Venous Thromboembolism (VTE) in May-Thurner Syndrome: Decision-Making Related to Long-Term Anticoagulation.

May-Thurner syndrome (MTS) involves the compression of the left iliac vein between the right iliac artery anteriorly and the lumbar vertebrae posteriorly. Patients may remain asymptomatic throughout their lives or experience unilateral lower limb swelling and symptoms of deep vein thrombosis (DVT), such as redness and pain in the limb, or features of its complication (pulmonary embolism) such as chest pain or shortness of breath. We present the case of a 34-year-old female exhibiting acute pain and tightness in her left leg, due to DVT of the left common femoral vein, extending up to the pelvic veins, which, on further diagnostic imaging, was found to be due to MTS. The patient was initiated on lifelong anticoagulation to prevent further complications. The rising incidence of MTS, coupled with frequent delays in its diagnosis, highlights the need to raise awareness among healthcare providers, especially acute medics (who are often the first point of contact for the patient) to expand their diagnostic umbrella of differentials to include MTS as a potential cause of such presentations and to look and think beyond DVT of the lower limb. This is especially important in females presenting with non-specific DVT symptoms, as early suspicion and referral to the respective medical teams including vascular medicine, can improve diagnostic accuracy and provide more management options, thereby improving long-term outcomes.

Endovascular treatment of a large bone cement pulmonary embolism: Case report.

We report a case of endovascular treatment of bone cement embolism after percutaneous vertebroplasty. The patient underwent percutaneous vertebroplasty for acute L1 compression fracture. Two weeks later, the patient developed symptoms of pulmonary embolism. Computed tomography pulmonary angiogram confirmed the presence of a bone cement foreign body in the pulmonary artery. Endovascular treatment was performed, and the cement embolism was caught, pulled to the level of the iliac vein, and fixed with stents. At the 1-year follow-up, the patient did not have any complaints, postoperative computed tomography pulmonary angiogram showed no obvious manifestations of pulmonary embolism, and angiography showed that the bone cement was fixed in place and that the iliac veins were normal.

Myocardial Infarction and Pulmonary Embolism: Causal or Temporal Association?

Ischemic electrocardiographic changes in the setting of pulmonary embolism are typically the result of dilatation of the right cavities and/or right ventricular ischaemia, without coronary occlusion. We present a patient with pulmonary embolism and concomitant myocardial infarction, with the aim of exploring the possible links between these 2 distinct entities.

Dyspnea After an Acute Intermediate-Risk Pulmonary Embolism: A Case-Based Approach to Evaluation and Treatment.

Exercise intolerance after acute pulmonary embolism may be caused by residual pulmonary vascular obstruction, which presents as chronic thromboembolic pulmonary disease with or without pulmonary hypertension. We present a case highlighting a systematic approach to evaluating functional limitations due to residual pulmonary vascular obstruction, emphasizing the utility of cardiopulmonary exercise testing.

Bringing PERT to Pediatrics: Initial Experience and Outcomes of a Pediatric Multidisciplinary Pulmonary Embolism Response Team (PERT).

INTRODUCTION: Multidisciplinary Pulmonary Embolism Response Teams (PERTs) streamline care of adults with life-threatening pulmonary embolism (PE). Given rarity of pediatric PE, developing a clinical, educational, and research PERT paradigm is a novel and underutilized concept in pediatrics. RESEARCH QUESTION: Is PERT feasible in pediatrics, and does it improve PE care? STUDY DESIGN AND METHODS: A strategy-to-execution proposal to launch a pediatric PERT was developed for institutional buy-in. Key stakeholders collectively implemented PERT. Data were collected for the two-year pre- and post-PERT eras, and outcomes were compared. RESULTS: PERT implementation took 12 months. Our PERT, led by hematology, comprises of pediatric experts in emergency medicine, critical care, interventional cardiology, anesthesiology, and interventional radiology. Data on 30 patients pre-PERT and 31 post-PERT were analyzed. Pre-PERT, 10%(3/30), 13%(4/30), 20%(6/30), and 57%(17/30), and post-PERT, 3%(1/31), 10%(3/31), 16%(5/31), and 71%(22/31) were categorized as high-risk, intermediate-LOW risk, intermediate-HIGH risk, and low-risk PE, respectively. Post-PERT, there were 13 unique PERT activations. PERT was activated on all eligible PE patients and, additionally, on four low-risk PEs. Time-to-echocardiogram was shorter post-PERT (4.7 hrs vs 2 hrs, P=0.0147). Anticoagulation was ordered (90 min vs 54 min, P=0.003) and given sooner (154 min vs 113 min, P=0.049) post-PERT. There were no differences in time-to-reperfusion therapies (12 hrs pre-PERT vs 8.7 hrs post-PERT, P=0.1). Five (83.3%) of six eligible (intermediate-HIGH and high-risk) patients received reperfusion therapies in the post-PERT era compared to three (37.5%) of eight eligible patients in the pre-PERT era (P=0.0001). There were no differences in major bleeding, mortality, or length of stay in either era. INTERPRETATION: The pediatric PERT paradigm was successfully created and adopted locally. Our PERT enhanced access to experts, facilitated timely advanced therapies, and held value for low-risk PE. The University of Texas Southwestern Medical Center (UTSW) and Children's Health System of Texas pediatric PERT may serve as a best-practice model for streamlining care for pediatric PE.

