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Deep Venous Thrombosis and Pulmonary Embolism :   Diagnostic Approach and Current Guidelines in Therapy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow University of Illinois Medical Center at Chicago
DISCLOSURE AND ACKNOWLEDGMENT ,[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Objective ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ryu et al. Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome. Respir Med 2007; 101:1537.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Horlander et al. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163:1711.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],Carson et al. The clinical course of pulmonary embolism: One year follow-up of PIOPED patients. N Engl J Med 1992; 326:1240 .
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wolde et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164:1685.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Grifoni et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med 2006; 166:2151 .
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Torbicki et al. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003; 41:2245.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cavallazzi et al. Natriuretic peptides in acute pulmonary embolism: a systematic review.  Intensive Care Med 2008
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kucher et al. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003; 107:2545.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],Becattini et al. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116:427.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],Weinmann et al. Deep-vein thrombosis. N Engl J Med 1994; 331:1630. Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stratmann et al. Neurogenic and humoral vasoconstriction in acute pulmonary thromboembolism. Anesth Analg. 2003 Aug;97(2):341-54
 
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Heit, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study Arch Intern Med 2002; 162:1245.
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Goldhaber et al. A prospective study of risk factors for pulmonary embolism in women.  JAMA 1997; 277:642. Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism : Overview
Acute Pulmonary Embolism : Overview ,[object Object],[object Object],[object Object],[object Object],Stein et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120:871.
Acute Pulmonary Embolism: Diagnosis Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],Stein et al. Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100:598 .
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sohne et al. Brain natriuretic peptide in hemodynamically stable acute pulmonary embolism.  J Thromb Haemost 2006; 4:552.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],Muller-Bardorff et al. Release kinetics of cardiac troponin T in survivors of confirmed severe pulmonary embolism. Clin Chem 2002; 48:673.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Panos et al. The electrocardiographic manifestations of pulmonary embolism. J Emerg Med 1988; 6:301. Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
S1 Q3 T3
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Geibel et al. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J 2005; 25:843.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Stein et al. Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100:598 .
[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object]
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
 
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
[object Object],Perfusion
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],Turkstra, et al. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1997; 126:775.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stein et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 140:589.
 
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
 
[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],Stein, PD et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354:2317.
[object Object],Stein, PD et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354:2317.
What if CTA is Negative? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Musset, et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 2002; 360:1914.
 
 
CTA is Not Inferior to V/Q Scanning for Ruling Out PE ,[object Object],[object Object],[object Object],[object Object],[object Object],Anderson et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007; 298:2743.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rodger et al. Steady-state end-tidal alveolar dead space fraction and D-dimer: bedside tests to exclude pulmonary embolism. Chest 2001; 120:115.
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Apical 4 chamber view ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
 
 
 
 
 
 
RECOMMENDED DIAGNOSTIC APPROACH CT Experienced Institutions: Christopher study  
RECOMMENDED DIAGNOSTIC APPROACH  CT inexperienced institutions: PIOPED Study
PERC FOR LOW RISK OUTPATIENT POPULATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
PERC FOR LOW RISK OUTPATIENT POPULATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],Kline et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6:772.
Acute Pulmonary Embolism: Treatment Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],Acute Pulmonary Embolism: Treatment Carson et al. The clinical course of pulmonary embolism: One year follow-up of PIOPED patients. N Engl J Med 1992; 326:1240 .
ACUTE PULMONARY EMBOLISM: TREATMENT ANTICOAGULATION ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
WHEN SHOULD I INITIATE ANTICOAGULANT THERAPY?  ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
WHICH ANTICOAGULANT SHOULD I INITIATE? IV UFH vs. SC LWMH  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
WHICH ANTICOAGULANT SHOULD I INITIATE? IV UFH vs. SC LWMH  ,[object Object],[object Object],[object Object],Hirsh et al. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:141S
THE ADVANTAGES OF USING SC LMWH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],van Dongen et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004; :CD001100.
WHAT ABOUT THE USE OF FONDAPARINUX? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Buller et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003; 349:1695.
LONG-TERM ORAL ANTICOAGULANT: WARFARIN ,[object Object],[object Object],[object Object],[object Object],[object Object],Hutten et al. Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism. Cochrane Database Syst Rev 2006; :CD001367.
FOR HOW LONG SHOULD WE OVERLAP WORFARIN WITH HEPARIN ,[object Object],[object Object],[object Object],Kearon et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest 2008; 133:454S.
 
