• Humans
• Pulmonary Embolism/therapy
• Pulmonary Embolism/physiopathology
• Anticoagulants/therapeutic use
• Female
• Male
• Quality of Life
• Middle Aged
• Thrombectomy/methods
• Exercise Test
• Aged
• Treatment Outcome

• U24 HL155811 NHLBI NIH HHS
• U34 HL147347 NHLBI NIH HHS
• UG3 HL155798 NHLBI NIH HHS
• UH3 HL155798 NHLBI NIH HHS

• Acute venous thromboembolism
• deep-vein thrombosis
• inferior vena cava filters
• major bleeding
• pulmonary embolism

• Humans
• Vena Cava Filters/adverse effects
• Pulmonary Embolism/etiology
• Hemorrhage/prevention & control
• Hemorrhage/etiology
• Treatment Outcome
• Databases, Factual
• Retrospective Studies
• Vena Cava, Inferior

Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension (CTEPH), approximately 20%-29% of patients exhibit a restrictive pattern on pulmonary function testing.

To quantify longitudinal changes in lung volume and cardiac cross-sectional area (CSA) in patients with CTEPH.

In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019, we evaluated 15 patients with CTEPH who had chest computed tomography (CT) performed at baseline and after at least 6 mo of therapy. We matched the CTEPH cohort with 45 control patients by age, sex, and observation period. CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.

Total, right lung, and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline (total, P = 0.004; right lung, P = 0.003; right lower lobe; P = 0.01). In the CTEPH group, the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group (total, P = 0.01; right lung, P = 0.007; right lower lobe, P = 0.01; CSA, P = 0.0002). There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.

After at least 6 mo of treatment, CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.

• Pulmonary hypertension
• Lung
• Computed tomography
• Retrospective study
• Lung volume measurements
• Follow-up studies

• follow-up after pulmonary embolism
• long term mortality after pulmonary embolism
• predictors of survival after pulmonary embolism
• pulmonary embolism

• OMERACT
• core outcome set
• outcome assessment
• scoping review
• venous thromboembolism

• Adult
• Humans
• Prospective Studies
• Venous Thromboembolism/diagnosis
• Venous Thromboembolism/drug therapy

• PJT-165897 CIHR

• Deep vein thrombosis
• Mechanical thrombolysis
• Pulmonary embolism
• Thrombolytic therapy

• Catheter directed thrombolysis
• Pulmonary embolism
• Systemic thrombolysis

• Acute Pulmonary Embolism
• Catheter Directed Interventions
• Catheter Thrombectomy
• Catheter Thrombolysis
• Suction Thrombectomy

The aim of this article is to define the place of new endovascular methods for the management of pulmonary embolisms (PE), on the basis of a multidisciplinary consensus.

Briefly, from the recent literature, for high-risk PE presenting with shock or cardiac arrest, systemic thrombolysis or embolectomy is recommended, while for lowrisk PE, anticoagulation alone is proposed. Normo-tense patients with PE but with biological or imaging signs of right heart dysfunction constitute a group known as “at intermediate risk” for which the therapeutic strategy remains controversial. In fact, some patients may require more aggressive treatment in addition to the anticoagulant treatment, because approximately 10% will decompensate hemodynamically with a high risk of mortality. Systemic thrombolysis may be an option, but with hemorrhagic risks, particularly intra cranial. Various hybrid pharmacomechanical approaches are proposed to maintain the benefits of thrombolysis while reducing its risks, but the overall clinical experience of these different techniques remains limited. Patients with high intermediate and high risk pulmonary embolism should be managed by a multidisciplinary team combining the skills of cardiologists, resuscitators, pneumologists, interventional radiologists and cardiac surgeons. Such a team can determine which intervention – thrombolysis alone or assisted, percutaneous mechanical fragmentation of the thrombus or surgical embolectomy – is best suited to a particular patient.

This consensus document define the place of endovascular thrombectomy based on an appropriate risk stratification of PE.

• Embolectomy
• Pharmacomechanical thrombectomy
• Pulmonary embolism
• Thrombectomy
• Thrombolytic therapy

• Aftercare
• COVID-19/complications
• COVID-19/diagnostic imaging
• COVID-19/physiopathology
• Chronic Disease
• Computed Tomography Angiography/methods
• Contrast Media
• Humans
• Hypertension, Pulmonary/diagnostic imaging
• Hypertension, Pulmonary/etiology
• Hypertension, Pulmonary/physiopathology
• Lung/blood supply
• Lung/diagnostic imaging
• Lung/physiopathology
• Perfusion Imaging
• Pulmonary Artery/diagnostic imaging
• Pulmonary Embolism/diagnostic imaging
• Pulmonary Embolism/etiology
• Pulmonary Embolism/physiopathology
• Pulmonary Fibrosis/diagnostic imaging
• Pulmonary Fibrosis/etiology
• Pulmonary Fibrosis/physiopathology
• Respiratory Function Tests
• SARS-CoV-2
• Thrombosis/diagnostic imaging
• Thrombosis/etiology
• Thrombosis/physiopathology
• Tomography, Emission-Computed, Single-Photon/methods
• Tomography, X-Ray Computed/methods
• Ventilation-Perfusion Scan/methods
• Post-Acute COVID-19 Syndrome

