Diagnostic approaches and surgical treatment of deep venous thrombosis and pulmonary embolism

Diagnostic approaches for thromboembolism include Doppler probe examination, impedance plethysmography, phleborheography, radio-labeled fibrinogen scanning, magnetic resonance imaging, duplex imaging, and venography. The two primary diagnostic approaches for pulmonary embolism include ventilation/perfusion lung scanning and pulmonary arteriography. Surgical options available for venous thromboembolism are generally limited to those condition in which limb viability is threatened from acute iliofemoral thrombosis. Vena caval interruption, performed in patients with a contraindication to anticoagulation, a complication during anticoagulant therapy, and recurrent pulmonary embolism in the presence of adequate anticoagulation (among other indications) is best accomplished with the Greenfield filter. Surgical approaches for pulmonary embolism, limited to patients with massive embolism with hypotension, include catheter pulmonary embolectomy and open pulmonary embolectomy.