Comparison of Safety and Efficacy of Aspiration Thrombectomy and Ultrasound Accelerated Thrombolysis for Management of Pulmonary Embolism: A Systematic Review and Meta-Analysis.

PURPOSE: To compare the safety and efficacy of mechanical thrombectomy (MT) and ultrasound-accelerated thrombolysis (USAT) in pulmonary embolism (PE) management by performing a systematic review of the literature. MATERIALS AND METHODS: The PubMed database was searched to identify articles on Inari's FlowTriever and Penumbra's Indigo mechanical thrombectomy devices (Group A) and the Ekos Endovascular system (Group B). Outcomes variables analyzed include pre- and post-procedure RV/LV ratio, pre- and post-procedure pulmonary artery pressure, hospital length of stay, technical success, specific complications, and mortality rate. Mean values were calculated using the weighted mean approach. RevMan Version 5.4 (Cochrane Collaboration) was used to perform the meta-analysis for this study. Cochrane Collaboration's Risk of Bias (RoB 2.0) approach was used to perform a quality assessment of the included articles in order to verify the validity and reliability of the research. RESULTS: 27 studies were in Group A and 28 studies pertained to Group B. There were 1662 patients in Group A and 1273 patients in Group B. Both groups had similar technical success (99.6% vs 99.4%). Thrombectomy showed longer mean procedure time (73.03 ± 14.57 min vs 47.35 ± 3.15 min), lower mean blood loss (325.20 ± 69.15 mL vs 423.05 ± 64.95 mL), shorter mean ICU stay (2.35 ± 1.64 days vs 3.22 ± 1.27 days), and shorter mean overall hospital stay (6.94 ± 4.38 days vs 7.23 ± 2.31 days). EKOS showed greater mean change in Miller Index (9.05 ± 3.35 vs 4.91 ± 3.70) and greater mean change in pulmonary artery pressure (14.17 ± 6.35 mmHg vs 8.11 ± 4.39 mmHg). CONCLUSION: Ultrasound accelerated thrombolysis and percutaneous mechanical thrombectomy are effective therapies for pulmonary embolism with comparable clinical outcomes.

JTH in Clinic: Management of Low-risk PE.

Pulmonary embolism (PE) is a common cardiovascular disease diagnosis in emergency departments that can be associated with significant morbidity and mortality. One of the first steps after diagnosing PE is to risk stratify for adverse outcomes using risk scores such as PE Severity Index and European Society of Cardiology risk scheme. While intermediate and high-risk PE patients should be admitted to the hospital, there is increasing evidence to support early discharge and home-based anticoagulation therapy for low-risk patients. The Hestia criteria encompass many of the clinicians' considerations for who may be suitable for early discharge, considering both medical and social factors. Additionally, professional guidelines have provided algorithms on determining which low risk patients may be suitable. Despite this, low risk acute PE patients are still often admitted for inpatient treatment. In this review, we present a case-based approach on how to risk stratify and evaluate patients who may be good candidates for early discharge and home therapy.

Thrombotic complications in pregnancy: a case-based review of the evidence.

