Dr Paulino Souza Neto Vascular Surgery, Endovascular Surgery

English » Venous Diseases » Pulmonary Embolism

The most feared consequence of the Deep Venous Thrombosis is the Pulmonary Embolism.

The conjunction of those pathologies is named Venous Thrombus Embolism (VTE).

In VTE, the clots formed within the deep veins of the pelvis and inferior limbs dislodge and flow freely through the venous system, passing through the right atrium and ventricle without difficulties and blocking the Pulmonary artery or its branches. Due this blockage, the blood can't exchange the respiratory gases leading to an acute respiratory distress. If the loss of gas exchange area is high, this condition might be incompatible with life. Therefore the high mortality rate of this event.

In the USA, 100.000 American souls are lost each year and an estimated 4.5 mi worldwide.

In Brazil is the 5th cause of maternal death and also occurs in children in a rate of 7 per million.

Some risk factors are known such as thrombophilia, Iliac Vein Stenosis, Venous aneurisms, post-op of abdominal, orthopedic and gynecological surgeries, systemic diseases and conditions like poli trauma and flight longer than 2 hours. The risk also increases with age and the presence of venous disease. It is a responsibility of the vascular surgeon to evaluate the patient in order to stratify the risk of Pulmonary Embolism.

This is a pleomorphic condition and is frequently indistinct from other diseases. In the great majority of cases, the clinical manifestation is minor. In the classic expression an acute chest pain is felt accompanied of breath rhythm acceleration (Tachipnea) and coughing with blood (hemoptysis). Unfortunatelly the first manifestation might be sudden death. Facing those facts, the medical comunity keep a constant surveillance of patients in higher risk for this event. Prevention is the keyword and shall be implemented with preventive use of anticoagulants, compression stockings or intermittent pneumatic compression according to the risk and clinical status. When a minor manifestation is diagnosed, the clinical treatment with anticoagulant and general measures is enough. However, when the Pulmonary Artery pressure raises high, a downsize in blood oxygen saturation is observed leading to acidosis due to anaerobic metabolism. A faster intervention might be needed. Venous thrombolysis accompanied by the Vena Cava filter implantation is the rule. The destruction of the clot in the lungs is the target and the filter prevents from any other major clot to migrate to the lung.

With the release of the Pulmonary circulation, the investigation of a source is needed. Color doppler ultrasound is a very sensitive method to below the groin screening. The investigation of the pelvic veins is more effective by means of the Intravascular Ultrasound (IVUS).

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