The clinical application of interventional therapy for lower limb deep venous thrombosis

International Nuclear Information System (INIS)

Tang Maoshun; Gao Wenhui; Chen Zhou; Zhang Ming; Qian Sheng

2009-01-01

Objective: To evaluate the clinical effect of comprehensive interventional treatment for lower extremity deep venous thrombosis. Methods: Comprehensive interventional therapy was performed in 33 patients with lower extremity deep venous thrombosis. The clinical data and the therapeutic results were retrospectively analyzed. Of 33 patients, placement of inferior vena cava filter with postoperative anticoagulant and thrombolytic therapy was employed in 10, while placing of inferior vena cava filter together with reopening of the affected-side iliac-femoral vein was carried out in 23. Results: During the follow-up period, no serious complications, such as massive hemorrhage and lethal pulmonary artery embolism, occurred. Complete dissolution of the thrombus in the lower extremity deep vein was obtained in 23 cases, and partial dissolution of the thrombus in 10 cases. Conclusion: Comprehensive interventional therapy is an effective,safe and feasible technique for the treatment of lower limb deep venous thrombosis. (authors)

Duplex imaging of residual venous obstruction to guide duration of therapy for lower extremity deep venous thrombosis.

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Stephenson, Elliot J P; Liem, Timothy K

2015-07-01

Clinical trials have shown that the presence of ultrasound-identified residual venous obstruction (RVO) on follow-up scanning may be associated with an elevated risk for recurrence, thus providing a potential tool to help determine the optimal duration of anticoagulant therapy. We performed a systematic review to evaluate the clinical utility of post-treatment duplex imaging in predicting venous thromboembolism (VTE) recurrence and in adjusting duration of anticoagulation. The Ovid MEDLINE Database, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were queried for the terms residual thrombus or obstruction, duration of therapy, deep vein thrombosis, deep venous thrombosis, DVT, venous thromboembolism, VTE, antithrombotic therapy, and anticoagulation, and 228 studies were selected for review. Six studies determined the rate of VTE recurrence on the basis of the presence or absence of RVO. Findings on venous ultrasound scans frequently remained abnormal in 38% to 80% of patients, despite at least 3 months of therapeutic anticoagulation. In evaluating for VTE recurrence, the definition of RVO varied widely in the literature. Some studies have shown an association between RVO and VTE recurrence, whereas other studies have not. Overall, the presence of RVO is a mild risk factor for recurrence (odds ratio, 1.3-2.0), but only when surveillance imaging is performed soon after the index deep venous thrombosis (3 months). RVO is a mild risk factor for VTE recurrence. The presence or absence of ultrasound-identified RVO has a limited role in guiding the duration of therapeutic anticoagulation. Further research is needed to evaluate its utility relative to other known risk factors for VTE recurrence. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Iliofemoral and iliocaval interventions in deep venous thrombosis

International Nuclear Information System (INIS)

Haage, P.; Guenther, R.W.

2005-01-01

Significant spontaneous thrombus disintegration in deep venous thrombosis (DVT) occurs very infrequently. On the contrary, these thrombi are prone to appositional growth and migration into the pulmonary arteries. The development of chronic venous insufficiency due to post-thrombotic syndrome is a frequent consequence of DVT. Therapeutic options in DVT include anticoagulation and recanalising procedures such as thrombolysis and thrombectomy. After appropriate indication assessment, the interventional radiologist can offer an efficacy-proven minimally-invasive vessel restitution approach by performing locoregional thrombolysis, pharmacomechanical therapy or, particularly in iliocaval thrombosis, mechanical thrombectomy. These methods not only serve to restitute of vessel patency, but also allow preserving venous valve function. In DVT with recurrent pulmonary embolism, retrievable filters with extended implantation duration can be deployed. In chronic proximal venous flow obstruction or in case of significant residual stenosis after thrombolysis, balloon angioplasty with stent implantation is the treatment modality of choice. Consequently, the radiologist can adopt an important role in the treatment of extensive venous disease. In this article, the treatment modalities concerning iliofemoral and iliocaval thrombosis are demonstrated and illustrated. (orig.)

Comparison of sonography and venography in the diagnosis of lower extremity deep venous thrombosis

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Mostbeck, G.H.; Kettenbach, J.; Henk, C.

1993-01-01

In recent years, non-invasive sonographic techniques [real-time ultrasound (US), duplex ultrasonography (DU) and color-coded duplex sonography (CCDS)] have increased in importance for the diagnosis of lower extremity deep venous thrombosis. To ascertain the accuracy and limitations of these techniques prospectively, various studies have been performed to compare sonography with venography. This review deals with basic methodologic considerations when two imaging methds are compared and describes the features of deep venous thrombosis seen on US, DU and CCDS. Reports comparing sonography and phlebography for the diagnosis of deep venous thrombosis are presented and discussed. The advantages and limitations of US, DU and CCDS for the diagnosis of iliac, femoral, popliteal and infrapopliteal venous thrombosis are compared with those of venography, and controversial areas are touched on. (orig.) [de

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus.

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Ma, Junhao; Li, Xinxi; Wang, Yang; Yang, Zhenwei; Luo, Jun

2017-12-01

Anticoagulant therapy is commonly used for the prevention and treatment of patients with deep venous thrombus. Evidence has shown that rivaroxaban is a potential oral anticoagulant drug for the acute treatment of venous thromboembolism. However, the rivaroxaban-mediated molecular mechanism involved in the progression of deep venous thrombosis has not been investigated. In the present study, we investigated the efficacy of rivaroxaban and the underlying signaling pathways in the prevention and treatment of rats with deep venous thrombosis. A rat model with deep vein thrombus formation was established and received treatment with rivaroxaban or PBS as control. The thrombin-activatable fibrinolysis inhibitor (TAFI) and plasminogen activator inhibitor-1 (PAI-1) were analyzed both in vitro and in vivo. The progression of thrombosis and stroke was evaluated after treatment with rivaroxaban or PBS. Nuclear factor-κB (NF-κB) signaling pathway in venous endothelial cells and in the rat model of deep venous thrombus was assessed. The therapeutic effects of rivaroxaban were evaluated as determined by changes in deep venous thrombosis in the rat model. Our results showed that rivaroxaban markedly inhibited TAFI and PAI-1 expression levels, neutrophils, tissue factor, neutrophil extracellular traps (NETs), myeloperoxidase and macrophages in venous endothelial cells and in the rat model of deep venous thrombus. Expression levels of ADP, PAIs, von Willebrand factor (vWF) and thromboxane were downregulated in vein endothelial cells and in serum from the experimental rats. Importantly, the incidences of inferior vena cava filter thrombus were protected by rivaroxaban during heparin-induced thrombolysis deep venous thrombosis in the rat model. We observed that activity of the NF-κB signaling pathway was inhibited by rivaroxaban in vein endothelial cells both in vitro and in vivo. Notably, immunohistology indicated that rivaroxaban attenuated deep venous thrombosis and the

Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity.