Pregnancy is a prothrombotic state due to an estrogen-driven shift in the coagulation system, increased venous stasis, and external restriction of blood flow caused by the gravid uterus. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnancy. Preventing, recognizing, and treating thrombosis in pregnancy, as well as the postpartum period, often challenges decision making in the clinical setting. In early pregnancy, guidance with respects to thrombophilia testing and anticoagulation in increasing the likelihood of live birth among patients with recurrent miscarriages is evolving. This review explores emerging data which supports clinical decision making in thrombosis care in women with common thrombotic complications in pregnancy. The first case outlines VTE diagnosis in pregnancy, initial anticoagulation management, management around delivery and postpartum, and subsequent long-term anticoagulation treatment. The second case examines testing for inherited and acquired thrombophilia in the setting of recurrent miscarriage and the management of obstetric antiphospholipid syndrome. Lastly, case three reviews VTE risk assessment and prevention in pregnancy and the postpartum period, as well as duration and dose of postpartum thromboprophylaxis. Review of these common clinical scenarios surrounding thrombotic complications in pregnancy demonstrates recent advances in high-quality data, current gaps in knowledge, and variation in expert opinion. Ultimately, multidisciplinary discussion and teamwork remains key to optimal, safe care. Clinicians must prioritize collaborative, high-quality trials and prospective clinical management studies to better understand and define best practice in this population.

Long-term monitoring and treatment of venous thromboembolic disease: recommendations of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine 2024.

Venous thromboembolim (VTE) is a highly prevalent condition that requires long-term monitoring and treatment. This monitoring includes: 1) completing the etiological study and determining the risk of VTE recurrence; 2) establishing the optimal duration of anticoagulant treatment, as well as the type of therapy and its dosage; 3) estimating the risk of bleeding, and 4) identifying the occurrence of chronic complications. This consensus document, prepared by the VTE Group of the Spanish Society of Internal Medicine (SEMI), aims to update and establish consensus recommendations on these aspects. The document focuses on four aspects of management: the first includes risk factors for VTE recurrence after an unprovoked VTE episode and describes the predictive scores of VTE recurrence; the second focuses on risk factors for bleeding; the third provides recommendations for long-term follow-up in VTE, addressing specific considerations for screening chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome of the lower limbs; and the fourth provides guidance on the optimal duration of extended anticoagulant treatment, as well as the type of therapy and its dosage;. For each area, an exhaustive literature review was conducted, analyzing the updated VTE clinical guidelines and recent studies. This document is intended to be a guide in the long-term management of VTE based on the most current knowledge.

Post-traumatic pulmonary embolism in the setting of cough-variant asthma.

Post-traumatic pulmonary embolism (PE) poses diagnostic complexities, especially with underlying lung pathologies and delayed symptoms. We report a 43-year-old male who presented with cough, frothy sputum, and dyspnea following blunt chest trauma 2 weeks ago. Due to a history of asthma, an asthma exacerbation was suspected but he failed to respond to bronchodilator therapy. Doppler USG (ultrasonography) was negative for deep venous thrombi, however, elevated D-dimer levels prompted further investigation with computed tomography pulmonary angiography (CTPA), confirming the diagnosis of PE. Prompt initiation of anticoagulation and thrombolysis resulted in clinical improvement. This case underscores the need to rule out posttraumatic PE, irrespective of age, type of, or time since injury, and underlying lung disease, to ensure timely diagnosis and intervention.

Short-Term Bedrest is not a Risk Factor for Venous Thromboembolism after Endoscopic Skull Base Surgery.

INTRODUCTION: Deep venous thromboembolisms (DVT) increase morbidity in postoperative patients, and no current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient ICP shifts which may impact skull base reconstruction. We seek to characterize if postoperative bedrest puts EEA patients at increased risk of developing thromboembolic complications. METHODS: Retrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative CSF leak via EEA for any skull base pathology between July 2018 and May 2024 was performed yielding 221 patients who met inclusion criteria. Univariate and multivariable regression were performed with patient demographics, extent of approach, intraoperative leak flow rate, bedrest duration, presence and length of postoperative lumbar drainage (LD), and use of postoperative mechanical VT prophylaxis. RESULTS: The mean age of included patients was 52.6 ± 16.8 years, 48% were male, and 3.6% of patients had DVTs. Age (OR 1.01, 95% CI 0.96-1.06, p=0.83), sex (OR 0.40, 95% CI 0.05-2.19, p=0.31), BMI (OR 0.98, 95% CI 0.87-1.07, p=0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, p=0.80), CSF leak flow rate (OR 5.71, 95% CI 0.77-118.90, p=0.14), bedrest duration (OR 1.06, 95% CI 0.77-1.27, p=0.60), and presence of LD (OR 1.10, 95% CI 0.55-2.02, p=0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis. CONCLUSION: Short-term bedrest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

Prevention of perioperative venous thromboembolic complications using pneumatic compression cuffs in oral cancer patients in maxillofacial surgery.

