A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection

Diagnosing acute pulmonary embolism (PE) involves clinical suspicion in combination with sequential diagnostic tests including d-dimer laboratory assays. Although the sensitivity of this assay is well validated and thoroughly tested, a false-positive result can lead to unnecessary and costly testing. The age-adjusted d-dimer (AADD) has been suggested in the literature to improve the usefulness of d-dimer cutoffs and safely decrease iodine and radiation exposure associated with definitively ruling out PE with computed tomographic angiography (CTA).1 We present an internal retrospective review utilizing the novel AADD cutoff to rule out PE and evaluate the potential extent of unnecessary testing with CTA. Using the AADD cutoff would have led to a 21.2% reduction in computerized tomography pulmonary embolus protocol. This internal quality improvement study suggests that changing our institutional conventional d-dimer to the novel AADD would provide a superior quality and cost–benefit.

Download Full-text

Utilization and Yield of Chest Computed Tomographic Angiography Associated with Low Positive D-dimer Levels

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2011.05.036 ◽

2012 ◽

Vol 43 (2) ◽

pp. 211-220 ◽

Cited By ~ 7

Author(s):

David S. Huckins ◽

Lori Lyn Price ◽

Kristina Gilley

Keyword(s):

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography ◽

D Dimer

Download Full-text

Combination of D-Dimer and Amino-Terminal Pro-B-Type Natriuretic Peptide Testing for the Evaluation of Dyspneic Patients With and Without Acute Pulmonary Embolism

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1326-codaap ◽

2006 ◽

Vol 130 (9) ◽

pp. 1326-1329

Author(s):

Stacy E. F. Melanson ◽

Michael Laposata ◽

Carlos A. Camargo, Jr ◽

Annabel A. Chen ◽

Roderick Tung ◽

...

Keyword(s):

Pulmonary Embolism ◽

Negative Predictive Value ◽

Natriuretic Peptide ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Amino Terminal ◽

Tomographic Angiography ◽

D Dimer

Abstract Context.—D-dimer concentration can be used to exclude a diagnosis of acute pulmonary embolism. However, clinicians frequently order unnecessary supplemental testing in patients with low concentrations of D-dimer. Elevations in natriuretic peptides have also been described in the setting of pulmonary embolism. Objective.—We investigated the integrative role of D-dimer with amino-terminal pro-B-type natriuretic peptide for the evaluation of patients with and without acute pulmonary embolism. Design.—Patients were selected for analysis from a previous study in which levels of D-dimer and amino-terminal pro-B-type natriuretic peptide were measured. The presence of pulmonary embolism was determined by computed tomographic angiography. Results.—The median levels of D-dimer were significantly higher in patients with acute pulmonary embolism. Similarly, the median levels of amino-terminal pro-B-type natriuretic peptide were higher in patients with pulmonary embolism. Conclusions.—The Roche Tina-quant D-Dimer immunoturbidimetric assay provides a high negative predictive value and can be used to exclude acute pulmonary embolism in patients with dyspnea. Measurement of amino-terminal pro-B-type natriuretic peptide in addition to D-dimer improves specificity for acute pulmonary embolism without sacrificing negative predictive value. A combination of both markers may offer reassurance for excluding acute pulmonary embolism, and thus avoid redundant, expensive confirmatory tests.

Download Full-text

Endoluminal Repair of Infrarenal AAA in the Presence of Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/152660280200900504 ◽

2002 ◽

Vol 9 (5) ◽

pp. 579-582 ◽

Cited By ~ 1

Author(s):

Girma Tefera ◽

Sandra Carr ◽

John Hoch ◽

Charles W. Acher ◽

William D. Turnipseed

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

False Lumen ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Endoluminal Repair ◽

Abdominal Aortic ◽

The Face ◽

Tomographic Angiography ◽

Thoracic And Abdominal

Purpose: To report a challenging case of infrarenal abdominal aortic aneurysm (AAA) treated with a commercial stent-graft in the face of thoracoabdominal aortic dissection. Case Report: A 73-year-old patient was admitted because of acute descending thoracic and abdominal aortic dissection. He was also found to have an 8-cm infrarenal AAA. After initial medical management of the acute aortic dissection, the patient underwent endoluminal AAA repair with an AneuRx stent-graft. The completion angiogram showed that the graft was deployed in the false lumen; this complication was treated with fenestration of the intimal flap, establishing flow through both lumens. The patient's recovery was uneventful, and he was discharged on the fourth postoperative day. Follow-up at 1 year with computed tomographic angiography documented a stable descending thoracic aorta with a suggestion of a type II endoleak and no change in the aneurysm volume. Conclusions: This case illustrates the feasibility of endograft repair of infrarenal AAA with a modular stent-graft in the presence of aortic dissection extending below the renal arteries.

Download Full-text