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Adhikari, Srikar; Zeger, Wes; Thom, Christopher; Fields, J Matthew

2015-09-01

Two-point compression ultrasonography focuses on the evaluation of common femoral and popliteal veins for complete compressibility. The presence of isolated thrombi in proximal veins other than the common femoral and popliteal veins should prompt modification of 2-point compression technique. The objective of this study is to determine the prevalence and distribution of deep venous thrombi isolated to lower-extremity veins other than the common femoral and popliteal veins in emergency department (ED) patients with clinically suspected deep venous thrombosis. This was a retrospective study of all adult ED patients who received a lower-extremity venous duplex ultrasonographic examination for evaluation of deep venous thrombosis during a 6-year period. The ultrasonographic protocol included B-mode, color-flow, and spectral Doppler scanning of the common femoral, femoral, deep femoral, popliteal, and calf veins. Deep venous thrombosis was detected in 362 of 2,451 patients (14.7%; 95% confidence interval [CI] 13.3% to 16.1%). Thrombus confined to the common femoral vein alone was found in 5 of 362 cases (1.4%; 95% CI 0.2% to 2.6%). Isolated femoral vein thrombus was identified in 20 of 362 patients (5.5%; 95% CI 3.2% to 7.9%). Isolated deep femoral vein thrombus was found in 3 of 362 cases (0.8%; 95% CI -0.1% to 1.8%). Thrombus in the popliteal vein alone was identified in 53 of 362 cases (14.6%; 95% CI 11% to 18.2%). In our study, 6.3% of ED patients with suspected deep venous thrombosis had isolated thrombi in proximal veins other than common femoral and popliteal veins. Our study results support the addition of femoral and deep femoral vein evaluation to standard compression ultrasonography of the common femoral and popliteal vein, assuming that this does not have a deleterious effect on specificity. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain

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Felipe Langer

2017-04-01

Full Text Available Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.

Primary Iliac Venous Leiomyosarcoma: A Rare Cause of Deep Vein Thrombosis in a Young Patient

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Nelson Oliveira

2011-01-01

Full Text Available Introduction. Primary venous tumours are a rare cause of deep vein thrombosis. The authors present a case where the definitive diagnosis was delayed by inconclusive complementary imaging. Clinical Case. A thirty-seven-year-old female presented with an iliofemoral venous thrombosis of the right lower limb. The patient had presented with an episode of femoral-popliteal vein thrombosis five months before and was currently under anticoagulation. Phlegmasia alba dolens installed progressively, as thrombus rapidly extended to the inferior vena cava despite systemic thrombolysis and anticoagulation. Diagnostic imaging failed to identify the underlying aetiology of the deep vein thrombosis. The definitive diagnosis of primary venous leiomyosarcoma was reached by a subcutaneous abdominal wall nodule biopsy. Conclusion. Primary venous leiomyosarcoma of the iliac vein is a rare cause of deep vein thrombosis, which must be considered in young patients with recurrent or refractory to treatment deep vein thrombosis.

Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower limb

International Nuclear Information System (INIS)

Babar, T.H.; Nafees, M.N.; Sarwar, S.; Ashraf, N.

2010-01-01

Objective: This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Study Design: Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Methods: Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Results: Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 (90%) were diagnosed to have deep venous thrombosis, 3 (10%) were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33 %. Conclusion: Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays. (author)

Deep venous thrombophlebitis following aortoiliac reconstructive surgery

International Nuclear Information System (INIS)

Reilly, M.K.; McCabe, C.J.; Abbott, W.M.; Brewster, D.C.; Moncure, A.C.; Reidy, N.C.; Darling, R.C.

1982-01-01

One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption

Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion

International Nuclear Information System (INIS)

Ruess, Lynne; Rusin, Jerome A.; Dent, Carly M.; Tiarks, Hailey J.; Yoshida, Michelle A.

2014-01-01

Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses. The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses. An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children's hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature. There were six female and three male infants. The mean age at presentation was 20 days (range: 0-90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0-12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via

Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion

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Ruess, Lynne; Rusin, Jerome A. [Nationwide Children' s Hospital, Department of Radiology, Columbus, OH (United States); The Ohio State University College of Medicine and Public Health, Columbus, OH (United States); Dent, Carly M.; Tiarks, Hailey J.; Yoshida, Michelle A. [Nationwide Children' s Hospital, Department of Radiology, Columbus, OH (United States)

2014-11-15

Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses. The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses. An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children's hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature. There were six female and three male infants. The mean age at presentation was 20 days (range: 0-90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0-12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via

Sarcoidosis, Celiac Disease and Deep Venous Thrombosis: a Rare Association

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Gökhan Çelik

2011-11-01

Full Text Available Sarcoidosis is a multisystem granulomatous disorder of unknown etiology and it may rarely be associated with a second disorder. Celiac disease is an immune-mediated enteropathy characterized with malabsorption caused by gluten intolerance, and several reports indicate an association between celiac disease and sarcoidosis. In addition, although celiac disease is associated with several extraintestinal pathologies, venous thrombosis has been rarely reported. Herein we present a rare case report of a patient with a diagnosis of sarcoidosis, celiac disease and deep venous thrombosis because of the rare association of these disorders. The patient was admitted with abdominal pain, weight loss, chronic diarrhea and a 5-day history of swelling in her right leg. A diagnosis of deep venous thrombosis was achieved by doppler ultrasonographic examination. The diagnosis of celiac disease was made by biopsy of duodenal mucosa and supported with elevated serum level of anti-gliadin IgA and IgG, and a diagnosis of sarcoidosis was achieved by transbronchial needle aspiration from the subcarinal lymph node during flexible bronchoscopy.

Relationship between deep venous thrombosis and pulmonary embolism by radionuclide techniques in 150 patients

International Nuclear Information System (INIS)

Shi, R.F.; Wang, X.M.; Liu, X.J.; Fang, W.

2002-01-01

Objective: This study was to evaluate the relationship between deep venous thrombosis and pulmonary embolism assessed by radionuclide imaging. Methods: One hundred and fifty patients with pulmonary embolism from September 1997 to September 2001 were included. Pulmonary perfusion/ventilation imaging and deep venous radionuclide venography was performed in all patients. There were 87 men, and 63 women, with an average age 39±18 years. Of them, 26 underwent pulmonary arteriography. Eleven patients had X Ray phleography of lower extremities, 18 patients had Impedence plethymography (IPG), and 36 patients had lower limb ultrasound study. Results: Out of 150 patients with pulmonary embolism, 128 (85.5%) had lower limb venous pathological changes. Among them, 100 patients had risk factors of deep venous thrombosis (78.3%). 120 patients had proximal vein (80.0%). The agreement between radionuclide venography and X Ray phleography of lower extremities UCG and IPG was 90.9%, 70.2% and 80.0% respectively. Conclusions: Our results indicate that DVT was one of most important cause for acute pulmonary embolism, and thrombosis is mostly located in the proximal veins

Unicompartmental muscle edema: an early sign of deep venous thrombosis

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Liu, Patrick T. [Mayo Clinic Scottsdale, Department of Diagnostic Radiology, 13400 E. Shea Boulevard, Scottsdale, AZ 85259 (United States); Ilaslan, Hakan [Mayo Clinic Rochester, Department of Diagnostic Radiology, Rochester, Minnesota (United States)

2003-01-01

The finding of muscle edema restricted to a single muscle compartment on MRI usually indicates a diagnosis of traumatic injury, myositis, denervation or neoplasm. This case demonstrates that deep venous thrombosis can also be the cause of isolated deep posterior compartment muscle edema in the calf and should be considered in the differential diagnosis even in the absence of diffuse soft tissue or subcutaneous edema. (orig.)

Risk factors associated with the occurrence of silent pulmonary embolism in patients with deep venous thrombosis of the lower limb.

