Temporary caval filter in the prevention of pulmonary embolism during delivery and postpartum

Objectives: The treatment of deep vein thrombosis (DVT) of the lower limbs during pregnancy remains controversial. There are a lot of problems related to anticoagulant therapy for the safety of the fetus; the use of caval filters rarely appears in the literature and it is not yet codified. So the choice of the right treatment is often difficult. The authors review their experience with a prophylactic use of a temporary caval filter for patients with proximal DVT of the last period of pregnancy, in order to avoid the inherent risk of major pulmonary embolism during delivery and postpartum. Methods: Ten women with proximal DVT were treated. The diagnosis was performed by Doppler ultrasonography (DU) and magnetic resonance (MR). At the end of pregnancy, a temporary caval filter (eight Prolyser and two Tempofilter) was percutaneously inserted under X-ray control. The patients were then subjected to a planned caesarean section. After 15 days, all filters were removed after a phlebography to check the absence of clots. Results: The mean time of X-ray exposure was about 1 min and 30 s. None of the patients suffered a major pulmonary embolism. All fetuses were born without problems or malformations. There were no complications related to the filters. No caval thrombosis or filters clots were found at the phlebography. The follow-up registered no pulmonary embolism episodes. Conclusions: The use of a temporary caval filter in pregnancy is safe and does not introduce any additional risk. It could be suggested for pregnant patients with proximal DVT beginning in the last period of pregnancy.

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Silent Pulmonary Embolism in Patients with Lower Limb Deep Vein Thrombosis

Blood ◽

10.1182/blood.v118.21.2306.2306 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2306-2306

Author(s):

Inna Tsoran-Rosenthal ◽

Gleb Sakharov ◽

Benjamin Brenner ◽

Karine Rivron-Guillot ◽

Adriana VisonÁ ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Major Bleeding ◽

Conflicts Of Interest ◽

Lower Limbs ◽

X Ray ◽

Vein Thrombosis ◽

Chest X Ray ◽

Deep Vein

Abstract Abstract 2306 Background: One in every three patients with deep vein thrombosis (DVT) may have silent pulmonary embolism (PE), but its clinical relevance has not been thoroughly studied. Methods: We used the RIETE Registry data to compare the clinical characteristics, diagnostic tests, and 3-month outcome in 842 patients with proximal DVT in the lower limbs and silent PE at baseline, 1533 with DVT without PE, and 585 patients with DVT and symptomatic PE. Results: On admission, a minority of DVT patients (with or without silent PE) presented with hypoxemia (9.0% vs. 6.4%, respectively), or typical PE signs on the chest X-ray (25% vs. 22%) or electrocardiogram (23% vs. 17%). Patients with symptomatic PE more frequently presented with hypoxemia (30%) or had PE signs on the chest X-ray (41%) or electrocardiogram (37%). After the initial 15 days of follow up the incidence of PE was higher among patients with DVT and silent PE compared to those with symptomatic PE (0.95% vs. 0.17%).During the first 90 days of anticoagulant therapy, patients with DVT without PE had a lower incidence of recurrent PE than bleeding (1.0% and 2.9%, respectively). Of note, an excessive risk for bleeding was observed during the first 2 weeks of therapy among patients without PE. Incidence of recurrent PE and major bleeding was similar in DVT patients with silent PE (1.8% and 1.9%) and in those with symptomatic PE (2.6% and 2.7%). Conclusions: Most DVT patients with silent PE have no hypoxemia, chest X-ray signs or electrocardiographic evidence suggestive of embolism. Frequency of recurrent PE was higher among patients with silent PE at the initial 15 days of follow up. In contrast to other subgroups, in DVT patients without PE at baseline, the incidence of major bleeding far exceeded that of PE development during follow up. Disclosures: No relevant conflicts of interest to declare.

