BACKGROUND: The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged. METHODS: All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed. RESULTS: Of the 491 PE deaths identified, 36% were surgical and 64% medical. Venous dissection for clots was performed in 380 patients; the PE source was the lower extremity (70.8%), pelvic veins (4.2 %), and upper extremity (1.1%). No source was identified in 22.6% of patients. Body mass index (adjusted odds ratio [AOR] 1.044, 95% confidence interval [CI] 1.011 to 1.078, P = .009) and age (AOR 1.018, 95% CI 1.001 to 1.036, P = .042) were independent predictors for identifying a PE source. Chronic obstructive pulmonary disease (AOR .173, 95% CI .046 to .646, P = .009) was predictive of not identifying a PE source. CONCLUSIONS: Most medical and surgical patients with fatal PE had a lower extremity source found, but a significant number had no source identified. Age and body mass index were positively associated with PE source identification. However, a diagnosis of chronic obstructive pulmonary disease was associated with no PE source identification.
BACKGROUND: The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged. METHODS: All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed. RESULTS: Of the 491 PE deaths identified, 36% were surgical and 64% medical. Venous dissection for clots was performed in 380 patients; the PE source was the lower extremity (70.8%), pelvic veins (4.2 %), and upper extremity (1.1%). No source was identified in 22.6% of patients. Body mass index (adjusted odds ratio [AOR] 1.044, 95% confidence interval [CI] 1.011 to 1.078, P = .009) and age (AOR 1.018, 95% CI 1.001 to 1.036, P = .042) were independent predictors for identifying a PE source. Chronic obstructive pulmonary disease (AOR .173, 95% CI .046 to .646, P = .009) was predictive of not identifying a PE source. CONCLUSIONS: Most medical and surgical patients with fatal PE had a lower extremity source found, but a significant number had no source identified. Age and body mass index were positively associated with PE source identification. However, a diagnosis of chronic obstructive pulmonary disease was associated with no PE source identification.
Authors: M Margaret Knudson; Ernest E Moore; Lucy Z Kornblith; Amy M Shui; Scott Brakenridge; Brandon R Bruns; Mark D Cipolle; Todd W Costantini; Bruce A Crookes; Elliott R Haut; Andrew J Kerwin; Laszlo N Kiraly; Lisa M Knowlton; Matthew J Martin; Michelle K McNutt; David J Milia; Alicia Mohr; Ram Nirula; Fredrick B Rogers; Thomas M Scalea; Sherry L Sixta; David A Spain; Charles E Wade; George C Velmahos Journal: JAMA Surg Date: 2022-02-09 Impact factor: 16.681
Authors: Olga Porembskaya; Vsevolod Zinserling; Vladimir Tomson; Yana Toropova; Eleonora A Starikova; Vitaliy V Maslei; Nika I Bulavinova; Olga V Kirik; Marina A Syrtsova; Leonid Laberko; Maxim I Galchenko; Vyacheslav Kravchuk; Sergey Saiganov; Alexander Brill Journal: Int J Mol Sci Date: 2022-05-23 Impact factor: 6.208
Authors: Olga Porembskaya; Yana Toropova; Vladimir Tomson; Kirill Lobastov; Leonid Laberko; Viacheslav Kravchuk; Sergey Saiganov; Alexander Brill Journal: Int J Mol Sci Date: 2020-07-18 Impact factor: 5.923