Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism.
BACKGROUND
There are few reports that examine the current imaging and management techniques according to the severity of acute pulmonary embolism (APE) or that clarify whether the management strategy ameliorated the mortality from APE.


RESULTS
The study group were 456 patients with APE who were clinically diagnosed before their death. The severity at diagnosis, and the imaging and management techniques were analyzed. Mortality from APE was 0.8% in patients without shock nor right ventricular overload, 2.7% in patients with right ventricular overload without shock, 15.6% in patients with shock, and 52.4% in patients with cardiopulmonary arrest (p<0.0001). In the more severe cases, pulmonary angiography and trans-thoracic echocardiography were used more frequently, whereas both ventilation and perfusion lung scans were used less frequently. Computed tomography was used widely, regardless of the severity. Thrombolytic therapy and catheter therapy were used more frequently in the more severe cases, but an inferior vena cava filter was the only management strategy that reduced the mortality from APE.


CONCLUSIONS
The severity of APE at diagnosis affected the selection of both the diagnostic techniques and the type of management. Implantation of inferior vena cava filters reduced the mortality from APE.
Sakuma
Masahito
M
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Nakamura
Mashio
M
Nakanishi
Norifumi
N
Miyahara
Yoshiyuki
Y
Tanabe
Nobuhiro
N
Yamada
Norikazu
N
Kuriyama
Takayuki
T
Kunieda
Takeyoshi
T
Sugimoto
Tsuneaki
T
Nakano
Takeshi
T
Shirato
Kunio
K
D000368:Aged; D002423:Cause of Death; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D014682:Vena Cava, Inferior