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Home > Vascular Annual Meeting > pvss23_martinez_chest

PVSS23. Chest and Abdominopelvic CT Scans Are Important Tools for Evaluating Patients with Iliofemoral Venous Thrombosis

Jorge Martinez, David Paolini, Anthony J. Comerota.
Jobst Vascular Center, Toledo, Ohio.

OBJECTIVES: Iliofemoral deep venous thrombosis (DVT) affects less than 5% of DVT patients, but is associated with severe postthrombotic morbidity and recurrence rates rivaling those of cancer patients. The central location of the thrombus puts patients at high risk for pulmonary embolus (PE), and the extensive nature of the presenting thrombotic episode suggests there may be a prothrombotic condition present other than underlying thrombophilia. The purpose of this study is to assess the value of chest, abdominal, and pelvic CT scans as part of the routine evaluation of patients with iliofemoral DVT for detecting PE and other associated pathology.

METHODS: Thirty-five patients with iliofemoral DVT had abdominopelvic CT scans and 29 also had chest CT scans as part of their clinical evaluation and form the basis of this study. The majority of the CT scans were performed prior to definitive therapy of their iliofemoral DVT.

RESULTS: Chest CT scans identified PE in 14/29 (48%) patients, of which 12/14 (86%) were asymptomatic. Malignant lesions were found in 3/29 (10%) patients (2 lung carcinomas, 1 mediastinum lymphoma). Abdominopelvic scans identified benign lesions in 15/35 (43%) patients and malignant lesions in 12/35 (34%) patients. Of patients with abdominopelvic malignancy, DVT was the initial presentation in 9/12 (75%). DVT presented prior to the diagnosis of tumor recurrence in the remaining 3/12 (25%). Metastatic lesions were observed in 3/35 (9%).

CONCLUSIONS: CT evaluation of the chest, abdomen, and pelvis in patients with iliofemoral DVT has a high yield of clinically important findings. Both malignant and benign lesions were found at higher frequencies than anticipated. These data indicate the value of chest, abdominal, and pelvic CT scans as part of the routine evaluation in patients with iliofemoral DVT.