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Li, Fenghe; Wang, Xuehu; Huang, Wen; Ren, Wei; Cheng, Jun; Zhang, Mao; Zhao, Yu

2014-08-01

The aim of our study is to investigate the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in the lower limbs and to evaluate the associated risk factors. A total of 322 patients with acute deep venous thrombosis confirmed by CT venography or Doppler ultrasonography were studied. The diagnosis of silent pulmonary embolism was established by computed tomography pulmonary arteriography (CTPA). The association between covariates and the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in lower limbs were assessed using chi-square test and multivariable regression. The incidence of silent pulmonary embolism was 33.5% (108 in 322 patients) in all patients with deep venous thrombosis in lower limbs. Chi-square test showed male gender, the right lower limb, proximal location of the thrombus, unprovoked venous thrombosis and coexisting heart diseases were related to a higher incidence of silent pulmonary embolism in patients with deep venous thrombosis in lower limbs. The multivariate regression analysis confirmed that the risk factors associated with silent pulmonary embolism in deep venous thrombosis patients included the right side and proximal location of the thrombus (odds ratio: 2.023, 95% CI: 1.215-3.368; odds ratio: 3.610, 95% CI: 1.772-7.354), unprovoked venous thrombosis (odds ratio: 2.037, 95% CI: 1.188-3.493), coexisting heart diseases (odds ratio: 4.507, 95% CI: 2.667-7.618). Silent pulmonary embolism occurred frequently in patients with deep venous thrombosis in lower limbs. The right side, the proximal location of the thrombus, unprovoked venous thrombosis and coexisting heart diseases increased the risk for the occurrence of silent pulmonary embolism. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Use of a Trellis Device for Endovascular Treatment of Venous Thrombosis Involving a Duplicated Inferior Vena Cava

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Saettele, Megan R., E-mail: SaetteleM@umkc.edu [University of Missouri, Kansas City, Department of Radiology, Saint Luke' s Hospital (United States); Morelli, John N., E-mail: dr.john.morelli@gmail.com [Texas A and M University Health Science Center, Department of Radiology, Scott and White Clinic and Hospital (United States); Chesis, Paul; Wible, Brandt C. [University of Missouri, Kansas City, Department of Interventional Radiology, Saint Luke' s Hospital (United States)

2013-12-15

Congenital anomalies of the inferior vena cava (IVC) are increasingly recognized with CT and venography techniques. Although many patients with IVC anomalies are asymptomatic, recent studies have suggested an association with venous thromboembolism. We report the case of a 62-year-old woman with extensive venous clot involving the infrarenal segment of a duplicated left IVC who underwent pharmacomechanical thrombectomy and tissue plasminogen activator catheter-directed thrombolysis with complete deep venous thrombosis resolution. To our knowledge this is the first reported case in the English literature of the use of a Trellis thrombectomy catheter in the setting of duplicated IVC.

Incidental Finding of Inferior Vena Cava Atresia Presenting with Deep Venous Thrombosis following Physical Exertion

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Shalini Koppisetty

2015-01-01

Full Text Available Inferior vena cava atresia (IVCA is a rare but well described vascular anomaly. It is a rare risk factor for deep venous thrombosis (DVT, found in approximately 5% of cases of unprovoked lower extremity (LE DVT in patients <30 years of age. Affected population is in the early thirties, predominantly male, often with a history of major physical exertion and presents with extensive or bilateral DVTs. Patients with IVC anomalies usually develop compensatory circulation through the collateral veins with enlarged azygous/hemizygous veins. Despite the compensatory circulation, the venous drainage of the lower limbs is often insufficient leading to venous stasis and thrombosis. We describe a case of extensive and bilateral deep venous thrombosis following physical exertion in a thirty-six-year-old male patient with incidental finding of IVCA on imaging.

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art.

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Sista, Akhilesh K; Vedantham, Suresh; Kaufman, John A; Madoff, David C

2015-07-01

The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article.

Deep venous thrombosis and agenesis of the intrahepatic segment of inferior vena cava

International Nuclear Information System (INIS)

Velasco, J.; Fernandez, M.M.; Manzanares, R.; Hernando, A.

1997-01-01

We present a case of agenesis of the intrahepatic segment of inferior vena cava (IVC) with drainage through the azygos and hemiazygos systems. The presenting sign was deep venous thrombosis (DVT) in both lower extremities. The different imaging studies led to the diagnosis of both the congenital and acquired venous abnormalities, which are discussed. (Author) 14 refs

An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy.

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Macklon, N S; Greer, I A; Bowman, A W

1997-02-01

To investigate gestational and postural changes in diameter and blood flow in the proximal deep leg veins during pregnancy. A longitudinal, prospective observational study. The ultrasound department of a teaching maternity hospital. Twenty-four healthy women with uncomplicated singleton pregnancies. Real-time and duplex Doppler ultrasound assessments of the vessel diameter, flow velocity and respiratory flow fluctuation in the proximal deep leg veins of women serially measured from the first trimester of pregnancy to six weeks postnatally. The effects of increasing gestation and the adoption of the left lateral position on the above parameters. An increase in vessel diameter and a fall in flow velocity with increasing gestation was observed. However, no change in venous flow variation was observed. Delivery had reverse effects. Flow velocity was slower in the left than right legs, but on adoption of the left lateral position an increase in flow velocity and venous flow variation was observed in both legs during pregnancy. These data are consistent with the observed increase in incidence and pattern of deep venous thrombosis in pregnancy and may aid interpretation of duplex Doppler ultrasound examinations for deep venous thrombosis in pregnancy. Postural changes should be part of this evaluation. The gravid uterus may not be the sole cause for postural changes in deep venous flow velocity.

Management of Cavoatrial Deep Venous Thrombosis: Incorporating New Strategies

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Zayed, Mohamed A.; De Silva, Gayan S.; Ramaswamy, Raja S.; Sanchez, Luis A.

2017-01-01

Cavoatrial deep venous thrombosis (DVT) is diagnosed with increasing prevalence. It can be managed medically with anticoagulation or with directed interventions aimed to efficiently reduce the thrombus burden within the target venous segment. The type of management chosen depends greatly on the etiology and chronicity of the thrombosis, existing patient comorbidities, and the patient's tolerance to anticoagulants and thrombolytic agents. In addition to traditional percutaneous catheter-based pharmacomechanical thrombolysis, other catheter-based suction thrombectomy techniques have emerged in recent years. Each therapeutic modality requires operator expertise and a coordinated care paradigm to facilitate successful outcomes. Open surgical thrombectomy is alternatively reserved for specific patient conditions, including intolerance of anticoagulation, failed catheter-based interventions, or acute emergencies. PMID:28265127

Symptomatic iliofemoral deep venous thrombosis treated with hybrid operative thrombectomy.

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Rodríguez, Limael E; Aponte-Rivera, Francisco; Figueroa-Vicente, Ricardo; Bolanos-Avila, Guillermo E; Martínez-Trabal, Jorge L

2015-10-01

During the past 15 years, strategies that promote immediate and complete thrombus removal have gained popularity for the treatment of acute-onset iliofemoral deep venous thrombosis. In this case report, we describe a novel operative approach to venous thrombus removal known as hybrid operative thrombectomy. The technique employs a direct inguinal approach with concomitant retrograde advancement of a balloon catheter by femoral venotomy. Moreover, it provides effective thrombus removal through a single incision, with or without stent placement, and has the advantage of a completion venogram. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[Sequelae of unilateral deep venous thrombosis in plethysmography of the calf].

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Zicot, M; Depairon, M

1982-01-01

Twenty four patients suffering from unilateral venous disturbances revealed by Doppler and secondary to a deep venous thrombosis were examined. The calf venous haemodynamics was analyzed by use of a strain-jauge plethysmograph. We determined the increase in venous volume due to the inflation of a thigh pneumatic cuff (pressure at 20, 40 and 60 mm Hg; delta V20, delta V40, delta V60). The maximal venous output (Vout) was measured after a quick release of the 60 mm Hg pressure. The maximal venous drainage (VMM) was assessed during a rhythmic exercise (tiptoeing) while standing; delta V20, delta V40 and delta V60 were nearly constantly reduced on the abnormal side (t of Student respectively 3.49; 6.09 and 5.07). Vout dropped proportionaly to delta V60. Some abnormalities due to valvular insufficiency were frequently present in the beginning of the inflation curve at the level of the abnormal limbs. VMM was nearly always largely decreased on the affected side (t = 5.43). The unilateral flow disturbances displayed by the Doppler were regularly going with abnormalities of the capacitive system, well demonstrated by comparison with the non-affected limbs.

