| Abstract: | ![]()
One hundred and fifty-five patients with a mean age of 59 years and suffering a recent pulmonary embolism (P.E.) underwent angiopneumography and phlebocavography before and after treatment. The P.E. was minimal in 42 cases (Muller less than 11) and severe in 113 cases (Muller greater than 11). There was an associated venous thrombosis (V.T.) in 134 cases (86%) affecting the iliac veins or vena cava in 44 cases (28%). Several types of treatment were used: heparin 66, SK 24, high dose UK 16, low dose UK + heparin 37, surgery 16. Fifty-two patients underwent a procedure to interrupt the I.V.C. Four patients received two types of treatment in succession. SK resulted in more rapid disappearance of the pulmonary clot than UK at the dose used but the results were comparable on the 15th day (SK = UK = H). With regard to V.T., the Marder index failed to reveal any significant difference between the types of treatment. However, SK resulted in the lowest therapeutic failure rate (19%) and it was the only agent which produced disobliteration of iliac or vena cava thromboses (6 cases out of 13), other types of treatment being ineffective (0 cases out of 28). The mortality rate was high (14%) but 86% of the patients who died had a massive P.E. (greater than 60%). The recurrence rate was less (6%) but recurrences were fatal in 6 cases out of 10. Sixty-four patients were seen again after a mean period of 20.7 months. Pulmonary sequelae were minor (CPC 4.6%, dyspnoea 18%). By contrast, one patient in two suffered from post-phlebitis syndrome. The latter was all the more common when obstruction of the proximal veins persisted after treatment. On the basis of these data, the authors emphasise the gravity of pulmonary thrombo-embolic disease: fatal in the early phase essentially as a result of recurrences, incapacitating in the late phase as a result of post-phlebitis syndrome. They note that proximal V.T. associated with P.E. is responsible for such complications. Such iliocaval disease must therefore be sought routinely by phlebocavography. Their presence justifies aggressive treatment designed to destroy them (SK) or protect against their consequences (I.V.C.I.). |
