Suspected deep venous thrombosis: is US of both legs necessary? [ comment].

PURPOSE: The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic leg was unnecessary. The second was to confirm the absence of deep venous thrombosis (DVT) in patients with bilateral symptoms. MATERIALS AND METHODS: Four hundred eighty-eight patients were evaluated at a peripheral vascular laboratory for signs and symptoms of DVT. All patients then underwent bilateral color Doppler US of their leg veins. RESULTS: Ninety-four patients had no lower extremity symptoms. Of these, 73 had no DVT, 11 had unilateral DVT, and 10 had bilateral DVT. Of 245 patients with unilateral symptoms, 180 had no DVT, 44 had ipsilateral DVT, three had contralateral DVT, and 18 had bilateral DVT. Of 149 patients with bilateral symptoms, 114 had no DVT, 10 had unilateral DVT, and 25 had bilateral DVT. CONCLUSION: The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates that both categories of patients need to be evaluated with bilateral US.

Utilization patterns with inferior vena cava filters: surgical versus percutaneous placement.

PURPOSE: To determine whether more inferior vena cava (IVC) filters were used after interventional radiologic placement methods became available, and if so, whether this increase could be due to expansion of indications. PATIENTS AND METHODS: A retrospective analysis of the number of filters placed, the method of placement used, the indications for placement, and patient survival was performed during the 3 years before and the 3 years after 1989, the first year filters were placed percutaneously at the authors' institution. RESULTS: From 1986 through 1988, 35 filters were all placed by surgeons in the operating room. From 1990 through 1992, 201 filters were all placed by radiologists in the special procedures suite. In the surgery group, 13 of 35 filters (37%) were placed for contraindications to anticoagulation therapy, 12 (34%) were placed for complications of anticoagulation, and nine (26%) were placed for recurrent thromboembolic disease despite anticoagulation. One filter was placed because of a free-floating thrombus in the IVC. In the radiology group, 98 of 161 patients (60%) underwent placement for contraindications to anticoagulation, 25 (16%) experienced complications of anticoagulation, 28 (17%) experienced recurrent thromboembolic disease, and nine (6%) had a free-floating thrombus. The 6-month survival in patients treated before 1989 was 80% versus 43% after 1989. CONCLUSION: At the authors' institution, filters are now placed exclusively by interventional radiologists. The overall indications for placement remain unchanged. The increase in utilization appears primarily related to more frequent placement in severely ill patients who may not experience considerably improved survival but may benefit from a substantial reduction in the risk of hemorrhagic complications.

Embolization to control iatrogenic ureteral hemorrhage: a case report.

Gross hematuria following percutaneous or endourological intervention is well known and widely documented. We report an unusual case of angiographically documented hemorrhage from a ureteral branch that was injured by cystoscopic removal of a Double-J stent, and subsequent successful transcatheter embolization. This case demonstrates the important role of angiographic diagnosis and therapy in the management of iatrogenic hemorrhage.