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Science.gov (United States)

Sista, Akhilesh K.; Vedantham, Suresh; Kaufman, John A.

2015-01-01

The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article. © RSNA, 2015 PMID:26101920

Do the venous blood samples replicate malaria parasite densities found in capillary blood? A field study performed in naturally-infected asymptomatic children in Cameroon.

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Sandeu, Maurice M; Bayibéki, Albert N; Tchioffo, Majoline T; Abate, Luc; Gimonneau, Geoffrey; Awono-Ambéné, Parfait H; Nsango, Sandrine E; Diallo, Diadier; Berry, Antoine; Texier, Gaétan; Morlais, Isabelle

2017-08-17

The measure of new drug- or vaccine-based approaches for malaria control is based on direct membrane feeding assays (DMFAs) where gametocyte-infected blood samples are offered to mosquitoes through an artificial feeder system. Gametocyte donors are identified by the microscopic detection and quantification of malaria blood stages on blood films prepared using either capillary or venous blood. However, parasites are known to sequester in the microvasculature and this phenomenon may alter accurate detection of parasites in blood films. The blood source may then impact the success of mosquito feeding experiments and investigations are needed for the implementation of DMFAs under natural conditions. Thick blood smears were prepared from blood obtained from asymptomatic children attending primary schools in the vicinity of Mfou (Cameroon) over four transmission seasons. Parasite densities were determined microscopically from capillary and venous blood for 137 naturally-infected gametocyte carriers. The effect of the blood source on gametocyte and asexual stage densities was then assessed by fitting cumulative link mixed models (CLMM). DMFAs were performed to compare the infectiousness of gametocytes from the different blood sources to mosquitoes. Prevalence of Plasmodium falciparum asexual stages among asymptomatic children aged from 4 to 15 years was 51.8% (2116/4087). The overall prevalence of P. falciparum gametocyte carriage was 8.9% and varied from one school to another. No difference in the density of gametocyte and asexual stages was found between capillary and venous blood. Attempts to perform DMFAs with capillary blood failed. Plasmodium falciparum malaria parasite densities do not differ between capillary and venous blood in asymptomatic subjects for both gametocyte and trophozoite stages. This finding suggests that the blood source should not interfere with transmission efficiency in DMFAs.

ABO blood groups and risk of deep venous thromboembolism in Chinese Han population from Chaoshan region in South China

Directory of Open Access Journals (Sweden)

Min Yu

2017-04-01

Full Text Available Objectives: To demonstrate the prevalence of ABO blood groups with deep venous thromboembolism in Chinese Han population. Methods: A retrospective study was conducted between January 2010 and March 2015 in The First Affiliated Hospital of Shantou University Medical College in Chaoshan District of Guangdong Province in South China. Eighty nine patients with confirmed diagnosis of deep venous thromboembolism were included. Frequency of blood groups was determined. Results: Of 89 patients with deep venous thromboembolism, 28 patients had blood group A (31.5%, 28 patients had blood group B (31.5%, 13 patients had blood group AB (14.6%, and 20 patients had blood group O (22.5%. Compared with O blood type, the odds ratios of deep venous thromboembolism for A, B and AB were 2.23 (95% CI, 1.27-3.91, 2.34 (95% CI, 1.34-4.09 and 4.43 (95% CI, 2.24-8.76. Conclusion: There is a higher risk of venous thromboembolism in non-O blood groups than O group.

ABO blood groups and risk of deep venous thromboembolism in Chinese Han population from Chaoshan region in South China.

Science.gov (United States)

Yu, Min; Wang, Cantian; Chen, Tingting; Hu, Shuang; Yi, Kaihong; Tan, Xuerui

2017-04-01

 Objectives: To demonstrate the prevalence of ABO blood groups with deep venous thromboembolism in Chinese Han population. A retrospective study was conducted between January 2010 and March 2015 in The First Affiliated Hospital of Shantou University Medical College in Chaoshan District of Guangdong Province in South China. Eighty nine patients with confirmed diagnosis of deep venous thromboembolism were included. Frequency of blood groups was determined. Results: Of 89 patients with deep venous thromboembolism, 28 patients had blood group A (31.5%), 28 patients had blood group B (31.5%), 13 patients had blood group AB (14.6%), and 20 patients had blood group O (22.5%). Compared with O blood type, the odds ratios of deep venous thromboembolism for A, B and AB were 2.23 (95% CI, 1.27-3.91), 2.34 (95% CI, 1.34-4.09) and  4.43 (95% CI, 2.24-8.76). Conclusion: There is a higher risk of venous thromboembolism in non-O blood groups than O group.

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus

OpenAIRE

Ma, Junhao; Li, Xinxi; Wang, Yang; Yang, Zhenwei; Luo, Jun

2017-01-01

Anticoagulant therapy is commonly used for the prevention and treatment of patients with deep venous thrombus. Evidence has shown that rivaroxaban is a potential oral anticoagulant drug for the acute treatment of venous thromboembolism. However, the rivaroxaban-mediated molecular mechanism involved in the progression of deep venous thrombosis has not been investigated. In the present study, we investigated the efficacy of rivaroxaban and the underlying signaling pathways in the prevention and...

Depiction of lower limb venous anatomy in patients undergoing interventional deep venous reconstruction-the role of balanced steady state free precession MRI.

Science.gov (United States)

Helyar, Vincent G; Gupta, Yuri; Blakeway, Lyndall; Charles-Edwards, Geoff; Katsanos, Konstantinos; Karunanithy, Narayan

2018-02-01

This study evaluates the use of balanced steady-state free precession MRI (bSSFP-MRI) in the diagnostic work-up of patients undergoing interventional deep venous reconstruction (I-DVR). Intravenous digital subtraction angiography (IVDSA) was used as the gold-standard for comparison to assess disease extent and severity. A retrospective comparison of bSSFP-MRI to IVDSA was performed in all patients undergoing both examinations for treatment planning prior to I-DVR. The severity of disease in each venous segment was graded by two board-certified radiologists working independently, according to a predetermined classification system. In total, 44 patients (225 venous segments) fulfilled the inclusion criteria. A total of 156 abnormal venous segments were diagnosed using bSSFP-MRI compared with 151 using IVDSA. The prevalence of disease was higher in the iliac and femoral segments (range, 79.6-88.6%). Overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the diagnostic ratio for bSSFP-MRI were 99.3%, 91.9%, 12.3, 0.007 and 1700, respectively. This study supports the use of non-contrast balanced SSFP-MRI in the assessment of the deep veins of the lower limb prior to I-DVR. The technique offers an accurate, fast and non-invasive alternative to IVDSA. Advances in Knowledge: Although balanced SSFP-MRI is commonly used in cardiac imaging, its use elsewhere is limited and its use in evaluating the deep veins prior to interventional reconstruction is not described. Our study demonstrates the usefulness of this technique in the work-up of patients awaiting interventional venous reconstruction compared with the current gold standard.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome

Directory of Open Access Journals (Sweden)

Eduardo Simões Da Matta

Full Text Available Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Extensive forearm deep venous thrombosis following a severe infliximab infusion reaction.

