Abstract Number: PB1195
Meeting: ISTH 2021 Congress
Theme: Venous Thromboembolism » VTE Epidemiology
Background: Subsegmental pulmonary embolism (SSPE) is relatively benign and can be managed with surveillance if bleeding risk is high and there are no other thromboses. SSPE may involve one or more subsegmental branches. It remains unexplored if solitary versus multiple SSPE have significant coexistence with upper and lower extremity deep vein thrombosis (DVT).
Aims: The aim of the study was to compare the location and burden of DVT in upper and lower extremities in solitary versus multiple SSPE.
Methods: Consecutive patients with SSPE anticoagulated at Mayo Clinic Thrombophilia Clinic (03/01/2013 – 12/31/2020) were followed prospectively.
Results: Out of 1542 patients with PE, 1317 patients had proximal PE and 225 (14.6%) SSPE, either solitary (n=139) or multiple (n=86; 47 with bilateral and 39 unilateral emboli). Of the proximal PE, 670 (50.9%) had coexisting DVT compared to 68 (30.2%) with SSPE (p<0.001). Proportion of patients with upper extremity DVT was not significantly different in solitary SSPE group compared to multiple SSPE group (21.6% vs 6.9%, p=0.166). Proportion of patients with lower extremity DVT was not significantly different in multiple SSPE group compared to solitary SSPE group (96.6% vs 83.8%, p=0.124). No DVT in the axial iliac-common femoral venous segment was found (one DVT in internal iliac vein) in solitary SSPE group versus 4 in multiple SSPE group (p=0.033). Thrombus burden assessed by a specially designed scoring system (Table 2) revealed more extensive DVT burden in multiple SSPE compared to solitary SSPE group (5.7 vs 2.4, p=0.008).
VTE recurrence, major bleeding, clinically relevant non-major bleeding, and mortality was not different in SSPE with DVT compare to those without DVT (data not shown).
| DVT Location | Solitary N=37 |
Multiple N=29 |
Total N=66 |
P-valuea |
| Iliac or Common Femoral Veins, n (%) | 1 (2.7%) | 5 (17.2%) | 6 (9.1%) | 0.079 |
| Common Iliac, External Iliac, or Common Femoral Veins, n (%) | 0 (0.0%) | 4 (13.8%) | 4 (6.1%) | 0.033 |
| Femoral or Popliteal Veins, n (%) | 13 (35.1%) | 12 (41.4%) | 25 (37.9%) | 0.620 |
| Calf Veins, n (%) | 25 (67.6%) | 22 (75.9%) | 47 (71.2%) | 0.586 |
| Lower Extremity Veins, n (%) | 31 (83.8%) | 28 (96.6%) | 59 (89.4%) | 0.124 |
| Upper Extremity Veins, n (%) | 8 (21.6%) | 2 (6.9%) | 10 (15.2%) | 0.166 |
| Upper or Lower Extremity Veins, n (%) | 37 (100%) | 29 (100%) | 66 (100%) | 0.170 |
| Extremity DVT burden score: Mean (SD) b, Range | 2.4 (2.0) 0.5 – 11.0 |
5.7 (6.6) 0.5 – 30.0 |
3.8 (4.9) 0.5 – 30.0 |
0.008 |
| a P-values result from analysis of variance for continuous variables and Chi square test for categorical variables b SD = standard deviation |
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Extremity deep vein thrombosis (DVT) location and burden in patients with solitary versus multiple subsegmental pulmonary emboli (SSPE).
| DVT Location | 100% Vein Involvement | 50-99% Involvement |
< 50% Involvement | |
| Iliac (Common, External, Internal) | 5 | 3 | 2 | |
| Innominate, Subclavian, Common Femoral, Popliteal |
3 | 2 | 1 | |
| Femoral divided into Proximal, Middle, Distal | Each segment = 3 | |||
| 100% Vein Involvement | <100% Involvement | |||
| Axillary, Brachial, Internal Jugular, Tibial (Anterior, Posterior), Peroneal, Soleal, Gastrocnemius C | 1 | 0.5 | ||
| Superficial Vein Thrombus Extending to Deep Vein Location | Sapheno-femoral junction = 2 Sapheno-Popliteal junction = 1 |
|||
| c If duplicated calf vein, each vein with DVT was scored per system | ||||
Extremity deep vein thrombosis (DVT) burden scoring system.
Conclusions: Extremity thrombus burden is significantly higher in multiple SSPE compared to solitary SSPE. DVT involving the axial iliac-common femoral segment is associated with multiple SSPE. Upper and lower extremity DVT were evenly distributed between groups.
To cite this abstract in AMA style:
Meverden R, Hirao-Try Y, Vlazny D, Casanegra A, Houghton D, Hodge D, Peterson L, McBane R, Wysokinski W. Location and Burden of Extremity Vein Thrombosis in Patients with Solitary versus Multiple Subsegmental Pulmonary Emboli [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/location-and-burden-of-extremity-vein-thrombosis-in-patients-with-solitary-versus-multiple-subsegmental-pulmonary-emboli/. Accessed October 2, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/location-and-burden-of-extremity-vein-thrombosis-in-patients-with-solitary-versus-multiple-subsegmental-pulmonary-emboli/