van Beek E J, Reekers J A, Batchelor D A, Brandjes D P, Büller H R
Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands.
Eur Radiol. 1996;6(4):415-9. doi: 10.1007/BF00182453.
The purpose of our study was to assess feasibility, safety and clinical utility of selective pulmonary angiography in patients with suspected pulmonary embolism and a nondiagnostic lung scan. The design was a prospective, descriptive study. The subjects were consecutive patients with clinically suspected pulmonary embolism and a nondiagnostic lung scintigram in whom pulmonary angiography was considered. Angiography was withheld in cases of manifest heart failure, renal failure, mean pulmonary artery pressure above 40 mmHg, or if there were compelling clinical reasons. All patients were followed-up for 6 months. The outcome measures were successful angiography, morbidity, mortality and recurrent pulmonary embolism in patients with normal angiogram in whom anticoagulants were withheld during 6 months of follow-up. Of 487 patients, 196 (40%) had nondiagnostic lung scan findings. In 46 patients (23%) pulmonary angiography was withheld. Pulmonary embolism was excluded in 105 patients (70%), and proven in 40 (27%) patients. In 5 (3%) patients the angiogram was inadequate for interpretation. No fatal complications were encountered [95% confidence interval (CI) 0-2.4%]. Nonfatal complications occurred in 3 patients (2%; 95% CI 0.4-6.0%); all recovered spontaneously. None of 105 patients with a normal angiogram returned with thromboembolism during follow-up (0%; 95% CI 0-3.4%). Pulmonary angiography is safe, rules out pulmonary embolism in two thirds of patients with a nondiagnostic lung scan and can be performed in almost 80% of these patients. It is safe to withhold long-term anticoagulants if a normal angiogram is obtained in this subgroup of patients with clinically suspected pulmonary embolism.
我们研究的目的是评估选择性肺血管造影在疑似肺栓塞且肺部扫描结果未确诊的患者中的可行性、安全性及临床实用性。研究设计为前瞻性描述性研究。研究对象为临床上疑似肺栓塞且肺部闪烁扫描未确诊、考虑进行肺血管造影的连续患者。若患者出现明显心力衰竭、肾衰竭、平均肺动脉压高于40 mmHg或有其他令人信服的临床理由，则不进行血管造影。所有患者均随访6个月。观察指标为血管造影成功情况、发病率、死亡率以及在随访6个月期间停用抗凝剂且血管造影正常的患者中复发性肺栓塞的情况。487例患者中，196例（40%）肺部扫描结果未确诊。46例患者（23%）未进行肺血管造影。105例患者（70%）排除了肺栓塞，40例患者（27%）确诊为肺栓塞。5例患者（3%）的血管造影结果无法解读。未发生致命并发症[95%置信区间（CI）为0 - 2.4%]。3例患者发生非致命并发症（2%；95% CI为0.4 - 6.0%）；所有患者均自发恢复。105例血管造影正常的患者在随访期间均未出现血栓栓塞（0%；95% CI为0 - 3.4%）。肺血管造影是安全的，可在三分之二肺部扫描未确诊的患者中排除肺栓塞，且几乎80%的此类患者均可进行该检查。对于临床上疑似肺栓塞的这一亚组患者，若血管造影正常，则停用长期抗凝剂是安全的。