Science.gov (United States)

Ryan, Barbara M; Romberg, Marielle; Wolters, Frank; Stockbrugger, Reinhold W

2004-09-01

Here we describe a patient with Crohn's disease who developed a severe infliximab infusion reaction (IIR), complicated 1 day later by severe swelling of the forearm and hand ipsilateral to the site of infliximab infusion. This proved to be extensive forearm deep venous thrombosis. The site of thrombosis and the chronological relationship with the IIR implicates a hypersensitivity to infliximab in the causation of the venous thrombosis in this case. With an increasing trend towards re-treating patients with known IIRs, clinicians should be aware of this potentially serious and previously unreported complication.

Iodine-123 miniplasmin for the detection of deep venous thrombosis

International Nuclear Information System (INIS)

Schubiger, P.A.; Haeberli, A.; Gallino, A.; Straub, P.W.

1989-09-01

Human plasminogen (MW 90'000) is cleaved by elastase into several fragments, including one with a molecular weight of 38'000 (mini-plasminogen). This fragment retains sufficiently preserved fibrin binding sites but lacks the affinity for α 2 -antiplasmin. Therefore radiolabelled miniplasmin was tested in 21 patients with suspected deep venous thrombosis, in 5 patients with lymphedema and in 5 healthy controls for its potential use as fast marker of deep venous thrombosis. 250 μCi of Iodine-123 miniplasmin was given i.v. after previous activation with 3000 IU urokinase. The tracer distribution was measured 15, 30 and 60 minutes after injection at 10 points over each leg. The mean left/right ratio obtained in the 5 volunteers was 1.04 (range 0.89-1.12). In the patients the test was considered positive when the left/right ratio was greater than 1.15 or smaller than 0.85 at two adjacent locations and in two consecutive measuring times. In the 21 patients studied both tests gave concurrent results in 19, while in one patient with a positive and in one patient with a negative phlebography the miniplasmintest gave opposite results. In 4 of the 5 patients with edema and no thrombosis the miniplasmintest was negative. Most positive tests were conclusive as early as 15 minutes after injection of miniplasmin. The sensitivity was calculated to be 90% and the specificity 85%. Therefore Iodine-123 miniplasmin has been estimated as a fast, non invasive marker for the diagnosis of deep venous thrombosis and preliminary clinical studies with scintigraphy have been performed on over 50 patients. Evaluation gave a sensitivity between 40% and 86% and a specificity between 62% and 100%. Clinical studies have not been continued. Since I-123 miniplasmin is not available around the clock, it can't be used in emergency diagnosis. (author) 2 figs., 5 tabs., 30 refs

Nurses' training and confidence on deep venous catheterization.

Science.gov (United States)

Liachopoulou, A P; Synodinou-Kamilou, E E; Deligiannidi, P G; Giannakopoulou, M; Birbas, K N

2008-01-01

The rough estimation of the education and the self-confidence of nurses, both students and professionals, regarding deep venous catheterization in adult patients, the evaluation of the change in self-confidence of one team of students who were trained with a simulator on deep venous catheterization and the correlation of their self-confidence with their performance recorded by the simulator. Seventy-six nurses and one hundred twenty-four undergraduate students participated in the study. Fourty-four University students took part in a two-day educational seminar and were trained on subclavian and femoral vein paracentesis with a simulator and an anatomical model. Three questionnaires were filled in by the participants: one from nurses, one from students of Technological institutions, while the University students filled in the previous questionnaire before their attendance of the seminar, and another questionnaire after having attended it. Impressive results in improving the participants' self-confidence were recorded. However, the weak correlation of their self-confidence with the score automatically provided by the simulator after each user's training obligates us to be particularly cautious about the ability of the users to repeat the action successfully in a clinical environment. Educational courses and simulators are useful educational tools that are likely to shorten but in no case can efface the early phase of the learning curve in clinical setting, substituting the clinical training of inexperienced users.

Diagnostic leg scanning for deep venous thrombosis in the recently heparinized patient

International Nuclear Information System (INIS)

Mant, M.J.; O'Brien, B.D.; Russell, D.B.

1981-01-01

Leg scanning with fibrinogen 125I, either alone on in combination with other procedures, has been proposed as an alternative to venography for diagnosis of deep venous thrombi. Clinical circumstances may necessitate anticoagulation before scanning can be performed, which could alter its reliability. We have compared the results of scanning with venographic findings in heparinized patients with venous thromboembolism. Different criteria for an abnormal leg scan gave different sensitivities and specificities. During the first four days of scanning with a requirement for a persistently abnormal result, five of eight criteria had high specificity (greater than 92%). However, sensitivities did not exceed 55%. With the use of transiently abnormal results and six days of scanning, higher sensitivities were obtained but specificities were reduced. No criterion gave results considered acceptable for a diagnostic test for deep venous thrombosis. Leg scanning should therefore not be used for this purpose in patients who have received anticoagulants. Our results also suggest that duration of symptoms has little effect on the sensitivity of leg scanning and that the test is more reliable for establishing the presence of thrombus than at defining its location

Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

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Calderwood, C.J. [St John' s Hospital, Livingston and Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom)], E-mail: catherine.calderwood@luht.scot.nhs.uk; Jamieson, R. [Princess Royal Maternity Unit, Glasgow Royal Infirmary, Glasgow (United Kingdom); Greer, I.A. [Hull York Medical School, University of York, York (United Kingdom)

2007-12-15

Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.

Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

International Nuclear Information System (INIS)

Calderwood, C.J.; Jamieson, R.; Greer, I.A.

2007-01-01

Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population

Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department.

Science.gov (United States)

Crisp, Jonathan G; Lovato, Luis M; Jang, Timothy B

2010-12-01

Compression ultrasonography of the lower extremity is an established method of detecting proximal lower extremity deep venous thrombosis when performed by a certified operator in a vascular laboratory. Our objective is to determine the sensitivity and specificity of bedside 2-point compression ultrasonography performed in the emergency department (ED) with portable vascular ultrasonography for the detection of proximal lower extremity deep venous thrombosis. We did this by directly comparing emergency physician-performed ultrasonography to lower extremity duplex ultrasonography performed by the Department of Radiology. This was a prospective, cross-sectional study and diagnostic test assessment of a convenience sample of ED patients with a suspected lower extremity deep venous thrombosis, conducted at a single-center, urban, academic ED. All physicians had a 10-minute training session before enrolling patients. ED compression ultrasonography occurred before Department of Radiology ultrasonography and involved identification of 2 specific points: the common femoral and popliteal vessels, with subsequent compression of the common femoral and popliteal veins. The study result was considered positive for proximal lower extremity deep venous thrombosis if either vein was incompressible or a thrombus was visualized. Sensitivity and specificity were calculated with the final radiologist interpretation of the Department of Radiology ultrasonography as the criterion standard. A total of 47 physicians performed 199 2-point compression ultrasonographic examinations in the ED. Median number of examinations per physician was 2 (range 1 to 29 examinations; interquartile range 1 to 5 examinations). There were 45 proximal lower extremity deep venous thromboses observed on Department of Radiology evaluation, all correctly identified by ED 2-point compression ultrasonography. The 153 patients without proximal lower extremity deep venous thrombosis all had a negative ED compression

Deep venous thrombus characterization: ultrasonography, elastography and scattering operator

Directory of Open Access Journals (Sweden)

Thibaud Berthomier

2017-04-01

Full Text Available A thrombus or a blood clot is the result of blood coagulation which is a natural process to prevent bleeding. An inappropriate formation of a thrombus in a deep vein is known as Deep Venous Thrombosis (DVT. The main complication of a DVT is a Pulmonary Embolism (PE which occurs when a thrombus breaks loose and travels to the lungs. DVT, PE, or both are also known as Venous thromboembolism (VTE. It affects an estimated 300,000–600,000 Individuals just in the United States per year and can cause considerable morbidity and mortality. This multifactorial disease related to advanced age, immobility, surgery or obesity is an important public health issue. Our project is looking to link the VTE epidemiology (risk factors, patient history, PE to the thrombus structure. To reach our goals, we are collecting ultrasonography (echogenicity and elastography (stiffness of human thrombus. This manuscript describes our approach to create and preprocess a database using Toshiba Aplio 500. Our approaches to characterize the thrombus structure with ultrasound images are also described. The feature extraction is made with the scattering operator. Obtained features are then reduced using Principal Component Analysis and are analyzed to evaluate our approach.