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Surgical Embolectomy In Massive Acute Pulmonary Embolism: Our Experience

Nepalese Heart Journal ◽

10.3126/njh.v12i2.13387 ◽

2015 ◽

Vol 12 (2) ◽

pp. 83-86

Author(s):

SV Nemirova ◽

AP Medvedev ◽

VV Pichugin ◽

Krishna Bhandari

Keyword(s):

Pulmonary Embolism ◽

Massive Pulmonary Embolism ◽

Vein Thrombosis ◽

Medical Academy ◽

Surgical Embolectomy ◽

Hospital Deaths ◽

State Medical Academy ◽

Deep Vein ◽

Mean Time

Background and Aims: Pulmonary embolism (PE) is the leading cause of hospital deaths among the non-surgical patients. Our aim was to evaluate the efficacy of surgical embolectomy in massive acute PE.Methods: It was a single centre, prospective study conducted between January 2007 and August 2013 in Specialized Cardiovascular Surgical Hospital of Nizhny Nizhny Novgorod State Medical Academy Nizhny Novgorod, Russia. One hundred and seventy five patients were diagnosed as PE. Only 77 patients were diagnosed as massive pulmonary embolism and were included in this study. Surgical embolectomy was performed without cardiopulmonary bypass through thoracotomy approach only in the involved pulmonary artery. Right atriotomy and evacuation of embolus was done, in cases of right ventricle thrombus.Results: Seventy-seven patients with acute massive PE underwent surgical embolectomy. Four (5.1%) patients died before discharge. Mean time of ICU stay was 70.1±11.0 hours. During six months of follow up after the embolotomy. Eleven (14%) patients had deep vein thrombosis, two had sub-massive PE. During 6 months of follow up 62 patients (81%) had no further episode of venous thrombloembolism.Conclusions: Our study showed surgical embolectomy can be done with good clinical outcome with acceptable mortality rate.Nepalese Heart Journal 2015;12(2):83-86

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Anticoagulant therapies for acute venous thromboembolism: a comparison between those discharged directly from the emergency department versus hospital in two Canadian cities

BMJ Open ◽

10.1136/bmjopen-2018-022063 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022063 ◽

Cited By ~ 3

Author(s):

Tammy J Bungard ◽

Bruce Ritchie ◽

Jennifer Bolt ◽

William M Semchuk

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Severity Index ◽

Vein Thrombosis ◽

Risk Patients ◽

Acute Venous Thromboembolism ◽

Record Review ◽

Deep Vein

ObjectiveTo compare the characteristics/management of acute venous thromboembolism (VTE) for patients either discharged directly from the emergency department (ED) or hospitalised throughout a year within two urban cities in Canada.DesignRetrospective medical record review.SettingHospitals in Edmonton, Alberta (n=4) and Regina, Saskatchewan (n=2) from April 2014 to March 2015.ParticipantsAll patients discharged from the ED or hospital with acute deep vein thrombosis or pulmonary embolism (PE). Those having another indication for anticoagulant therapy, pregnant/breast feeding or anticipated lifespan <3 months were excluded.Primary and secondary outcomesPrimarily, to compare proportion of patients receiving traditional therapy (parenteral anticoagulant±warfarin) relative to a direct oral anticoagulant (DOAC) between the two cohorts. Secondarily, to assess differences with therapy selected based on clot burden and follow-up plans postdischarge.Results387 (25.2%) and 665 (72.5%) patients from the ED and hospital cohorts, respectively, were included. Compared with the ED cohort, those hospitalised were older (57.3 and 64.5 years; p<0.0001), more likely to have PE (35.7% vs 83.8%) with a simplified Pulmonary Embolism Severity Index (sPESI) ≥1 (31.2% vs 65.2%), cancer (14.7% and 22.3%; p=0.003) and pulmonary disease (10.1% and 20.6%; p<0.0001). For the ED and hospital cohorts, similar proportions of patients were prescribed traditional therapies (72.6% and 71.1%) and a DOAC (25.8% and 27.4%, respectively). For the ED cohort, DOAC use was similar between those with a sPESI score of 0 and ≥1 (35.1% and 34.9%, p=0.98) whereas for those hospitalised lower risk patients were more likely to receive a DOAC (31.4% and 23.8%, p<0.055). Follow-up was most common with family physicians for those hospitalised (51.5%), while specialists/VTE clinic was most common for those directly discharged from the ED (50.6%).ConclusionsTraditional and DOAC therapies were proportionately similar between the ED and hospitalised cohorts, despite clear differences in patient populations and follow-up patterns in the community.

