López-Beret P, Pinto J M, Romero A, Orgaz A, Fontcuberta J, Oblas M
Unit of Vascular Surgery, Cardiovascular Institute, Virgen de la Salud Hospital, Avenida de Barber, Toledo, Spain.
J Vasc Surg. 2001 Mar;33(3):515-21. doi: 10.1067/mva.2001.111978.
This study was carried out to evaluate the prevalence and extension of pulmonary thromboembolism (PTE) in symptom-free patients with symptomatic deep venous thrombosis (DVT) of lower limbs and to evaluate their possible implication in the adequate treatment of thromboembolic disease.
We prospectively studied, using noninvasive examination (pulmonary spiral computed tomography [CT] angiography), 159 consecutive patients with acute DVT confirmed by duplex scanning without symptoms of PTE. CT was repeated at 30 days to study evolution of these clinically occult PTE.
We observed silent PTE in 65 patients (41%) in all levels of lower limb venous thrombosis. Prevalence of PTE showed significant association with male sex (P =.001) and previously diagnosed heart disease (P =.023). There was no significant association between the level of DVT and the presence of PTE nor the DVT side and thromboembolic pulmonary localization. Of the 65 patients with positive CT exploration results for PTE, 52 had characteristics of acute PTE, 10 had chronic PTE, and 3 patients had both. Chronic PTE was found more frequently in patients with previous episodes of DVT (P =.024). A total of 165 pulmonary artery-affected segments were found at several locations: 5 main, 35 lobar, 58 interlobar, and 67 segmental. Multiple segments were affected in 59% of patients. Repeat CT examinations were performed at 30 days in 53 of 65 patients with positive CT scanning results. In 48 cases (90.6%) PTE had completely disappeared.
Silent PTE occurred frequently in association with clots of lower limbs. The CT scan had a good availability and cost-effectiveness to detect clinically underestimated PTE. The incorporation of this exploration in the systematic diagnostic strategy of most patients with DVT to establish the extension of thromboembolic disease at diagnosis may be useful in the evaluation of added pulmonary artery symptoms and treatment strategies.
本研究旨在评估无症状的下肢症状性深静脉血栓形成（DVT）患者中肺血栓栓塞症（PTE）的患病率及病变范围，并评估其在血栓栓塞性疾病恰当治疗中的潜在意义。
我们采用无创检查（肺部螺旋计算机断层扫描[CT]血管造影）对159例经双功扫描确诊为急性DVT且无PTE症状的连续患者进行前瞻性研究。30天时重复CT检查以研究这些临床隐匿性PTE的演变情况。
我们在所有下肢静脉血栓形成水平的65例患者（41%）中观察到无症状PTE。PTE的患病率与男性（P = 0.001）及先前诊断的心脏病（P = 0.023）显著相关。DVT的水平与PTE的存在之间、DVT的部位与血栓栓塞性肺定位之间均无显著关联。在65例CT检查结果为PTE阳性的患者中，52例具有急性PTE的特征，10例为慢性PTE，3例兼具两者。慢性PTE在既往有DVT发作史的患者中更常见（P = 0.024）。共在多个部位发现165个受影响的肺动脉节段：5个主肺动脉节段、35个叶肺动脉节段、58个叶间肺动脉节段和67个段肺动脉节段。59%的患者有多个节段受影响。65例CT扫描结果为阳性的患者中有53例在30天时进行了重复CT检查。48例（90.6%）的PTE已完全消失。
无症状PTE常与下肢血栓形成相关。CT扫描在检测临床被低估的PTE方面具有良好的实用性和成本效益。将此项检查纳入大多数DVT患者的系统诊断策略中，以在诊断时确定血栓栓塞性疾病的病变范围，可能有助于评估新增的肺动脉症状及治疗策略。
