Abstract:

Background: pulmonary embolism (PE), is one of the most common cardiopulmonary pathologies in the world, has a high risk of developing after major operations on the osteoarticular system. Mortality from PE remains high, ranking third after myocardial infarction and stroke.

Aim: was to identify tomographic signs of PE in patients with osteoarticular pathology in the postoperative period.

Materials and methods: we analyzed results of computed angiopulmonography of 11 patients with suspicion on pulmonary embolism who were operated on osteoarticular pathology at the Federal Center for Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of the Russian Federation (Cheboksary). Patients showed such indirect signs of PE as discshaped atelectasis of lung tissues, expansion of diameter of pulmonary trunk and right pulmonary artery, signs of congestion in pulmonary circulation and pulmonary hypertension. Direct radiological signs included occlusion of a branch of pulmonary artery by thrombus.

Results: in 91% of examined patients, occlusion of branch of pulmonary artery by thrombus was detected, in 82% of cases - the defeat of branches of right pulmonary artery. Embolism at the level of lobar arteries was detected in 30%, segmental branches - in 60% of patients; signs of pulmonary embolism of one of subsegmental branches of right pulmonary artery - in one patient (10%). Bilateral thrombosis was observed in two patients, including massive bilateral PE in one case. One patient had discoid atelectasis of lung tissues. Expansion of diameter of pulmonary trunk and right pulmonary artery was observed in 78% of patients with PE, signs of congestion in pulmonary circulation - in 27% of cases, pulmonary hypertension - in 73% of cases.

Conclusion: visualization of direct and indirect signs of pulmonary embolism during computed pulmonary angiography confirmed the diagnosis in all examined patients. The detection of blood clots in pulmonary arteries themselves is the main criterion in making the final diagnosis.

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Abstract:

The authors report 44 successful implantations of original retrieval Nitinol stent-filters, unique "closed" design of which comprehensively described in the article. All the devices placed for pulmonary embolism (PE) management in patients with lower extremity and pelvic deep vein (DV) thrombosis. Authors announce absolute efficiency of their stent-filters for PE prophylaxis, and the procedure itself declared to be safe and minimally invasive.

Stent-filter implantation into iliac veins compared to standard filter placement in inferior vena cava (IVC) excludes risks of total infrarenal IVC thrombosis - the major complication of such procedures. It is also associated with early DV recanalization, that in sum radically reduces disability rate. Moreover, in case of IVC abnormalities, kinking or external compression stent-filter into iliac position remains the only option for endovascular PE management. All the above can be mentioned as advantages of using stent-filters.

At the same time authors observe that stent-filters quick incorporation into vessel wall prevented endovascular retrieval of the device in quite a number of cases. Persistent PE threat, requiring prolonged antithrombotic therapy under endovascular protection, might also contribute for low retrievability of the device. 

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