Free-Floating Thrombus and Pulmonary Embolism

Greenfield, Lazar J.

doi:10.1001/archinte.1997.00440430143017

Arch Intern Med

1997

DOI: 10.1001/archinte.1997.00440430143017

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Free-Floating Thrombus and Pulmonary Embolism

Lazar J. Greenfield¹

Abstract: The recent article by Pacouret et al1 and the accompanying editorial by Goldhaber2 raise issues that deserve comment. In their prospec-

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Cited by 4 publications

References 13 publications

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Cost–benefit assessment of inferior vena cava filter placement in advanced cancer patients

Marcy

Magné

Gallard

et al. 2002

Support Care Cancer

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We retrospectively collected data recorded between 1994 and 2000, with the aim of evaluating the cost and benefits of IVCFP (inferior vena cava filter placement) in advanced cancer patients treated in our institution alone from the radio-diagnosis department's point of view. A total of 30 procedures were performed. The benefits were represented by the efficacy and the safety of the filter. The costing procedure consisted in multiplying the value of the unit index by the number of relative complexity indices. Eighty percent (24/30) of the patients were dead at the time of the study. Twenty percent (6/30) of the patients died before even being discharged from hospital. Three of them died from renal failure, owing to complete renal vein thrombosis (n=2) or hydronephrosis (n=1), and 1 from pulmonary embolism because it was exceptionally severe; the other 2 patients were cachectic, i.e., in poor general condition. The individual cost of the procedures represented only 2% of the mean entire cost of hospitalization. Seventy-six percent, 56% and 40% of the patients, were still alive at 1 month; 3 months and 6 months, respectively, with an improved quality of survival in at least 53% of the patients. The low complication rate and the low cost relative to the mean cost of hospitalization (2%) are factors in favor of using IVCFP if it is medically indicated.

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Cost–benefit assessment of inferior vena cava filter placement in advanced cancer patients

Marcy

Magné

Gallard

et al. 2002

Support Care Cancer

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The hemodynamics and diagnosis of venous disease

Meissner

Moneta

Burnand

et al. 2007

Journal of Vascular Surgery

313

233

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The venous system is, in many respects, more complex than the arterial system and a thorough understanding of venous anatomy, pathophysiology, and available diagnostic tests is required in the management of acute and chronic venous disorders. The venous system develops through several stages, which may be associated with a number of development anomalies. A thorough knowledge of lower extremity venous anatomy, anatomic variants, and the recently updated nomenclature is required of all venous practitioners. Effective venous return from the lower extremities requires the interaction of the heart, a pressure gradient, the peripheral muscle pumps of the leg, and competent venous valves. In the absence of pathology, this system functions to reduce venous pressure from approximately 100 mm Hg to a mean of 22 mm Hg within a few steps. The severe manifestations of chronic venous insufficiency result from ambulatory venous hypertension, or a failure to reduce venous pressure with exercise. Although the precise mechanism remains unclear, venous hypertension is thought to induce the associated skin changes through a number of inflammatory mechanisms. Several diagnostic tests are available for the evaluation of acute and chronic venous disease. Although venous duplex ultrasonography has become the standard for detection of acute deep venous thrombosis, adjuvant modalities such as contrast, computed tomographic, and magnetic resonance venography have an increasing role. Duplex ultrasonography is also the most useful test for detecting and localizing chronic venous obstruction and valvular incompetence. However, it provides relatively little quantitative hemodynamic information and is often combined with measurements of hemodynamic severity determined by a number of plethysmographic methods. Finally, critical assessment of venous treatment modalities requires an understanding of the objective clinical outcome and quality of life instruments available.

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Duplex follow-up of patients with DVT: Does it have clinical significance?

Meissner

2001

Seminars in Vascular Surgery

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Free-Floating Thrombus and Pulmonary Embolism

Abstract: The recent article by Pacouret et al1 and the accompanying editorial by Goldhaber2 raise issues that deserve comment. In their prospec-

Cited by 4 publications

References 13 publications

Cost–benefit assessment of inferior vena cava filter placement in advanced cancer patients

Cost–benefit assessment of inferior vena cava filter placement in advanced cancer patients

The hemodynamics and diagnosis of venous disease

Duplex follow-up of patients with DVT: Does it have clinical significance?

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