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Risk Factors for Pulmonary Artery (PE) Embolization following Deep Venous Thrombosis (DVT)
Nicholas J. Gargiulo, III, MD FACS.
The Brookdale University Hospital & Medical Center, New York, NY, USA.

Background: The prevention of deep venous thrombosis (DVT) and pulmonary artery embolization (PE) continues to remain a vexing clinical challenge not only for inpatients but also in outpatients. Numerous recommendations have been advocated for DVT/PE prophylaxis and yet there still remains a national reported incidence of 0.5% to 1.9%. Several risk factor scales have been employed to predict the development of DVT. It remains unclear, however, which DVTs progress to pulmonary artery embolization (PE). The purpose of this study was to elucidate which risk factors, if any, may result in venous thrombotic embolization to the pulmonary arteries (PE).
Methods: A prospective hospital-wide quality study was initiated over an 8 month period evaluating all inpatients and outpatients presenting with acute DVT. All DVTs were diagnosed by duplex ultrasound performed by certified vascular technologists. The real time images were interpreted by 2 certified vascular surgeons. An acute DVT was diagnosed by thrombus echogenicity, change in vein diameter, diminished compressibility and lack of respiratory phasicity. All PEs were diagnosed by pulmonary artery computed tomographic arteriography (PACTA).
Results: A total of 234 patients were identified with acute DVT (190 (81%) patients with DVT alone and 44 (19%) patients with DVT and PE). The two cohorts were similar with regards to age, gender, site of venous thrombosis, hypercoagulable profile, oncologic manifestations, neurosurgical and orthopedic injuries, and other associated traumatic (i.e. abdominal, chest, vascular) injuries. Those patients with DVT and concomitant PE had a statistically higher incidence of catheter directed thrombolysis and inferior vena cava filter placement (p<0.05). There were no identifiable risk factors in the DVT/PE cohort that could have predicted the observed pulmonary artery embolization (PE).
Conclusions: In this prospective study, there are no identifiable risk factors for patients with DVT and concomitant PE to explain the observed pulmonary artery embolization (PE). This may support the concept that DVT and PE are in fact intrinsic venous thromboses unrelated to embolic physiology.


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