J. Moriarty

The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy

Objective: To examine the use of the modified Wells score in pregnancy as a risk stratification tool in the diagnosis of pulmonary embolism (PE). Methods: All pregnant or post-partum patients who were referred for CT Pulmonary Angiography (CTPA) to evaluate suspected PE over a 5-year period were included in the study. Patient records were used to apply the modified Wells score (MWS) and analyze their risk of PE. Results: A total of 125 women were referred for CTPA over 5 years. A MWS of 6 or greater (“High Risk”) was 100% sensitive and 90% specific with a positive predictive value of 36% for PE on CTPA. No patients with a low MWS (less than 6) had a PE, giving a negative predictive value of 100%. pu2009≤u20090.001. D-dimers, chest X-ray, blood gases and EKG were significantly less effective than the MWS in aiding the diagnosis of PE. Conclusion: Current methods employed for the diagnosis of PE are inadequate. Risk stratification using the MWS may allow safe exclusion of PE before resorting to CTPA. To the best of our knowledge this is the first study to have used the MWS in a pregnant patient group.

A Novel Technique for Endovascular Removal of Large Volume Right Atrial Tumor Thrombus

Venous thromboembolic disease is a significant cause of morbidity and mortality, particularly in the setting of large volume pulmonary embolism. Thrombolytic therapy has been shown to be a successful treatment modality; however, its use somewhat limited due to the risk of hemorrhage and potential for distal embolization in the setting of large mobile thrombi. In patients where either thrombolysis is contraindicated or unsuccessful, and conventional therapies prove inadequate, surgical thrombectomy may be considered. We present a case of percutaneous endovascular extraction of a large mobile mass extending from the inferior vena cava into the right atrium using the Angiovac device, a venovenous bypass system designed for high-volume aspiration of undesired endovascular material. Standard endovascular methods for removal of cancer-associated thrombus, such as catheter-directed lysis, maceration, and exclusion, may prove inadequate in the setting of underlying tumor thrombus. Where conventional endovascular methods either fail or are unsuitable, endovascular thrombectomy with the Angiovac device may be a useful and safe minimally invasive alternative to open resection.

Complications after transcatheter arterial embolization for pelvic trauma: relationship to level and laterality of embolization

PurposeTranscatheter arterial embolization (TAE) is commonly used to control hemorrhage after pelvic trauma. Despite the procedures reported safety, there can be severe complications, mostly related to ischemia of embolized tissues. Our purpose was to examine the complications of trauma patients resulting from the embolization techniques utilized at our level 1 trauma center.Materials and methodsA retrospective chart review was conducted. One hundred and seven patients who underwent pelvic embolization between January 2003 and December 2013 were included. Patient demographics, ISS, angiography techniques, and major complications including gluteal and skin necrosis, wound breakdown, and deep infection were compared.ResultsNine patients (8.4xa0%) developed major complications after undergoing TAE. This rate dropped to 5.1xa0% after exclusion of patients with Morel-Lavallee lesions. Nonselective embolization trended toward a higher complication rate compared to superselective embolization. Patients who developed complications were more likely to have undergone pelvic surgery.ConclusionThe majority of patients who developed complications had nonselective TAE. Morel-Lavallee lesions are a confounding factor, but TAE may impose an additional risk. Pelvic surgery after TAE may further predispose patients to complications. We recommend superselective embolization as first-line treatment and caution the use of prophylactic embolization, especially in patients with substantial pelvic soft tissue injuries.