Thrombolysis for treating deep venous thrombosis by high-dose urokinase: the usefulness of preventive placement of inferior vena cava filter

International Nuclear Information System (INIS)

Guo Jinhe; Teng Gaojun; He Shicheng; Qiu Haibo; Fang Wen; Zhu Guangyu; Deng Gang

2002-01-01

Objective: To investigate the feasibility and efficacy of high-dose urokinase thrombolysis for treating lower limb deep venous thrombosis (DVT) after inferior vena cava (IVC) filter placement. Methods: Thirteen patients of venographically proved DVT underwent preventive IVC filter placement for thrombolysis by high-dose urokinase. Antegrade infusion of high-dose urokinase was performed via the dorsalis pedis vein of the involved lower limb. The total dose of urokinase was 9 000 000 ∼ 16 000 000 units, and the procedure of thrombolysis was performed in ICU ward where the patients were closely monitored clinically and laboratorially. Results: A total of 13 IVC filters were successfully deployed without disposition and migration. The therapeutic effects were divided into four scales as follows: complete disappearance of the venous thrombosis and clinically asymptomatic (n = 2); remarkable recovery characterized by markedly improved clinical symptoms and venographically proved patent lumen in which the diameter was larger than 70% (n = 9); effective treatment indicating improved symptoms to some degrees and venographically proved patent lumen in which the diameter was smaller than 70% ( n = 2); and ineffective treatment (n = 0). No pulmonary embolism and hemorrhage occurred during the procedure of thrombolysis. Conclusion: High-dose urokinase for treating DVT is safe and effective after preventive placement of IVC filter

Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

International Nuclear Information System (INIS)

Nazir, Sarfraz Ahmed; Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman

2009-01-01

Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

Deep venous thrombosis in patients with chronic spinal cord injury.

Science.gov (United States)

Mackiewicz-Milewska, Magdalena; Jung, Stanisław; Kroszczyński, Andrzej C; Mackiewicz-Nartowicz, Hanna; Serafin, Zbigniew; Cisowska-Adamiak, Małgorzata; Pyskir, Jerzy; Szymkuć-Bukowska, Iwona; Hagner, Wojciech; Rość, Danuta

2016-07-01

Deep venous thrombosis (DVT) is a well-known complication of an acute spinal cord injury (SCI). However, the prevalence of DVT in patients with chronic SCI has only been reported in a limited number of studies. The aim of our study was to examine the prevalence of DVT in patients with SCI beyond three months after injury. Cross-sectional study. Rehabilitation Department at the Bydgoszcz University Hospital in Poland. Sixty-three patients with SCI that were more than 3 months post injury. The patients, ranging in age from 13 to 65 years, consisted of 15 women and 48 men; the mean age of the patients was 32.1 years. The time from injury varied from 4 to 124 months. Clinical assessment, D-dimer and venous duplex scan. The venous duplex scan revealed DVT in 5 of the 63 patients. The post-injury time in four of the patients varied between 4 and 5 months; one patient was 42 months post-injury. DVT occurred in patients with chronic SCI, mainly by the 6th post injury month.

Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

Science.gov (United States)

Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

2016-08-23

BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all Pdeep venous thrombosis.

Endovascular management of deep venous thrombotic diseases of the lower extremity

International Nuclear Information System (INIS)

Roh, Byung Suk

2004-01-01

Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken

Endovascular management of deep venous thrombotic diseases of the lower extremity

Energy Technology Data Exchange (ETDEWEB)

Roh, Byung Suk [School of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

2004-07-01

Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

Detecting deep venous thrombosis with limited flip angle gradient refocused MR imaging

International Nuclear Information System (INIS)

Spritzer, C.E.; Sussman, S.K.; Herfkens, R.J.; Blinder, R.A.; Saeed, M.; Vogler, J.A.; Baker, M.E.

1987-01-01

This study was undertaken to determine if limited flip angle gradient refocused MR pulse sequences (GRASS) could be used to accurately diagnose deep venous thrombosis (DVT). Sixteen patients (17 extremities) with possible DVT were prospectively evaluated with MR imaging and venography. Typical imaging parameters included a 16-msec echo time, 33-msec repetition time, 30 0 flip angle, and section thickness of 2 nex. MR imaging correctly disclosed the presence (nine cases) or absence (eight cases) of DVT. In one study, GRASS images overestimated the extent of clot due to slow venous blood flow. Subsequently the flip angle was varied to distinguish between venous thrombus and slow flow. When this technique was used, no false-positive studies occurred in the remaining patients. MR gradient refocused imaging appears to be an accurate aid for the diagnosis of DVT

Fibrin d-dimer concentration, deep vein thrombosis symptom duration, and venous thrombus volume.

Science.gov (United States)

Kurklinsky, Andrew K; Kalsi, Henna; Wysokinski, Waldemar E; Mauck, Karen F; Bhagra, Anjali; Havyer, Rachel D; Thompson, Carrie A; Hayes, Sharonne N; McBane, Robert D

2011-04-01

To determine the relationship between fibrin D-dimer levels, symptom duration, and thrombus volume, consecutive patients with incident deep venous thrombosis (DVT) were evaluated. In a cross-sectional study design, patient symptom onset was determined by careful patient questioning. Venous thrombosis was confirmed by compression duplex ultrasonography. Thrombus volume was estimated based on patient's femur length using a forensic anthropology method. Fibrin D-dimer was measured by latex immunoassay. 72 consecutive patients with confirmed leg DVT agreed to participate. The median symptom duration at the time of diagnosis was 10 days. The median D-dimer concentration was 1050 ng/dL. The median thrombus volume was 12.92 cm(3). D-Dimer levels correlated with estimated thrombus volume (P venous thrombosis and correlates with thrombus volume.

A novel approach for assessing the progression of deep venous thrombosis by area of venous thrombus in ultrasonic elastography.

Science.gov (United States)

Wang, Chao; Wang, Lei; Zhang, Yuhui; Chen, Ming

2014-04-01

Exact age determination of deep venous thrombosis (DVT) is important for an appropriate treatment. The purpose of this present study is to assess the age of acute DVT with the area of venous thrombi in elasticity imaging during the thrombosis procession. The thrombus area is obtained from a specially designed program. It was applied to clot specimens induced in human great saphenous (n = 15) at selected time points following the initiation of thrombosis. The relative mean proportion of blood clots was 50.01% ± 12.44% at day 1; 69.94% ± 8.19% at day 3; 81.93% ± 6.15% at day 6; and 92.37% ± 4.06% at day 9. The results indicated that the thrombus area increased significantly over time, while the normalized strain values inside the thrombus changed only a little. The pathological analyses also showed the same results. Therefore, we conclude that the area of venous thrombi in elasticity imaging may be a novel function for acute DVT staging.

Diagnosis of venous disorders

International Nuclear Information System (INIS)

Minar, E.

1993-01-01

Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.) [de

Deep venous thrombosis after orthopedic surgery in adult cancer patients.

