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JAMA Revisited
February 19, 2014

Significance of Phlebography in Phlebothrombosis

JAMA. 2014;311(7):741. doi:10.1001/jama.2013.279341

Few complications in medicine and surgery are as unpredictable, treacherous and dramatically tragic as the thromboembolic phenomena. Fatal pulmonary embolism in a patient apparently convalescing uneventfully and preparing to leave the hospital is a fearsome and pathetic catastrophe. Whereas the mortality rate in surgical patients has steadily decreased since the introduction of asepsis and continued improvement in surgical technic and anesthesia as well as the more recent development of the sulfonamides, little has actually been accomplished in the control of pulmonary embolism until relatively recently. Indeed there is some statistical evidence to support the belief that the thromboembolic incidence is increasing. That the condition occurs with sufficient frequency to deserve the assiduous and intensive efforts of investigators has been clearly demonstrated by repeated observations. Thus Snell at the Mayo Clinic and Dietrich in Germany found that pulmonary embolism was considered the cause of death in approximately 8 per cent of all autopsies. In a statistical consideration of this subject Gibbon was able to express the incidence of fatal pulmonary embolism as follows: Of every thousand patients admitted to the surgical wards, 1 will die of pulmonary embolism; of every thousand operated on, 2 will die from pulmonary embolism; and of every hundred postoperative deaths, eight will be due to pulmonary embolism.…

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