OBJECTIVES: Venous thromboembolism (VTE) is still considered to be a significant medical issue. Physical measures to prevent perioperative venous thrombosis include early mobilization and intermittent pneumatic compression (IPC). The aim of this study was to evaluate whether IPC can reduce the incidence of postoperative thromboembolic events in patients with oral squamous cell carcinoma (OSCC) undergoing maxillofacial surgery. MATERIALS AND METHODS: Between March 2020 and May 2021, 75 patients with OSCC who did not receive perioperative prophylaxis using IPC were retrospectively examined to determine the occurrence of postoperative thromboembolism. Accordingly, 79 patients who received perioperative thrombosis prophylaxis using an IPC system as part of surgical tumor therapy from May 2021 to September 2023 were included in the study. The primary outcome measure was the occurrence of postoperative thromboembolism. RESULTS: In the control group without IPC, thromboembolic events were observed in five out of 75 patients during postoperative hospitalization. In the intervention group, no thromboembolic occurrences were identified among the 79 patients studied (p = 0.02). The mean Caprini score in the control group was 7.72, whereas in the intervention group it averaged 8.30 (p = 0.027). CONCLUSIONS: The implementation of IPC-devices as supplementary perioperative thrombosis prophylaxis resulted in a notable decrease in postoperative venous thromboembolism (Number Needed to Treat = 15), which is why implementation of the system as a regular part of the clinical routine for perioperative management of OSCC patients can be considered a sensible approach. CLINICAL RELEVANCE: The use of IPC enhances patient outcomes and may lead to improved postoperative care protocols in this high-risk patient population.

Saddle Pulmonary Embolism Following Total Knee Arthroplasty: A Rare Incidence.

Pulmonary embolism (PE) is a life-threatening condition that occurs due to the blockage of the pulmonary artery by blood clots. The occurrence of PE after total knee arthroplasty (TKA) is quite rare. Individuals with a history of PE have a high risk of recurrent venous thromboembolism (VTE). We have encountered a case of saddle PE (SPE) following TKA. The patient underwent a TKA due to advanced osteoarthritis. She started to develop respiratory distress after day 2 of surgery. Further investigation showed that she developed SPE. The conclusion from this case is that, while the occurrence is rare, it is critical to identify the risk factors for each patient prior to surgery. Individuals with VTE are at risk of developing recurrent VTE. Those with a previous history of VTE may require long-term anticoagulant medication to prevent a recurrence. Early diagnosis of the risk factor for VTE before the surgical procedure helps assure a positive outcome and prognosis following the procedure. As an additional benefit, it will lower the rates of perioperative morbidity and mortality.

Fat embolism mimicking pulmonary embolism: A case report.

Fat embolism syndrome is a rare clinical entity. The diagnosis is largely clinical, with the imaging studies supporting the clinical diagnosis. Here we present the case of a 19-year-old boy who presented with a tibial fracture and developed sudden onset shortness of breath on the following day. His clinical and investigation findings were suggestive of acute respiratory distress syndrome with fever, tachycardia, and tachypnea along with acute hemoglobin and platelet drop with positive fat globules. According to two clinical criteria, his diagnosis of fat embolism was established. The diagnostic dilemma arose when S1Q3T3 was seen in the electrocardiogram raising a doubt whether it could be a pulmonary embolism.

DVT with Pulmonary Embolism in Patient with Grade 2 Compound Tibia Shaft Fracture- Treated with Thrombolysis and Use of Prophylactic IVC Filter: Case Report.

