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Symptomatic pulmonary embolus during lower extremity deep venous thrombolysis: the role of IVC filters

Authors :
Ulku C. Turba
C.L. Anderson
Wael E. Saad
S.J. Lyman
Source :
Journal of Vascular and Interventional Radiology. 24:S172
Publication Year :
2013
Publisher :
Elsevier BV, 2013.

Abstract

Learning Objectives 1. Determine the prevalence of trapped thrombus in IVC filters during lower extremity deep venous thrombolysis 2. Determine the prevalence of symptomatic pulmonary embolus (PE) requiring evaluation with pulmonary angiography 3. Discuss the role of IVC filters in preventing symptomatic PE Background IVC filters are known to trap thrombus during lower extremity thrombolysis, but also are known to serve as a nidus for thrombosis. The role of IVC filters in preventing clinically important PE in thrombolysis patients remains uncertain. Clinical Findings/Procedure Details Between January 2003 and December 2011, 64 patients underwent 76 lower extremity thrombolysis procedures at a single institution. Venograms were retrospectively evaluated for presence or placement of an IVC filter and for trapped thrombus in the filter at any time during the lysis. Pulmonary angiography within one year was also reviewed. A filter was in place for 53 procedures (70%). Trapped thrombus could be evaluated in 43 cases; of these, thrombus measuring an average of 9 mm (range 4 - 16 mm) was present in 16 cases (37%). CT or conventional pulmonary angiography was performed following only 11 procedures (14%), all in patients with a filter in place (Fisher exact p = 0.018). Four were positive for PE (36%, 5% of procedures). Conclusion and/or Teaching Points Trapped thrombus was seen in a relatively high proportion of IVC filters, but symptoms requiring evaluation for PE were an unusual event and clinically apparent PE a rare event. Filters did not protect against either evaluation for PE or presence of PE, and therefore their role in thrombolysis remains unclear.

Details

ISSN :
10510443
Volume :
24
Database :
OpenAIRE
Journal :
Journal of Vascular and Interventional Radiology
Accession number :
edsair.doi...........ddd423edf59fc5760a8855a2486303e8
Full Text :
https://doi.org/10.1016/j.jvir.2013.01.436