Science.gov (United States)

Lin, P P; Graham, D; Hann, L E; Boland, P J; Healey, J H

1998-05-01

Patients with cancer and patients undergoing major orthopedic procedures are two groups at risk of deep venous thrombosis (DVT). The objective was to determine the rate of venous thromboembolic disease in patients with a malignant neoplasm and major orthopaedic surgery of the lower limb. The study included 169 patients. All patients were given knee-high intermittent pneumatic compression devices for prophylaxis. Postoperative surveillance for thrombosis was performed on all patients with venous duplex doppler ultrasonography. Proximal DVT occurred in 24 of 169 patients (14.2%). One patient (0.6%) developed a symptomatic, nonfatal pulmonary embolus (PE). The development of DVT was not associated with age, sex, type of surgery, type of neoplasm, location, or pathologic fracture. The addition of anticoagulant medication such as warfarin did not significantly reduce the rate of DVT in a subset of 54 patients. In three patients, the DVT occurred only in the contralateral limb, and in four patients, there were bilateral DVTs. When intermittent compression boots were used for prophylaxis in conjunction with ultrasound screening, the risk of proximal DVT was substantial (14.2%), but the rate of symptomatic PE was low (0.6%).

Diagnosis of deep venous thrombosis by radioisotopic phlebography; Valor da flebografia radioisotopica no diagnostico da trombose venosa profunda

Energy Technology Data Exchange (ETDEWEB)

Araujo, Antonio Luiz de [Universidade do Rio de Janeiro (UNIRIO), RJ (Brazil)

1993-10-01

The author studied 20 patients with deep venous thrombosis of members (one of them attacked on both arms), from various etiologies, by mean radioisotopic phlebography, in the Vascular Diseases, Radiology and Nuclear Medicine Services of Army Central Hospital (Rio de Janeiro, Brazil) from january 1988 to june 1990. The years old was 18 to 72. The cause most frequency of deep venous thrombosis was idiopathic (seven cases 33.3%). The presence of clot by radionuclide marker in all cases, 16 observations (76.2%) in the lower members and five in the upper extremities (23.9%); 17 cases (85%) also were a conventional venography and his images were confirmed. The diagnostic of deep venous thrombosis from {sup 99m} T{sub c}MAA (macro aggregate of albumin tagged with technetium) should always de complemented by pulmonary mapping, tracking possible silent emboli. Permit as well repetitions evolutionary until daily and using in patients with history of allergy to radiologic contrast because has not complication. (author)

Personal experience in the early diagnosis of deep venous thrombosis with the /sup 135/I-fibrinogen test

Energy Technology Data Exchange (ETDEWEB)

Diaz, G P; Vicente, A B; Mestre, A P; Iglesias, R S; Irijoa, V; Garcia-Bengochea, J B

1973-01-01

The results in the early diagnosis of various surgical patients with a high rate of deep venous thrombosis, using the /sup 125/I Fibrinogen Test are presented. A 22 percent incidence of thrombosis was found, and certain limitations have been noticed which make the test only ideal for the venous system distal to the inguinal area and in legs without recent surgical wounds. The real value of the test, as the earliest method for detecting silent venous thrombosis of the legs is emphasized.

Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

Science.gov (United States)

Chen, James X; Sudheendra, Deepak; Stavropoulos, S William; Nadolski, Gregory J

2016-01-01

The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial

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Ari Zekcer

Full Text Available Abstract Background Tranexamic acid (TXA is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. Objectives To verify the prevalence of deep venous thrombosis (DVT in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. Methods All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a “topical group” (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release, 30 to an “intravenous group” (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia, and 30 to a control group (100 ml of saline, given at the same time as anesthesia. All patients had duplex ultrasound scans of the legs on the 15th postoperative day. Results Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group. All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests. Conclusions Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

Pregnancy-associated venous thromboembolism: Part I- Deep vein thrombus diagnosis and treatment

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Al-Gahtani, Farjah H.

2009-01-01

Venous thromboembolic (VTE) complications are leading causes of mortality in the developed world. Over the past 20 years, there has been an increase of deep venous thrombosis (DVT) in the pregnant women, and this increase may be explained by the risk factors including older age, cesarean section, history of VTE and presence of thrombophilia. To reduce the incidence of VTE in pregnancy and improve the outcomes, a wider understanding of the risk factors and a better identification of women at a risk of the thrombosis, with objective diagnosis and provide the optimal effective and safe treatment. Deep venous thrombosis and pulmonary embolism, considered manifestations of the same disease, are often preventable and usually treatable. Nevertheless, VTE remains a substantial problem despite the dramatic decline in pregnancy-related mortality in industrialized countries over the past century. While diagnosis and management of VTE in pregnancy are challenging, and many diagnosis tests are less accurate in pregnant than non-pregnant patients and the available options are suboptimal. This is a review in 2 parts, in part I, we address the following questions. In pregnant women, who developed DVT; how to diagnose and the treatment once the diagnosis is confirmed. For each of these problems, the relevant background is briefly summarized, approaches recommended and the suggested practical and relatively safe diagnostic management approaches. Part II, we address pregnant women with pulmonary embolism, how to diagnose and treat. (author)

Developmental venous anomalies with capillary stain: a subgroup of symptomatic DVAs?

NARCIS (Netherlands)

Roccatagliata, Luca; van den Berg, René; Soderman, Michael; Boulin, Anne; Condette-Auliac, Stéphanie; Rodesch, Georges

2012-01-01

Intracranial developmental venous anomalies (DVAs) are considered benign vascular dispositions; they are asymptomatic in the vast majority of cases. They represent extreme variations of the venous drainage and may rarely be responsible for focal venous ischemia leading to neurological dysfunction.

Electrical stimulation of acupoint combinations against deep venous thrombosis in elderly bedridden patients after major surgery.

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Hou, Lili; Chen, Cuiping; Xu, Lei; Yin, Peihao; Peng, Wen

2013-04-01

To compare the effects of electrical stimulation of different acupoint combinations among postoperative bedridden elderly patients on hemorheology and deep venous blood flow velocity and investigate the.role of electrical stimulation against deep vein thrombosis (DVT). From November 2010 to October 2011, a total of 160 elderly bedridden patients after major surgery were divided into the conventional care group, invigorating and promoting Qi group, blood-activating and damp-eliminating group, and acupoint-combination stimulation group. Whole blood viscosity, plasma viscosity, D-dimer levels, lower limb skin temperature, lower limb circumference, and flow velocities of the external iliac vein, femoral vein, popliteal vein, and deep calf veins in all patients were documented and compared among the four groups. Whole blood viscosity, plasma viscosity, D-dimer levels, and lower limb circumference were significantly reduced in the blood-activating and damp-eliminating group compared with the conventional care group (P 0.05). Lower limb venous flow velocities were accelerated in the invigorating and promoting Qi group compared with the other groups, excluding the acupoint-combination stimulation group (P bedridden elderly patients were improved after combined electrical stimulation at Yinlingquan (SP 9) and Sanyinjiao (SP 6). Combined electrical stimulation at Zusanli (ST 36) and Taichong (LR 3), on the other hand, accelerated lower limb venous flow.

[The diagnostic scores for deep venous thrombosis].

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Junod, A

2015-08-26

Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan).

Prevention of deep venous thrombosis in patients with acute spinal cord injuries: use of rotating treatment tables

International Nuclear Information System (INIS)

Becker, D.M.; Gonzalez, M.; Gentili, A.; Eismont, F.; Green, B.A.

