption procedures should be reserved for patients in whom anticoagulation is contraindicated or for those who develop recurrent pulmonary embolism despite adequate anticoagulation.
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PMID:Prevention of venous thromboembolism. 266 85

Various interventions are available to assist in the management of patients with pulmonary embolism. Most are reserved for patients who either fail standard systemic anticoagulation therapy or are not candidates for anticoagulant therapy. The most common intervention is placement of a vena caval filter. Several different filter devices are available, most of which may be placed percutaneously. Pulmonary thrombolysis with urokinase or streptokinase may be appropriate in some patients with severe, symptomatic pulmonary embolism. Finally, pulmonary embolectomy by means of either a transvenous catheter or surgical technique may be necessary in cases of refractory cardiovascular collapse.
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PMID:Interventions in pulmonary embolism. 269 5


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