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Circulation, Vol 85, 462-468, Copyright © 1992 by American Heart Association
PD Stein, C Athanasoulis, A Alavi, RH Greenspan, CA Hales, HA Saltzman, CE Vreim, ML Terrin and JG Weg
BACKGROUND. The Prospective Investigation of Pulmonary Embolism Diagnosis
(PIOPED) addressed the value of ventilation/perfusion scans in acute
pulmonary embolism (PE). The present study evaluates the risks and
diagnostic validity of pulmonary angiography in 1,111 patients who
underwent angiography in PIOPED. METHODS AND RESULTS. Complications were
death in five (0.5%), major nonfatal complications in nine (1%), and less
significant or minor in 60 (5%). More fatal or major nonfatal complications
occurred in patients from the medical intensive care unit than elsewhere:
five of 122 (4%) versus nine of 989 (1%) (p less than 0.02). Pulmonary
artery pressure, volume of contrast material, and presence of PE did not
significantly affect the frequency of complications. Renal dysfunction,
either major (requiring dialysis) or less severe, occurred in 13 of 1,111
(1%). Patients who developed renal dysfunction after angiography were older
than those who did not have renal dysfunction: 74 +/- 13 years versus 57
+/- 17 years (p less than 0.001). Angiograms were nondiagnostic in 35 of
1,111 (3%), and studies were incomplete in 12 of 1,111 (1%), usually
because of a complication. Surveillance after negative angiograms showed PE
in four of 675 (0.6%). Angiograms, interpreted on the basis of consensus
readings, resulted in an unchallenged diagnosis in 96%. CONCLUSIONS. The
risks of pulmonary angiography were sufficiently low to justify it as a
diagnostic tool in the appropriate clinical setting. Clinical judgment is
probably the most important consideration in the assessment of risk.
ARTICLES
Complications and validity of pulmonary angiography in acute pulmonary embolism
Henry Ford Heart and Vascular Institute, Detroit, Mich. 48202.
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E. J. R. van Beek, P. M. M. Kuijer, H. R. Buller, D. P. M. Brandjes, P. M. M. Bossuyt, and J. W. t. Cate The Clinical Course of Patients With Suspected Pulmonary Embolism Arch Intern Med, December 8, 1997; 157(22): 2593 - 2598. [Abstract] [PDF]
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A. Perrier, L. Buswell, H. Bounameaux, D. Didier, A. Morabia, P. de Moerloose, D. Slosman, P.-F. Unger, and A. Junod Cost-effectiveness of Noninvasive Diagnostic Aids in Suspected Pulmonary Embolism Arch Intern Med, November 10, 1997; 157(20): 2309 - 2316. [Abstract] [PDF]
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A. PERRIER, S. DESMARAIS, C. GOEHRING, P. de MOERLOOSE, A. MORABIA, P.-F. UNGER, D. SLOSMAN, A. JUNOD, and H. BOUNAMEAUX D-dimer Testing for Suspected Pulmonary Embolism in Outpatients Am. J. Respir. Crit. Care Med., July 1, 1997; 156(2): 492 - 496. [Abstract] [Full Text]
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J. F.M. Meaney, J. G. Weg, T. L. Chenevert, D. Stafford-Johnson, B. H. Hamilton, and M. R. Prince Diagnosis of Pulmonary Embolism with Magnetic Resonance Angiography N. Engl. J. Med., May 15, 1997; 336(20): 1422 - 1427. [Abstract] [Full Text] [PDF]
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V. F. Tapson Pulmonary Embolism -- New Diagnostic Approaches N. Engl. J. Med., May 15, 1997; 336(20): 1449 - 1451. [Full Text]
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J. Hirsh and J. Hoak Management of Deep Vein Thrombosis and Pulmonary Embolism : A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association Circulation, June 15, 1996; 93(12): 2212 - 2245. [Full Text]
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R. D. Hull, W. Feldstein, P. D. Stein, and G. F. Pineo Cost-effectiveness of Pulmonary Embolism Diagnosis Arch Intern Med, January 8, 1996; 156(1): 68 - 72. [Abstract] [PDF]
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P. D. Stein, R. D. Hull, and G. Pineo Strategy That Includes Serial Noninvasive Leg Tests for Diagnosis of Thromboembolic Disease in Patients With Suspected Acute Pulmonary Embolism Based on Data From PIOPED Arch Intern Med, October 23, 1995; 155(19): 2101 - 2104. [Abstract] [PDF]
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R. D. Hull, G. E. Raskob, G. F. Pineo, and R. F. Brant The Low-Probability Lung Scan: A Need for Change in Nomenclature Arch Intern Med, September 25, 1995; 155(17): 1845 - 1851. [Abstract] [PDF]
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R. D. Hull, G. E. Raskob, J. S. Ginsberg, A. A. Panju, P. Brill-Edwards, G. Coates, and G. F. Pineo A Noninvasive Strategy for the Treatment of Patients With Suspected Pulmonary Embolism Arch Intern Med, February 14, 1994; 154(3): 289 - 297. [Abstract] [PDF]
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 G. E. Hastings, D. S. Seery, and D. L. Vine Recent Developments in the Diagnosis, Treatment, and Prevention of Pulmonary Embolism Arch Fam Med, June 1, 1993; 2(6): 655 - 669. [Abstract] [PDF]
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M. Oudkerk, E. J. R. van Beek, W. L. J. van Putten, and H. R. Buller Cost-effectiveness Analysis of Various Strategies in the Diagnostic Management of Pulmonary Embolism Arch Intern Med, April 26, 1993; 153(8): 947 - 954. [Abstract] [PDF]
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 E. S. Malden, V. M. Tartar, and F. R. Gutierrez Acute Fatality Following Pulmonary Angiography in a Patient on an Amiodarone Regimen--A Case Report Angiology, February 1, 1993; 44(2): 152 - 155. [Abstract] [PDF]
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S. Z. Goldhaber, M. Morpurgo, the WHO/ISFO Task Force on Pulmonary Embolism, M. L. Brochier, H. Denolin, M. Morpurgo, C. Bosken, H. Bounameaux, J. E. Dalen, P. F. Fedullo, et al. Diagnosis, Treatment, and Prevention of Pulmonary Embolism: Report of the WHO/International Society and Federation of Cardiology Task Force JAMA, October 7, 1992; 268(13): 1727 - 1733. [Abstract] [PDF]
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 RISKS AND ACCURACY OF PULMONARY ANGIOGRAPHY Journal Watch (General), February 21, 1992; 1992(221): 1 - 1. [Full Text]
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