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VENOGRAPHY (VG) OF THE LOWER LIMBS IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED PULMONARY EMBOLISM (PE)

10.1055/s-0038-1644197 ◽

1987 ◽

Author(s):

W H J Kruit ◽

A K Sing ◽

G J H den Ottolander ◽

A C de Beor ◽

J J C Jonker

Keyword(s):

Pulmonary Embolism ◽

Impedance Plethysmography ◽

Lower Limbs ◽

Surgical Patients ◽

Additional Patient ◽

Suspected Pulmonary Embolism ◽

X Ray ◽

Group A ◽

Group B

In a prospective cohort study, we evaluated X-ray VG in the management of non-surgical patients with clinically suspected PE. Thusfar follow up is available on 131 consecutive patients with suspected PE. In all patients a perfusion lungscan (PS) was carried out within 24 hours. In case of a normal PS (group A, n=32), no anticoagulant (AC) therapy was given. In case of an abnormal PS, AC therapy was started (heparin) and a bilateral ascending VG was carried out within 72 hours. In 46 patients (group C) venous thrombosis (DVT) was demonstrated by VG, and these patients were treated with AC for 6 months. In 53 patients with suspected PE and an abnormal lungscan, bilateral VG did not show DVT (group B). AC therapy was discontinued in these patients These patients were then screened for 14 days with fibrinogen legscanning and impedance plethysmography (IPG), followed by IPG alone every 2 months for at least 1 year. In group B, 6 patients died in the follow up period. None of the patients had signs of PE at autopsy. One additional patient in group B developed DVT documented by repeat VG, 6 months after entry into the trial. According to these preliminary data, it seems safe to base the decision whether or not to treat a patient with suspected PE with AC, on the presence or absence of DVT in the lower limbs as demonstrated by VG

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Thrombus risk versus bleeding risk: a clinical conundrum

BMJ Case Reports ◽

10.1136/bcr-2018-228344 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228344

Author(s):

Elisabeth Ng ◽

Adel Ekladious ◽

Luke P Wheeler

Keyword(s):

Aortic Dissection ◽

Bleeding Risk ◽

Pressure Control ◽

Lower Limbs ◽

Vein Thrombosis ◽

Pulmonary Angiogram ◽

Therapeutic Anticoagulation ◽

Apex Beat ◽

The Right ◽

Deep Vein

A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection. Subsequent ultrasound of the lower limbs confirmed an extensive, non-occlusive deep vein thrombosis in the right calf. Management of this patient involved therapeutic anticoagulation and tight blood pressure control, with plans for surgical repair delayed due to worsening renal impairment and subsequent supratherapeutic anticoagulation. Co-existence of an aortic dissection and PE has been rarely described and optimal management remains unclear.

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Saddle pulmonary embolism with fluorouracil: A case report

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220909424 ◽

2020 ◽

Vol 26 (7) ◽

pp. 1769-1773

Author(s):

