Combined CT Venography and Pulmonary Angiography: A Comprehensive Review

Katz, Douglas S.; Loud, Peter A.; Bruce, Dennis; Gittleman, Adam M.; Mueller, Richard; Klippenstein, Donald; Grossman, Zachary D.

doi:10.1148/radiographics.22.suppl_1.g02oc17s3

Cited by 93 publications

(47 citation statements)

References 44 publications

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“…Due to the wide range of reported sensitivity of CT angiography [23][24][25] and the uncertain significance of a missed subsegmental PE, 26 the guideline suggested CTVPA as the imaging modality of choice. 27,28 However, CTVPA was not recommended in patients with renal insufficiency, pregnancy, or allergy to iodinated contrast dye. 6 In such cases, the guideline suggested that the treating physician consult with the radiologist regarding imaging alternatives.…”

Section: Methodsmentioning

confidence: 99%

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

Brown¹,

Vance²,

Kline³

2005

Acad Emergency Med

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Objective: To assess the clinical outcome of patients suspected of pulmonary embolism (PE) following implementation of an emergency department (ED) diagnostic guideline. Methods: A prospective observational study of all patients suspected of PE who presented to the ED during a four-month study period. The authors' modification of the Charlotte criteria recommended D-dimer testing in those younger than 70 years of age with a low clinical suspicion of PE and no unexplained hypoxemia, unilateral leg swelling, recent surgery, hemoptysis, pregnancy, or prolonged duration of symptoms. The primary outcome was the identification of venous thromboembolism during a three-month follow-up period. The negative predictive value of the overall diagnostic strategy and the test characteristics of D-dimer were calculated. Results: A total of 1,207 consecutive patients were evaluated for suspected PE; 71 (5.8%) were diagnosed with venous thromboembolism. One missed case of PE was identified on follow-up, yielding a negative predictive value of 99.9% (95% confidence interval [CI] = 99.5% to 100%). The missed case was a patient who presented with pleuritic chest pain and shortness of breath; a chest radiograph revealed pneumothorax, and the physician decided not to pursue the positive D-dimer result. The patient returned six weeks later with PE. Subgroup analysis of patients having D-dimer performed (n = 677) yields a sensitivity of 0.93 (95% CI = 0.77 to 0.98) and a specificity of 0.74 (95% CI = 0.70 to 0.77). Conclusions: Implementation of a PE diagnostic guideline in a community ED setting is safe and has improved the specificity of the enzyme-linked immunosorbent assay D-dimer test when compared with previous studies. Key words: pulmonary embolism; diagnosis; guideline. ACADEMIC EMERGENCY MEDICINE 2005; 12:20-25. The evaluation of patients suspected of pulmonary embolism (PE) is complex, and numerous diagnostic strategies have been suggested. [1][2][3][4][5][6][7] Clinical guidelines or protocols may assist physicians with complicated diagnostic algorithms and improve care by decreasing inappropriate variance in practice style. 8,9 At the same time, algorithms that reduce patient care into a sequence of binary decisions often do injustice to the complexity of medicine. 10 The rationale for a PE ruleout protocol has been described; however, the safety and efficiency of a PE rule-out protocol awaits empiric confirmation. 11,12Generally, simple innovations spread faster than complicated ones. 13 A prediction rule will be used if it makes clinical sense and is simple.14 One of the aims of our PE diagnostic guideline was to simplify the complicated algorithms and decision rules that have been proposed. 1 The guideline focus was on pretest probability assessment and the appropriate use of D-dimer testing. 7,8,12 The implementation of a PE ruleout protocol or guideline requires the understanding and approval of physicians at the local level. The emergency physicians at our institution agreed to start with empiric clinical ju...

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Section: Methodsmentioning

confidence: 99%

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

Brown¹,

Vance²,

Kline³

2005

Acad Emergency Med

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“…Imaging techniques such as ultrasonography, 151 contrast CT, 152 MRV, and venography are used to confirm the morphological diagnosis of DVT. During lower limb venous ultrasonography (Figure 4), the following four steps of investigation should be performed: (1) determination of the presence/absence of thrombus in lower limb veins; (2) when thrombus is detected, evaluation of its characteristics to stage disease; (3) when acute-phase DVT is present, determination of the extent of thrombus to determine the type of DVT; and (4) examination of the central edge of the thrombus to evaluate it as a potential source of emboli.…”

Section: ) Imaging Techniquesmentioning

confidence: 99%

Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2009) - Digest Version -

Group¹

2011

Circ J

269

108

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“…Thrombolysis versus thrombectomy in acute deep vein thrombosis review A practical approach to the management of a patient with acute dVT Just as catheter angiography in the assessment of peripheral vascular disease has largely been replaced by CT or MRI angiography so too has catheter venography been replaced by ultrasound and or CT or MR venography [38][39][40][41].…”

Section: A U T H O R P R O O F Future Science Groupmentioning

confidence: 99%

Thrombolysis versus thrombectomy in acute deep vein thrombosis

O’Sullivan

2011

Interventional Cardiology

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Thrombolysis versus thrombectomy in acute deep vein thrombosis reviewDeep vein thrombosis (DVT) is a significant health problem leading to the admission of over 250,000 Americans each year. Its most serious acute complication, namely pulmonary embolus kills approximately 100,000 each year, and is the third most common cardiovascular related mortality after myocardial infarction and stroke. Chronic leg problems following DVT include leg heaviness, tiredness, cramping and ulceration. These are termed the post-thrombotic syndrome. The current standard therapy of anticoagulation has changed little over 50 years. It does not remove or destroy thrombus, relying instead on the bodies own fibrinolytic mechanisms to do so. DVT needs to be more accurately categorized on an anatomical basis, and for a variety of reasons, the area of most importance is the iliofemoral region. The rationale for active, rather than passive, thrombus removal relies on multiple observations that, by doing so improves luminal patency, restores valvular function and has the potential to reduce the severity of post-thrombotic syndrome. Techniques of thrombus removal include catheter-directed thrombolysis, mechanical thrombectomy, and various combinations of both (pharmacomechanical catheter-directed thrombolysis). Although there no few direct trials comparing these directly, there is a reasonable body of evidence demonstrating their efficacy.

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Combined CT Venography and Pulmonary Angiography: A Comprehensive Review

Cited by 93 publications

References 44 publications

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2009) - Digest Version -

Thrombolysis versus thrombectomy in acute deep vein thrombosis

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