Frequency of pulmonary embolism in ambulant patients with pelvic vein thrombosis: A prospective study

Abstract

One hundred thirty-nine consecutive patients (average age 70.1 years) who were able to walk with a swollen leg were seen at the clinic where diagnosis of acute deep vein thrombosis (DVT) extending to the pelvis was confirmed by injecting microspheres labeled with technetium 99m into the dorsal foot vein (radionuclide venography). Thirty-nine (28%) of these patients had malignant disease. Perfusion lung scans performed immediately after radionuclide venography were supplemented by inhalation scans (99mTc-labeled diethylenetriamine pentaacetic acid aerosol) in case of perfusion defects. During scintigraphy patterns highly indicative of pulmonary embolism (PE) were found in 80 patients (58%), but only 11 (7.9%) had minor clinical symptoms. All patients were admitted to the ward, were given standard heparin subcutaneously (35,000 to 40,000 units/24 hr) and firm bandages, and were encouraged to walk. After 11 days pulmonary scintigraphy was repeated and revealed no change in 55 of 59 patients without PE and in 40 of 80 patients with PE. Thirty-three patients (23.7%) showed regression of perfusion defects. New PE developed in 11 patients (7.9%, four without and seven with previous PE). Autopsy revealed that one 80-year-old patient with prostatic carcinoma had died of massive PE. When comparing this frequency of newly developed PE during ambulation with the occurrence of PE after bed rest, according to the literature, it is no more dangerous for a mobile patient with proximal DVT to walk wearing a firm bandage than it is for the patient to be in bed. Therefore we recommend treating mobile patients with DVT by use of anticoagulation and firm compression bandages and without immobilization.

Systematic Lung Scans Reveal a High Frequency of Silent Pulmonary Embolism in Patients With Proximal Deep Venous Thrombosis

“…Others studies using the criteria of Biello et al 13 or PIOPED 12 for ventilation perfusion scan analysis have reported similar results, 2-7 but they differed from our study by the type of DVT, location of the thrombosis, and methods used for diagnosing DVT. [2][3][4][5][6][7] In addition, our study underlines that, among patients who have abnormal scans, the proportion of high-probability scans is higher in patients younger than 30 years. Evaluating various methods of scan analysis, our study also indicates that the frequencies of high-probability patients in this population are similar when the perfusion scans are compared with chest radiographs or with ventilation scans.…”

Thrombus Embolization Into IVC Filters During Catheter-Directed Thrombolysis for Proximal Deep Venous Thrombosis

“…[12][13][14][15][16][17][18][19] Patients with DVT subjected to CDT are generally young and otherwise healthy and presumably have a large cardiopulmonary reserve. Therefore, PE in this patient group is probably more likely to occur silently, both in general and during endovascular interventions in the inferior vena cava.…”

Venous thromboembolism: diagnosis and management of deep venous thrombosis

“…About half of patients with symptomatic proximal DVT have clinically silent PE at the time of diagnosis, 6 and 10% have symptomatic PE 7 , 8 . The prevalence of PE increases with age, particularly above 70 years 7 , 8 …”