Kylee E White ◽

Christopher T Elder

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Case Report ◽

Single Agent ◽

Vein Thrombosis ◽

Increased Risk ◽

Additive Risk ◽

The Right ◽

Deep Vein ◽

To Receive

Introduction As a single agent, fluorouracil has been documented to have a small but present chance of causing extravasation of the port when not properly administered. It has also been shown that cancer patients receiving chemotherapy are at increased risk of deep vein thrombosis, symptomatic or silent. Case report A 43-year-old male patient with stage III colon cancer receiving FOLFOX developed a saddle pulmonary embolism involving possible extravasation that was discovered following cycle 3 of chemotherapy. CT scan and lower extremity Doppler confirmed non-occlusive deep vein thrombosis along with saddle pulmonary embolism. Management and outcome: For acute management, patient underwent bilateral pulmonary artery thrombolysis. Following this, the patient was initiated on rivaroxaban indefinitely. The right subclavian port was removed, and a new port was placed in the left subclavian. Patient went on to receive three more cycles of chemotherapy. Discussion Fluorouracil, an inflammitant, has been shown to have damaging potential, especially in terms of the integrity of the endothelium. Over time, this can lead to serious complications such as cardiotoxicity, including deep vein thrombosis formation. Based on how and when the thrombi were discovered, it is not possible to deduce whether the port, the 5-FU, extravasation or other factors were the precipitators of the formation of the thrombi. The combination of chemotherapy treatment along with CVC placement appears to have an additive risk to the formation of a thrombus. Practitioners should take caution when evaluating for extravasation and CVC integrity and note other potential differentials for causes, including deep vein thrombosis/saddle pulmonary embolism formation.

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Integrierte Diagnostik bei Verdacht auf tiefe Venenthromben und Lungenembolie

VASA ◽

10.1024/0301-1526.31.1.15 ◽

2002 ◽

Vol 31 (1) ◽

pp. 15-21 ◽

Cited By ~ 3

Author(s):

Bounameaux

Keyword(s):

Large Scale ◽

Daily Practice ◽

Pulmonary Angiography ◽

Lower Limbs ◽

Vein Thrombosis ◽

Venous Compression ◽

Lung Scan ◽

Deep Vein ◽

Compression Ultrasonography

Diagnosing deep vein thrombosis and pulmonary embolism has become definitely easier and more reliable over the past fifteen years, especially thanks the development of lower limbs venous compression ultrasonography and fibrin D-Dimer measurement. These tests allowed reducing the requirement for venography and pulmonary angiography to a small minority of patients. Simultaneously, ventilation/perfusion lung scan criteria have been standardized, and the performance of spiral computed tomography has been analyzed in an appropriate way. New sequential, mainly noninvasive strategies could be developed that proved to be safe in large-scale prospective cohort studies with prolonged follow-up. They should now be implemented in daily practice according to cost-effectiveness analyses as well as local facilities and expertise.

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Large diverticulum of the urinary bladder: A rare cause of deep vein thrombosis with consecutive pulmonary embolism

Canadian Urological Association Journal ◽

10.5489/cuaj.2533 ◽

2015 ◽

Vol 9 (5-6) ◽

pp. 321

Author(s):

Oliver Zimmermann ◽

Jan Torzewski ◽

Ekkehard Reichenbach-Klinke ◽

Christine Zenk

Keyword(s):

Pulmonary Embolism ◽

Urinary Bladder ◽

Left Kidney ◽

Pulmonary Arteries ◽

Vein Thrombosis ◽

Progressive Dyspnea ◽

Vena Femoralis ◽

The Right ◽

Deep Vein ◽

Vena Femoralis Superficialis

A 73-year-old man was admitted with progressive dyspnea; he also had benign prostatic hyperplasia (BPH). An angio computed tomography scan showed pulmonary embolism with thrombi in both main pulmonary arteries. By duplex ultrasonography, we detected a thrombus in the right vena femoralis superficialis and vena femoralis communis. Simultaneously, we also noticed a large diverticulum on the right side of the urinary bladder and urinary stasis II of the left kidney. We consider the BPH as the trigger for a secondary diverticulum of the urinary bladder. As a result of its large dimensions, mechanical compression of the deep right pelvic veins resulted in thrombosis which finally caused the pulmonary embolism. With respect to the urinary stasis II, surgical excavation of the diverticulum with infravesical desobstruction was planned. The potentially lethal course of large diverticula may require surgery.