HOW SHOULD I MONITOR LMWH?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
HOW SHOULD I MONITOR UFH?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hull et al. Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis. Arch Intern Med 1997; 157:2562. Hull et al. The importance of initial heparin treatment on long-term clinical outcomes of antithrombotic therapy. The emerging theme of delayed recurrence. Arch Intern Med 1997; 157:2317.
HOW SHOULD I MONITOR COUMADIN?  ,[object Object],[object Object],[object Object],Kearon et al. Comparison of Low-Intensity Warfarin Therapy with Conventional-Intensity Warfarin Therapy for Long-Term Prevention of Recurrent Venous Thromboembolism. N Engl J Med 2003; 349:631 .
WHAT ARE THE COMMON COMPLICATIONS?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
WHAT ARE THE COMMON COMPLICATIONS?  ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
FOR HOW LONG SHOULD I TREAT?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kearon et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:454S.
FOR HOW LONG SHOULD I TREAT?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kearon et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:454S.
Acute Pulmonary Embolism: Treatment ,[object Object],[object Object],[object Object]
SHOULD I ADMINISTER THROMBOLYTIC THERAPY? ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],Fam, NP, Verma, A. Thrombolysis of a massive pulmonary embolism.  N Engl J Med, 2002; 347:1161.  Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Thrombolytic Therapy Does Not Improve Mortality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Thabut et al. Thrombolytic therapy of pulmonary embolism: a meta-analysis. J Am Coll Cardiol 2002; 40:1660. Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Thrombolytic Therapy Improves Important Physiologic Parameters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Kearon, et al. Antithrombotic therapy for venous thromboembolic disease:  American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 Suppl 6:454.
Thrombolytic Therapy in Patients Undergoing CPR due to PE-induced Cardiac Arrest ,[object Object],[object Object],[object Object],[object Object],Bailen et al. Thrombolysis during cardiopulmonary resuscitation in fulminant pulmonary embolism: A review.  Crit Care Med 2001; 29:2211. Abu-Laban et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity.  N Engl J Med 2002; 346:1522.
Adverse Effect Associated with Thrombolysis ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Thrombolytic Therapy in DVT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Systemic  vs. Catheter-directed Thrombolysis: Which One is Better? ,[object Object],[object Object],[object Object],[object Object],Laiho et al. Preservation of venous valve function after catheter-directed and systemic thrombolysis for deep venous thrombosis. Eur J Vasc Endovasc Surg 2004; 28:391
Kearon, et al. Antithrombotic therapy for venous thromboembolic disease:  American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 Suppl 6:454.
The ATTRACT Trial ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Acute Pulmonary Embolism: Treatment ,[object Object],[object Object],[object Object]
SHOULD AN IVC FILTER BE PLACED?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
IVC FILTERS: OUTCOME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Decousus et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998; 338:409 .
IVC FILTERS: COMPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
LONG-TERM vs. RETRIEVABLE IVC FILTERS ,[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
EMBOLECTOMY ,[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Catheter Embolectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Normal inferior pulmonary artery and peripheral reperfusion immediately  and one month after thrombectomy Huge thrombus  in the right inferior pulmonary artery Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Surgical Embolectomy  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Meneveau et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism.  Chest 2006; 129:1043.
Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Chang et al. Pregnancy-related mortality surveillance--United States, 1991--1999.  MMWR Surveill Summ 2003; 52:1.
Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy ,[object Object],[object Object],[object Object],Simpson et al. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 2001; 108:56.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Ginsberg et al. Venous thrombosis during pregnancy: Leg and trimester of presentation. Thromb Haemost 1992; 67:519.
[object Object],[object Object],[object Object],[object Object],[object Object],Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Goodrich et al. Peripheral venous distensibility and velocity of venous blood flow during pregnancy or during oral contraceptive therapy. Am J Obstet Gynecol 1964; 90:740.
[object Object],[object Object],[object Object],[object Object],[object Object],Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Marik et al. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359:2025. Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Marik et al. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359:2025
Diagnosis of DVT/PE During Pregnancy can be a Challenge ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Diagnosis of DVT/PE During Pregnancy can be a Challenge ,[object Object],[object Object],Kline et al. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 51:825.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Diagnosis of DVT During Pregnancy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Diagnosis of PE During Pregnancy Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
[object Object],[object Object],[object Object],Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology.  Eur Heart J 2000; 21:1301.
Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD  Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD  ,[object Object],[object Object],[object Object],[object Object],[object Object],Rizkallah et al. Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD: A Systematic Review and Meta-analysis  CHEST March 2009 vol. 135 no. 3 786-793
Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD  ,[object Object],[object Object],[object Object],[object Object],Rizkallah et al. Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD: A Systematic Review and Meta-analysis  CHEST March 2009 vol. 135 no. 3 786-793
[object Object],Rizkallah et al. Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD: A Systematic Review and Meta-analysis  CHEST March 2009 vol. 135 no. 3 786-793
Diagnostic Vascular Ultrasonography Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Should we Perform our Own Compression Studies? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Lower Extremity Deep Venous Anatomy ,[object Object],[object Object],[object Object],[object Object],Proximal Distal Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Why Do we Ignore Calf DVT? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Why Do we Ignore Calf DVT? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Incidence of DVT in ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Do we Need to Utilize Doppler and Color Modalities? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Do we Need to Scan Every 2 cm from CFV to PV? ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies in Acutely Ill Medical Patients? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Can We Accurately Perform Compression Studies in High Risk Patients? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Summary Slide ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Performance of Compression Study ,[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5
Compression Technique ,[object Object],[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5 Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Compression Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5 1 2 3 4 5 Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
 
 
 
 
 
BEAN SIGN CFV GSV
Compression Points ,[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5 1 2
PA PV PA
PA PA PV PV
How to Distinguish Acute from Chronic Thrombus  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5 Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
Important Hints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blaivas M. Ultrasound in the detection of venous thromboembolism. Crit Care Med 2007 Vol. 35 No. 5 Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow
 
 
[object Object],Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow

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Deep Venous Thrombosis and Pulmonary Embolism : Diagnostic Approach and Current Guidelines in Therapy. Diagnostic Vascular Ultrasonography

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