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Embolie pulmonaire et maladie thrombo-embolique

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Urgences cardio-vasculaires: place de la radiologie interventionnelle

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Résumé

La fréquence estimée en France de la survenue d’une embolie pulmonaire était de 100000 par an, comme dans les autres pays d’Europe, et cette fréquence n’a pas changé ces trois dernières décennies (1). La gravité de l’affection repose sur la mise en jeu du pronostic vital, avec un taux de décès très variable selon les populations considérées mais globalement estimé de 7 à 11% il y a 30 ans, avec une tendance actuelle à la baisse dans les pays industrialisés liée à une meilleure prise en charge de la maladie thrombo-embolique (2, 3). De plus, il est indispensable d’obtenir un diagnostic de certitude car le traitement par anticoagulant est long (plusieurs mois), contraignant (surveillance par INR), et non dénué de risques (mortalité de l’ordre de 0,5 à 1% par an par accidents hémorragiques graves) (4). Ne pas faire le diagnostic expose à un risque de récurrence au moins triplé de l’embolie pulmonaire à 3 mois (5). Or, la problématique essentielle et persistante est que le diagnostic clinique d’embolie pulmonaire est difficile. La clinimétrie de la triade évocatrice «dyspnée-douleur thoraciquehémoptysie» est de moins de 30% (6) et la plupart des patients présentant un tableau clinique évocateur n’ont pas d’embolie pulmonaire (7).

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  1. Service de radiologie vasculaire, CHU, 371, avenue du Doyen Gaston Giraud, 34295, Montpellier

    H. Vernhet Kovacsik

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  1. H. Vernhet Kovacsik
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Vernhet Kovacsik, H. (2009). Embolie pulmonaire et maladie thrombo-embolique. In: Urgences cardio-vasculaires: place de la radiologie interventionnelle. Collection de la Société française d’imagerie cardiaque et vasculaire. Springer, Paris. https://doi.org/10.1007/978-2-287-99166-0_17

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  • DOI: https://doi.org/10.1007/978-2-287-99166-0_17

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-99165-3

  • Online ISBN: 978-2-287-99166-0

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