• bleeding disorders & coagulopathies
• epidemiology
• thromboembolism

• Adult
• Female
• Humans
• Outcome Assessment, Health Care
• Pregnancy
• Prospective Studies
• Research Report
• Venous Thromboembolism/drug therapy
• Scoping Reviews As Topic

• PJT-165897 CIHR
• CDT-142654 CIHR
• CanVECTOR Network
• Canadian Institutes of Health Research

• Disease management
• Exercise
• Pulmonary embolism
• Qualitative research
• Rehabilitation

Background: Patients with pulmonary embolism (PE) may suffer from long-term consequences, including decreased functional capacity. Data on pulmonary rehabilitation (PR) in patients with PE are scarce, and no data on outpatient PR are available so far. Methods: We analyzed data of 22 PE patients who attended outpatient PR due to exertional dyspnea. Patients underwent a multi-professional 6-week PR program. The primary outcome was change in 6-min walk test (6MWT). Secondary outcomes included changes in strength and endurance tests. To assess long-term benefits, follow-up was performed a median of 39 months after PR. Results: Patients started PR a median of 19 weeks after the acute PE event. Their median age was 47.5 years, 33% were women and all presented with NYHA (New York Heart Association) class II and higher. After PR, patients showed significant and clinically relevant improvements in 6MWT (mean difference: 49.4 m [95% CI 32.0−66.8]). Similarly, patients increased performance in maximum strength, endurance and inspiratory muscle strength. At long-term follow-up, 78% of patients reported improved health. Conclusion: We observed significant improvements in exercise capacity in PE patients undergoing outpatient PR. The majority of patients also reported a long-term improvement in health status. Prospective studies are needed to identify patients who would benefit most from structured PR.

• dyspnea
• exercise training
• outpatient
• pulmonary embolism
• pulmonary rehabilitation

• Deep vein thrombosis
• Pulmonary embolism
• Pulmonary embolism response team
• Venous thromboembolism

• cardiovascular medicine
• interventional cardiology
• venous thromboembolism

• Aged
• Exercise Therapy/methods
• Female
• Humans
• Male
• Middle Aged
• Patient Reported Outcome Measures
• Pulmonary Embolism/nursing
• Pulmonary Embolism/rehabilitation
• Quality of Life
• Sick Leave/statistics & numerical data
• Walk Test/statistics & numerical data

• Age Factors
• Computed Tomography Angiography
• Decision Trees
• Fibrin Fibrinogen Degradation Products
• Humans
• Obesity
• Practice Guidelines as Topic
• Pulmonary Embolism/diagnosis
• Pulmonary Embolism/mortality
• Venous Thrombosis/diagnosis

• pulmonary embolism
• venous thromboembolism

The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection from pulmonary embolism (PE) and then bioconvert to become incorporated in the vessel wall, leaving a patent IVC lumen. Objective. To evaluate the performance and stages of incorporation of the Sentry IVC filter in an ovine model. Methods. Twenty-four bioconvertible devices and 1 control retrievable filter were implanted in the infrarenal IVC of 25 sheep, with extensive daily monitoring and intensive imaging. Vessels and devices were analyzed at early (≤98 days, n = 10) and late (180 ± 30 days, n = 14 study devices, 1 control) termination and necropsy time-points. Results. Deployment success was 100% with all devices confirmed in filtering configuration, there were no filter-related complications, and bioconversion was 100% at termination with vessels widely patent. By 98 days for all early-incorporation analysis animals, the stabilizing cylindrical part of the Sentry frame was incorporated in the vessel wall, and the filter arms were retracted. By 180 days for all late-incorporation analysis animals, the filter arms as well as frames were stably incorporated. Conclusions. Through 180 days, there were no filter-related complications, and the study devices were all bioconverted and stably incorporated, leaving all IVCs patent.

As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.

1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.

A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.

The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.

1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.

The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.

