Brachial venous pressure measurement for diagnosis of pulmonary embolism

Background. Imaging methods for diagnosis of pulmonary embolism (PE) are not available at small medical or rural centres as well as during night time. Herein, we evaluated the diagnostic value of brachial venous pressure measurement in the diagnosis of PE in patients with deep vein thrombosis. Materials and Methods. One-hundred and fifty consecutive patients with deep vein thrombosis and suspected PE were prospectively evaluated by measuring brachial vein pressure by CW Doppler. Diagnosis of PE was made by computed tomography angiography and pulmonary angiography. Results. Seventy-one patients (47.3%) had PE. A significant correlation was observed between brachial venous pressure and systolic pulmonary artery pressure (sPAP) estimated at echocardiography (rho 0.922, p<0.0001) as well as with invasively measured sPAP (rho 0.965, p<0.0001). Brachial venous pressure was significantly higher in the PE group (38.5 vs. 13.9 mmHg, p<0.0001) and was associated with increased extent of PE (p<0.0001). A cut-off of brachial venous pressure >15 mmHg had a sensitivity of 100%, a specificity of 77% and a negative likelihood ratio of 0.0%. A cut-off of brachial venous pressure > 19 mmHg had a sensitivity of 100% and specificity of 100% as no patient with PE had a brachial venous pressure below 20 mmHg, and no patients without PE had a venous pressure above this value. Conclusions. Brachial venous pressure may assist in the diagnosis of PE at bed-side in patients with deep vein thrombosis. Further studies are needed to confirm the validity and reliability of this method. Clin Ter 2012; 163(5):e287-291