Popliteal Venous Aneurysm Causing Pulmonary Embolism and Paradoxical Embolisation in a Patient with Antiphospholipid Syndrome

Williamson, J M L; Dalton, Richard; Chester, J. F.

doi:10.1016/j.ejvs.2008.03.005

Cited by 14 publications

(7 citation statements)

References 5 publications

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“…Case reports have described the presence of patent foramen ovale (PFO) in patients with APS and stroke. [19][20][21] Few studies, however, have assessed the relationship between PFO and APS. 19,22 A previous TCD study showed a high prevalence of RLS in patients with APS (58.5%); however, there was no association between large RLS (>10 high-intensity transient signs) and stroke.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler findings in antiphospholipid syndrome

Ricarte

Dutra

Barsottini

et al. 2019

Lupus

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Introduction Transcranial Doppler is a method that enables the assessment of different cerebral hemodynamic parameters. It also allows for the evaluation of the presence of right-to-left circulation shunts (RLS) and for the detection of microembolic signals (MESs), which might be associated with an increased risk of cerebrovascular events. For instance, the presence of MESs on transcranial Doppler in patients with systemic lupus erythematous (SLE) and antiphospholipid syndrome (APS) is associated with an increased risk of stroke. Therefore, transcranial Doppler could be a useful tool for stroke risk stratification in these patients. Objective Our objective was to evaluate transcranial Doppler cerebral mean blood flow velocities as well as the presence of MESs and RLS in patients with antiphospholipid syndrome and SLE. Patients and methods Twenty-two patients with primary APS (PAPS), 24 patients with secondary APS (SAPS), 27 patients with SLE without APS and 21 healthy controls were evaluated. Clinical and epidemiological data were compiled from medical charts, and all subjects underwent transcranial Doppler examination with breath-holding index calculation. Both middle cerebral arteries were monitored for 60 min for the detection of MESs. RLS was investigated with agitated saline injected as a bolus. Results There were no significant differences in mean blood flow velocities among the groups. MESs were more frequently found in patients with SLE when compared with controls and patients with APS (SLE: 17.4%, SAPS: 4.3%, PAPS: 0%, controls: 0%, p = 0.03). Anticoagulant therapy was more frequently used in the APS group (PAPS: 81.8%, SAPS: 75.2%, SLE: 1.7%, p < 0.001). Patients with APS had a higher frequency of RLS when compared with volunteers (63.6% versus 38.1%, p = 0.05). Breath-holding index values tended to be lower in patients with SAPS than in control subjects and patients with PAPS and SLE ( p = 0.06). Conclusions Patients with APS had a higher frequency of RLS than healthy controls. This finding alerts to the importance of cardiac investigation in patients with stroke and APS, because further therapies such as RLS occlusion might eventually add protection. The higher frequency of MES in patients with SLE could suggest an effect of anticoagulant therapy on MES prevention, more frequently used in patients with APS.

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Section: Discussionmentioning

confidence: 99%

Transcranial Doppler findings in antiphospholipid syndrome

Ricarte

Dutra

Barsottini

et al. 2019

Lupus

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“…In one of those cases it was decided to keep the filter in place in the long term (21). Three patients had developed PE at the time of PVA diagnosis despite oral anticoagulation (21,25,28).…”

Section: Resultsmentioning

confidence: 99%

Popliteal vein aneurysm: Is it necessary to apply anticoagulants after a surgery?

Geremek¹,

Trochimczuk²,

Janik³

et al. 2014

Phlebologie

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SummaryAim: This study is intended to evaluate indications for antithrombotic therapy in patients with tangentially resected popliteal vein aneurysm.Methods: Evaluation of the course of therapy in a patient with popliteal vein aneurysm. Literature review covered literature data published within the last decade. Studies were identified by searching Medline and PubMed databases for the following phrases: ”popliteal venous aneurysm” and ”popliteal vein aneurysm”.Results: The case study and literature review revealed that thromboembolic risk cannot be entirely eliminated by means of tangential resection of popliteal vein aneurysm. Vein suture and residual postoperative dilatation of the popliteal vein can be considered predisposing factors to thromboembolic complications.Conclusion: Patients with tangentially resected popliteal vein aneurysm involving vein suture can be administered oral antithrombotic therapy within three months postoperatively. Therapy extension should be made conditional on the degree of vein dilation reduction. Where the diameter at surgical site is larger than 20 mm, it appears appropriate to continue antithrombotic therapy and to repeat assessment in six months time.

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“…Common peroneal nerve compression and paradoxical embolization via patent foramen ovale have also been described in few cases. [14][15][16][17] Although rare, the life-threatening presentation of recurrent PE in the course of therapeutic levels of anticoagulation has been reported. Just over 22 such cases have been reported in the world literature to date; however, true prevalence is not well documented.…”

Section: Discussionmentioning

confidence: 99%

Popliteal Venous Aneurysm as a Cause of Recurrent Pulmonary Embolism

Tomko

Malý

Jiška

et al. 2013

Vasc Endovascular Surg

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We report 2 cases of recurrent pulmonary embolism (PE) in popliteal venous aneurysm (PVA). Patients were 78-year-old and 72-year-old women. Both were initially seen for acute PE. Saccular and fusiform PVAs were diagnosed in each patient based on duplex ultrasound. However, despite anticoagulation therapy, both patients had PE. At the time of the event, 1 patient was receiving inadequate dose of low-molecular-weight heparin. The other patient was treated with warfarin and had adequate international normalized ratio at the time of re-embolism, and thus, an inferior vena cava filter was inserted. Both patients underwent successful aneurysm resection without any additional thromboembolic events.

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Popliteal Venous Aneurysm Causing Pulmonary Embolism and Paradoxical Embolisation in a Patient with Antiphospholipid Syndrome

Abstract: This case is unusual as the patient suffered a paradoxical embolism due to his patent foramen ovale. Although antiphospholipid syndrome is associated with venous thrombosis, this is usually prevented by therapeutic anticoagulation.

Cited by 14 publications

References 5 publications

Transcranial Doppler findings in antiphospholipid syndrome

Transcranial Doppler findings in antiphospholipid syndrome

Popliteal vein aneurysm: Is it necessary to apply anticoagulants after a surgery?

Popliteal Venous Aneurysm as a Cause of Recurrent Pulmonary Embolism

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