• Acute Disease
• Adult
• Aged
• Catheterization, Peripheral/adverse effects
• Catheterization, Peripheral/mortality
• Chi-Square Distribution
• Echocardiography
• Female
• Fibrinolytic Agents/administration & dosage
• Fibrinolytic Agents/adverse effects
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Propensity Score
• Pulmonary Embolism/diagnostic imaging
• Pulmonary Embolism/drug therapy
• Pulmonary Embolism/mortality
• Pulmonary Embolism/physiopathology
• Recovery of Function
• Retrospective Studies
• Risk Factors
• Thrombolytic Therapy/adverse effects
• Thrombolytic Therapy/methods
• Thrombolytic Therapy/mortality
• Time Factors
• Treatment Outcome
• Ventricular Dysfunction, Right/diagnostic imaging
• Ventricular Dysfunction, Right/physiopathology
• Ventricular Function, Right

• T32 HL098036 NHLBI NIH HHS

• catheter-directed lysis
• catheter-directed therapy
• embolectomy
• massive pulmonary embolism
• pulmonary embolism
• pulmonary embolism severity index
• submassive pulmonary embolism
• venous thromboembolic disease

• Anticoagulants/administration & dosage
• Clinical Protocols
• Computed Tomography Angiography
• Fibrinolytic Agents/administration & dosage
• Fibrinolytic Agents/adverse effects
• Humans
• Mechanical Thrombolysis/adverse effects
• Mechanical Thrombolysis/methods
• Prospective Studies
• Pulmonary Embolism/diagnostic imaging
• Pulmonary Embolism/physiopathology
• Pulmonary Embolism/therapy
• Quality of Life
• Recovery of Function
• Research Design
• Single-Blind Method
• Thrombolytic Therapy/adverse effects
• Time Factors
• Treatment Outcome
• Ultrasonic Therapy/adverse effects

• T32 HL098036 NHLBI NIH HHS

• High-risk PE
• Intermediate-risk PE
• Pulmonary embolism
• Risk-stratification
• Thrombolysis

The existing evidence base in pulmonary embolism (PE) is primarily focused on diagnostic methods, medical treatment, and prognosis. Only a few studies have investigated how everyday life is affected by PE, although many patients are negatively affected both physically and emotionally after hospital discharge. Currently, no documented rehabilitation options are available for these patients. We aim to examine whether an 8-week home-based exercise intervention can influence physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients medically treated for PE.

One hundred forty patients with incident first-time PE will be recruited in five hospitals. After inclusion, patients will be randomly allocated to either the control group, receiving usual care, or the intervention group, who will be exposed to an 8-week home-based exercise program in addition to usual care. The intervention includes an initial individual exercise planning session with a physiotherapist, leading to a recommended exercise program of a minimum of three weekly training sessions of 30–60 minutes’ duration. The patients have regular telephone contact with the physiotherapist during the 8-week program. At the time of inclusion, after 2 months, and after 6 months, the patients’ physical capacity is measured using the Incremental Shuttle Walk test. Furthermore the patients’ quality of life, sick leave, and use of psychotropic drugs is measured using self-reported questionnaires. In both randomization arms, all follow-up measurements and visits will take place at the hospital from which the patient was discharged. Levels of eligibility, consent, adherence, and retention will be used as indicators of study feasibility.

We expect that the home-based exercise program will improve the physical capacity and quality of life for the patients in the intervention group. The study will furthermore contribute significantly to the limited knowledge about the optimal rehabilitation of PE patients, and may thereby form the basis of future recommendations in this field.

ClinicalTrials.gov, NCT02684721. Registered on 20 January 2016.

The online version of this article (doi:10.1186/s13063-017-1939-y) contains supplementary material, which is available to authorized users.

• Exercise
• Multicenter study
• Pulmonary embolism
• Randomized clinical trial
• Study protocol

• Aged
• Catheterization
• Female
• Fibrinolytic Agents/therapeutic use
• Humans
• Male
• Middle Aged
• Pulmonary Embolism/therapy
• Retrospective Studies
• Treatment Outcome
• Ventricular Function, Right

• T32 HL098036 NHLBI NIH HHS

• A 1298C
• C677T
• MTHFR
• Polymorphism
• Pulmonary embolism

Acute pulmonary embolism (PE) can be devastating. It is classified into three categories based on clinical scenario, elevated biomarkers, radiographic or echocardiographic features of right ventricular strain, and hemodynamic instability. Submassive PE is diagnosed when a patient has elevated biomarkers, CT-scan, or echocardiogram showing right ventricular strain and no signs of hemodynamic compromise. Thromboemboli in the acute setting increase pulmonary vascular resistance by obstruction and vasoconstriction, resulting in pulmonary hypertension. This, further, deteriorates symptoms and hemodynamic status. Studies have shown that elevated biomarkers and right ventricular (RV) dysfunction have been associated with increased risk of mortality. Therefore, aggressive treatment is necessary to “unload” right ventricle. The treatment of submassive PE with thrombolysis is controversial, though recent data have favored thrombolysis over conventional anticoagulants in acute setting. The most feared complication of systemic thrombolysis is intracranial or major bleeding. To circumvent this problem, a newer and safer approach is sought. Ultrasound-accelerated thrombolysis is a relatively newer and safer approach that requires local administration of thrombolytic agents. Herein, we report a case series of five patients who underwent ultrasound-accelerated thrombolysis with notable improvement in symptoms and right ventricular function.