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SEMI-QUANTITATIVE RADIONUCLIDE PHLEBOGRAPHIC (RNP) ASSESSMENT OF DEEP VEIN THROMBOSIS (DVT) AND CHRONIC VENOUS INSUFFICIENCY (CVI)

10.1055/s-0038-1642895 ◽

1987 ◽

Author(s):

J Zahavi ◽

S Zaltzman ◽

E Firsteter ◽

E Avrahami

Keyword(s):

Venous Insufficiency ◽

Cost Effective ◽

Vein Thrombosis ◽

Below The Knee ◽

High Incidence ◽

Complete Thrombosis ◽

The Right ◽

High Level ◽

Deep Vein

A semi-quantitative RNP using 99Technetium macroaggregated albumin for the evaluation and follow-up of DVT and CVI has been developed. Values were assigned to the deep veins of the calf, knee, tigh and pelvis based upon the localization and the characteristics of the images obtained: stasis, hot spots and collateral circulation. A maximum score of 18 reflected complete thrombosis of all 4 segments. 208 patients (mean age 53.7 years, range 18-92), 161 of whom had a proven risk factor for DVT were studied. 99Technetium was injected into the dorsal foot vein of 407 limbs with appropriate tourniquets and early and late imaging of the limbs, pelvis and lungs was performed. In 48 patients, 83 limbs, X-ray contrast phlebography (CP) was also done. The mean RNP score was 4.1 units (range 0.4-18) and higher in the left than the right lower limb. It was mostly high in patients with proximal recurrent DVT or in DVT superimposed on CVI. The score was easy to follow and helpful in the assessment of the extent of DVT. It was particularly helpful in 3 instances. 1) Assessment of venous patency following anticoagulant therapy. 2) Estimation of recurrent DVT. 3) Differentiation of recent DVT from venous insufficiency. Overall RNP method had a sensitivity of 87.6%, a specificity of 54% and an accuracy of 64.8%. The sensitivity was similar in above & below-knee thrombi. Yet the specificity was higher in above-knee thrombi. The highest accuracy (87.3%) was observed in pelvic and groin thrombi. The distribution of thrombi on CP was 19% below the knee, 31% above it and 50% both above and below the knee. Pulmonary embolism (PE) was initially observed in 54 patients (26%) with no clinical evidence of DVT and therefore untreated. This high level is most probably related to the high incidence of proximal DVT in the patients. 181 patients were treated with heparin & coumadin and the RNP score was decreased to 3.6 units (range 0.4-8.8). PE occurred during treatment in 11 (6.1%) and recurrent DVT in 16 (8.8%) patients. CVI was observed in 23 patients before treatment and in another 24 patients (13.2%) after treatment. These results indicate that the RNP method is a simple, semi-quantitative and useful technique for the evaluation and follow-up of DVT and CVI. It is most helpful in the assessment of the extent of DVT. It is also a rapid, noninvasive and cost effective techniaue.

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Recurrent pulmonary embolism related with Paget–Schroetter syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz118 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Yuki Sahashi ◽

Junko Naito ◽

Masanori Kawasaki

Keyword(s):

Pulmonary Embolism ◽

Lifestyle Modification ◽

Axillary Vein ◽

Vein Thrombosis ◽

Cardiology Department ◽

Recurrent Pulmonary Embolism ◽

The Right ◽

Contrast Ct ◽

First Rib Resection ◽

Deep Vein

Abstract Background Paget–Schroetter syndrome (PSS) is an unusual cause of venous thromboembolism, which is frequently misdiagnosed and undiagnosed in clinical settings. Although axillary-subclavian vein thrombosis is related with PSS typically presents in healthy young athletes, it is possible for this phenomenon to occur in various age settings. Case summary We present a case of recurrent pulmonary embolism caused by a thrombus in dilated axillary vein related with PSS. A 74-year-old man was referred to our cardiology department for chest discomfort and hypoxaemia. The contrast computed tomography (CT) revealed that he suffered from bilateral pulmonary embolism. However, we could not find the source of embolism despite other examinations such as ultrasonography of the inferior limb deep vein. Three months later, the patient complained of dyspnoea for a second time, and a contrast CT scan was subsequently performed revealing a new pulmonary embolism. Surgical resection of the giant thrombus was performed, resulting in a good clinical course without recurrence. Discussion We experienced a case of recurring pulmonary embolism in a patient with undiagnosed PSS, which was related to the active and vigorous movement of the right arm during his working. Although there are various treatments for PSS including anticoagulation, first rib resection, and lifestyle modification, we need to consider what is the best treatment individually.

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