Author + information
- Feng Wei,
- Yushun Zhang,
- Hongyan Tian,
- Junbo Zhang and
- Qiang Ma
Paradoxical peripheral arterial embolism is an important clinical entity and potentially morbidity-threatening. However, the risk factors of paradoxical peripheral arterial embolism are unclear. We investigated what clinical presentations are likely risk factors for paradoxical peripheral arterial embolism and whether combined medical therapy can reduce the recurrence of paradoxicalembolism.
Eleven consecutive subjects who were hospitalized in the cardiovascular center of our hospital from July 2012 to Dec 2015 with peripheral arterial embolism associated with intracardiac shunts (patent foramen ovale or/and atrial septal defect) and venous thromboembolism (deep venous thromboembolism or/and pulmonary embolism) were enrolled in this study. The control group comprised 14 patients with symptomatic venous thromboembolism (VTE) coincided with patent foramen ovale (PFO) or/and atrial septal defect (ASD). For clinical treatment, subjects with arterial embolism were treated with catheter-directed thrombolysis or/and anticoagulation. Patients suffered with VTE were treated with thrombolysis or/and anticoagulation according to recommendations from guideline of ACCP9 (American College of Chest Physicians). Patients with pulmonary hypertension were also administered by reducing pulmonary artery pressure. Baseline characteristics and transthoracic ultracardiogram were analyzed between the two groups. All subjects were followed-up by 6 months to 42 months. The end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Continuous data between groups were analyzed by independent samples t-test. Categorical data were compared using chi-square test.
Pulmonary hypertension occurred in 10 of the 11 patients (90.9%) in paradoxical embolism group, compared with control group (1/14, 7.1%) (90.9% vs 7.1%, P=0.000), while massive or sub-massive pulmonary embolism occurred in 9 of the 11 patients (81.8%) in paradoxical embolism group, compared with control group (2/14, 14.3%) (81.8% vs 14.3%, P=0.001). Age, gender, smoking, the presence of hypertension, diabetes, dyslipidemia, non-congenital heart disease, cancer and the size of PFO or ASD were not significant variables in the analysis. The mean duration of follow-up was 2.1 years in the study group and 2.0 years in control group. The end point occurred in 1 (nonfatal stroke) of the 11 patients (9.1%) in the study group and in 1 (nonfatal stroke) of the 14 patients (7.1%) in the control group, respectively (9.1% vs 7.1%, P = 0.94).
Pulmonary hypertension and massive or sub-massive pulmonary embolism are the high risk factors for paradoxical peripheral arterial embolism. For secondary prevention of paradoxical peripheral arterial embolism, combined medical therapy can result in a significant reduction in the risk of recurrent embolic events or death.