Introduction: Major orthopedic procedures place patients at risk for Deep venous thrombosis (DVT) and pulmonary embolism (PE). DVT has a 10-40% incidence after isolated fractures of the tibia and distal bones of the lower extremity. Diagnostic techniques are venous compression ultrasonography, venography, and pulmonary angiography. Prevention methods for venous thromboembolism (VTE) include mechanical prophylaxis and pharmacological prophylaxis. Inferior vena cava filter (IVCF) intercepts thrombus in inferior vena cava and prevents it from reaching the pulmonary artery. Case Report: A 39-year-old female having compound Type 2 mid-shaft tibia fracture and operated with intramedullary nailing at a corporate hospital, Navi Mumbai in January 2024. Despite giving DVT prophylaxis, she developed shortness of breath on 3rd day. 2D echocardiogram (ECHO) showed dilated right atrium and right ventricular and computed tomography pulmonary angiography (CTPA) showed saddle embolism at the junction of pulmonary artery division. The cardiologist immediately advised intravenous (IV) thrombolysis (injection tenecteplase 30 mg stat) followed by IV anticoagulants (injection low molecular weight heparin 0.6) and oral (rivaroxaban 20 mg) for 15 days. However, she complained of high-grade fever, right leg persistent swelling, and per vaginal (PV) bleeding. Venous Doppler showed persistent thrombi. Hence oral rivaroxaban was stopped, and IVCF was inserted in February 2024 to prevent further embolization. After observing her menstrual cycles, she was resumed on oral rivaroxaban after 1 month. Follow-up after 3 months of surgery (April 2024) showed signs of healing of shaft tibia fracture. Follow-up after 3 months of IVCF placement (May 2024) showed no persistent thrombi in bilateral lower limb venous Doppler. Hence decision of F removal was made at 3 months. Conclusion: Clinical evaluation of patients is important for the detection of DVT-PE. Complain of breathlessness on exertion suggested the diagnosis of PE, confirmed by 2D ECHO and CTPA, and immediately treated by the cardiac team with thrombolytics and anticoagulants. Since the patient developed bleeding PV, the insertion of an IVCF is the best option for treatment and prophylaxis of future VTE episodes.

International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence.

Despite abundant clinical innovation and burgeoning scientific investigation, pulmonary embolism (PE) has continued to pose a diagnostic and management challenge worldwide. Aging populations, patients living with a mounting number of chronic medical conditions, particularly cancer, and increasingly prevalent health care disparities herald a growing burden of PE. In the meantime, navigating expanding strategies for immediate and long-term anticoagulation, as well as advanced therapies, including catheter-based interventions for patients with more severe PE, has become progressively daunting. Accordingly, clinicians frequently turn to evidence-based clinical practice guidelines for diagnostic and management recommendations. However, numerous international guidelines, heterogeneity in recommendations, as well as areas of uncertainty or omission may leave the readers and clinicians without a clear management pathway. In this review of international PE guidelines, we highlight key areas of consistency, difference, and lack of recommendations (silence) with an emphasis on critical clinical and research needs.

[Role of mechanical thrombectomy in the management of acute pulmonary embolism]. / Place de la thrombectomie dans le traitement de l'embolie pulmonaire aiguë.

Venous thromboembolism disease complicated by pulmonary embolism is a common cause of admission to emergencies and critical care unit. It is burdened by high mortality in the absence of early and appropriate treatment. Rapid diagnosis, anticoagulation to avoid recurrence and, in case of hemodynamic instability, use of systemic fibrinolysis are the corner stones of its management. For several years, interventional radiology techniques have been developed to treat the most critical patients in addition to or instead of systemic fibrinolysis. Among these techniques, mechanical thrombectomy deserves to be integrated into our therapeutic arsenal. We propose here an original decision-making algorithm integrating this technique based on a review of the literature, with the support of multidisciplinary team for the management of pulmonary embolism in our department.

La maladie thromboembolique veineuse compliquée d'une embolie pulmonaire est une cause fréquente d'admission aux urgences et en soins intensifs. Elle est grevée d'une mortalité élevée en l'absence d'un traitement précoce et adapté. Sa prise en charge repose sur un diagnostic rapide, une anticoagulation pour éviter la récidive et, pour les patients présentant une instabilité hémodynamique, le recours à une fibrinolyse systémique. Depuis plusieurs années, des techniques de radiologie interventionnelle ont été élaborées pour traiter les patients les plus sévèrement atteints en complément ou en alternative de la fibrinolyse. Parmi ces techniques, la thrombectomie mécanique, au vu de son essor récent, mérite d'être intégrée dans notre arsenal thérapeutique. Nous proposons un algorithme décisionnel original intégrant cette technique, basé sur une revue de la littérature et utilisé avec l'appui d'une équipe pluridisciplinaire de prise en charge de l'embolie pulmonaire dans notre institution.

Enhanced classification performance using deep learning based segmentation for pulmonary embolism detection in CT angiography.

