Value of phlebography for diagnosis and treatment of pulmonary embolism

The frequency of recurrencies and of post-phlebitic syndrome after PE lead the Authors to perform phlebography of the legs before and after treatment of PE. A venous thrombosis was found in 124 cases out of 144 recent PE proven by angiopneumography. The thrombosis affected the ilio-caval veins 43 times, in 27/103 severe PE cases (24%), in 16/33 moderate PE cases (40%). Patients were treated: by H. in 67 cases; 33 (group I) with moderate PE, (4 (group II) with severe PE; by Streptokinase (SK) 24 times: 5 cases with moderate PE, 19 (group III) with severe PE; but U.K., high dose (UKf) 19 times; by U.K., moderate dose (UKm) 40 times, 3 cases with moderate PE, 37 cases (group V) with severe PE. After treatment, the mean volume of the venous clot, measured by the Marder's index, decreased in all groups. However, S.K. lysed 7 out of 17 proximal thrombosis, whereas the other treatments were unefficient. Failures were less frequent with S.K. (3/16) than with U.K. f (11/15), U.K.m (12/28) and H. (29/65). Recurrency was noticed 8 times: in 7 cases, it was seen in patients affected with proximal V.T. and not treated by I.V.C. interruption. Such facts warrant the systematic search for V.T. when PE is suspected. They justify the use of thrombolytic drugs not only for severe PE, but also for moderate PE which are associated to a proximal V.T.