Purpose: To develop a deep learning-based algorithm that automatically and accurately classifies patients as either having pulmonary emboli or not in CT pulmonary angiography (CTPA) examinations. Materials and methods: For model development, 700 CTPA examinations from 652 patients performed at a single institution were used, of which 149 examinations contained 1497 PE traced by radiologists. The nnU-Net deep learning-based segmentation framework was trained using 5-fold cross-validation. To enhance classification, we applied logical rules based on PE volume and probability thresholds. External model evaluation was performed in 770 and 34 CTPAs from two independent datasets. Results: A total of 1483 CTPA examinations were evaluated. In internal cross-validation and test set, the trained model correctly classified 123 of 128 examinations as positive for PE (sensitivity 96.1 %; 95 % C.I. 91-98 %; P < .05) and 521 of 551 as negative (specificity 94.6 %; 95 % C.I. 92-96 %; P < .05), achieving an area under the receiver operating characteristic (AUROC) of 96.4 % (95 % C.I. 79-99 %; P < .05). In the first external test dataset, the trained model correctly classified 31 of 32 examinations as positive (sensitivity 96.9 %; 95 % C.I. 84-99 %; P < .05) and 2 of 2 as negative (specificity 100 %; 95 % C.I. 34-100 %; P < .05), achieving an AUROC of 98.6 % (95 % C.I. 83-100 %; P < .05). In the second external test dataset, the trained model correctly classified 379 of 385 examinations as positive (sensitivity 98.4 %; 95 % C.I. 97-99 %; P < .05) and 346 of 385 as negative (specificity 89.9 %; 95 % C.I. 86-93 %; P < .05), achieving an AUROC of 98.5 % (95 % C.I. 83-100 %; P < .05). Conclusion: Our automatic pipeline achieved beyond state-of-the-art diagnostic performance of PE in CTPA using nnU-Net for segmentation and volume- and probability-based post-processing for classification.

A Practical Approach to the Diagnosis and Initial Management of Acute Right Ventricular Failure during Pregnancy using Point-of-Care Ultrasound.

Acute right ventricular failure is a critical condition in pregnancy that can lead to severe maternal and fetal complications. This expert review discusses the instrumental role of Point-of-Care Ultrasound in diagnosing and managing ARVF in pregnant patients, highlighting its benefits for immediate clinical decision-making in obstetric emergencies. The unique physiological changes during pregnancy, such as increased blood volume and cardiac output, can exacerbate underlying or latent cardiac issues, making pregnant patients particularly susceptible to acute right ventricular failure. Common causes during pregnancy include pulmonary embolism, peripartum cardiomyopathy, and congenital heart diseases, each presenting distinct challenges in diagnosis and management. The real-time capability of point-of-care ultrasound allows for the immediate assessment of right ventricular size and function, evaluation of fluid status via the inferior vena cava, and identification of potential pulmonary embolism, offering a non-invasive, rapid, and dynamic diagnostic tool right at the bedside. The expert review details specific point-of-care ultrasound techniques adapted for pregnant patients, including the parasternal long and short axis and apical four-chamber view, essential for evaluating right heart function and guiding acute management strategies. These include fluid management, adjustment of pharmacological treatment, and immediate interventions to support cardiac function and reduce ventricular overload. Point-of-care ultrasound enhances clinical outcomes by allowing clinicians to make informed decisions quickly, reducing the time to intervention, and tailoring management strategies to individual patient needs. However, despite its apparent advantages, the adoption of point-of-care ultrasound requires specialized training and familiarity with obstetric-specific protocols. This review advocates for the integration of point-of-care ultrasound into standard obstetric care protocols, emphasizing the need for clear guidelines and structured protocols that equip healthcare providers with the skills necessary to utilize this technology effectively. Future research should aim to refine these protocols and expand the evidence base to solidify the role of point-of-care ultrasound in improving maternal and fetal outcomes in acute right ventricular failure.

Venous Interventions: Controversies in the Management of Acute Deep Venous Thrombosis and the Role of the Interventional Radiologist.

Lower extremity deep venous thrombosis (DVT) is estimated to occur in 1 in 1000 persons annually in adult populations, with prevalence predicted to double by the year 2050. While acute DVT and pulmonary embolism are a major cause of cardiovascular morbidity and mortality, the long-term prognosis for patients with venous thromboembolism is in part determined by the development of post-thrombotic syndrome (PTS), which occurs in up to 50% of patients. PTS refers to a chronic syndrome complex, invariably characterized by intractable edema, pain, stasis dermatitis, and venous stasis ulceration when severe.