1987-01-01

A randomized clinical trial of 15 patients with acute spinal cord injuries was performed to test the hypothesis that rotating treatment tables prevent deep venous thrombosis in this population. Four of 5 control (nonrotated) patients developed distal and proximal thrombi, assessed by 125 I fibrinogen leg scans and impedance plethysmography. In comparison, only 1 of 10 treated (rotated) patients developed both distal and proximal thrombosis. These results suggest but do not prove that rotating treatment tables prevent the development of proximal deep venous thrombosis in spinal cord-injured patients. Larger clinical trials are needed to confirm this heretofore undocumented benefit of rotating treatment tables

The consensus among Chinese interventional experts on the standard of interventional therapy for deep venous thrombosis of lower extremity

International Nuclear Information System (INIS)

Academic Group of Interventional Radiology, Radiology Branch of Chinese Medical Association

2011-01-01

This paper aims to introduce the indications and contraindications of catheter-directed thrombolysis, percutaneous mechanical thrombectomy, balloon angioplasty and stent implantation for deep venous thrombosis of lower extremity, and also aims to summarize and to illustrate the manipulating procedure, the points for attention, the perioperative complications and preventions in performing different kind of interventional technique. Great importance is attached to the interventional therapy for both acute and subacute deep venous thrombosis of lower extremity in order to effectively reduce the occurrence of post-thrombosis syndrome. (authors)

CT-Venography for the diagnosis of deep venous thrombosis of the lower extremities

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Matsuhashi, Toshio [Iwaki Kyoritsu Hospital, Fukushima (Japan); Ishii, Kiyoshi; Tsuboi, Masahiro; Saito, Haruo; Ishibashi, Tadashi; Takahashi, Shoki

2000-12-01

We evaluated imaging of deep venous thrombosis (DVT) of the lower extremities using CT-Venography. CT-Venography was performed in 11 patients with suspected DVT. This method clearly demonstrated thrombus extension of DVT and collateral circulation. We concluded that CT-Venography was useful in the evaluation of DVT of the lower extremities. (author)

Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis

NARCIS (Netherlands)

Tick, L. W.; Kramer, M. H. H.; Rosendaal, F. R.; Faber, W. R.; Doggen, C. J. M.

2008-01-01

BACKGROUND: Post-thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT). OBJECTIVES: To determine the risk of PTS after DVT and to assess risk factors for PTS. METHODS: Patients were recruited from the Multiple Environmental and Genetic Assessment (MEGA) study of risk

A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery.

Science.gov (United States)

Soderdahl, D W; Henderson, S R; Hansberry, K L

1997-05-01

Intermittent pneumatic compression of the calf and/or thigh effectively decreases the incidence of deep venous thrombosis and other thrombotic sequelae but clinical data comparing these modalities are currently lacking. A total of 90 patients undergoing major urological surgery was randomly assigned to receive calf length or thigh length pneumatic compression for antithrombotic prophylaxis. Duplex ultrasound of the lower extremities was performed preoperatively and twice postoperatively to evaluate for deep venous thrombosis. Health care providers in the operating room, recovery room and ward were asked to compare the compression systems, and a cost analysis was performed. A total of 47 patients wore the thigh length sequential pneumatic sleeves and 43 wore calf length uniform compression systems. A pulmonary embolus without evidence of deep venous thrombosis was detected in 1 patient (2%) using the thigh length system. A thrombus was detected in the common femoral vein by duplex ultrasonography in 1 patient (2%) with the calf length system. Nursing personnel found the calf length sleeves easier to apply and more comfortable by patient account but they were satisfied with both systems. There was a significant cost savings with the calf length pneumatic compression system. Calf and thigh length pneumatic compression systems similarly decrease the risk of deep venous thrombosis in patients undergoing urological surgery. The calf length system has the added advantage of being less expensive and easier to use.

Iliofemoral and iliocaval interventions in deep venous thrombosis; Iliofemorale und iliocavale Interventionen bei tiefer Venenthrombose

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Haage, P.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum der RWTH Aachen (Germany)

2005-05-01

Significant spontaneous thrombus disintegration in deep venous thrombosis (DVT) occurs very infrequently. On the contrary, these thrombi are prone to appositional growth and migration into the pulmonary arteries. The development of chronic venous insufficiency due to postthrombotic syndrome is a frequent consequence of DVT. Therapeutic options in DVT include anticoagulation and recanalising procedures such as thrombolysis and thrombectomy. After appropriate indication assessment, the interventional radiologist can offer an efficacy-proven minimally-invasive vessel restitution approach by performing locoregional thrombolysis, pharmacomechanical therapy or, particularly in iliocaval thrombosis, mechanical thrombectomy. These methods not only serve to restitute of vessel patency, but also allow preserving venous valve function. In DVT with recurrent pulmonary embolism, retrievable filters with extended implantation duration can be deployed. In chronic proximal venous flow obstruction or in case of significant residual stenosis after thrombolysis, balloon angioplasty with stent implantation is the treatment modality of choice. Consequently, the radiologist can adopt an important role in the treatment of extensive venous disease. In this article, the treatment modalities concerning iliofemoral and iliocaval thrombosis are demonstrated and illustrated. (orig.)

Sodium-hydrogen exchange in erythrocytes of patients with acute deep venous thromboses.

Science.gov (United States)

Polykarpov, S A; Orlov, S N

1992-05-15

The rate of delta microH(+)-induced Na/H-exchange in erythrocytes of patients with occlusive and with floating types of acute deep venous thromboses, and in control volunteers, was estimated. In patients with occlusive thrombi Na/H-exchange was revealed to be fourfold higher in comparison with patients with floating thrombi and with controls, while no difference was observed between the two latter groups.

Deep Venous Reflux Associated with a Dilated Popliteal Fossa Vein Reversed with Endovenous Laser Ablation and Sclerotherapy

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Daniel P. Link

2013-01-01

Full Text Available Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV. Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV. Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms. Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein.

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

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Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong [School of Medicine, Wonkwang University, Iksan (Korea, Republic of)

2000-09-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

International Nuclear Information System (INIS)

Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong

2000-01-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

Catheter-directed thrombolysis of below-knee deep venous thrombosis of the lower extremities

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Roh, Byung Suk; Sohn, Young Jun; Heo, Eun A; Cho, Hyun Sun; Park, Seong Hoon; Lee, Young Hwan [Wonkwang University Hospital, Iksan (Korea, Republic of)

2008-02-15

To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombosis and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT.

Catheter-directed thrombolysis of below-knee deep venous thrombosis of the lower extremities

International Nuclear Information System (INIS)

Roh, Byung Suk; Sohn, Young Jun; Heo, Eun A; Cho, Hyun Sun; Park, Seong Hoon; Lee, Young Hwan

2008-01-01

To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombosis and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT

A multimodality regimen for deep venous thrombosis prophylaxis in total knee arthroplasty.

Science.gov (United States)

Reitman, Richard D; Emerson, Roger H; Higgins, Linda L; Tarbox, Tiffera R

2003-02-01

Data indicate that deep venous thrombosis (DVT) occurs at the time of knee arthroplasty. Nevertheless, literature concerning DVT prophylaxis has only recently addressed this contention. This prospective study evaluated the efficacy of a perioperative prophylactic regimen. Between January 1996 and June 2001, 1,308 knees (964 surgeries) underwent total knee arthroplasty. Patients were treated routinely with intraoperative heparin (1000 units intravenous push before inflation of the tourniquet and 500 units at deflation), hypotensive epidural anesthesia (MAP 70-90), external pneumatic compression boots, and aspirin (325 mg, PO, BID for 6 weeks). Duplex venous ultrasonography was performed before discharge. DVT was detected in 4% of cases (1% proximal and 3% distal). Bleeding complications occurred in 1%, and perioperative medical complications occurred in 12%. Copyright 2003, Elsevier Science (USA). All rights reserved.

Placement of a Retrievable Guenther Tulip Filter in the Superior Vena Cava for Upper Extremity Deep Venous Thrombosis

International Nuclear Information System (INIS)

Nadkarni, Sanjay; Macdonald, Sumaira; Cleveland, Trevor J.; Gaines, Peter A.

2002-01-01

A retrievable Guenther Tulip caval filter(William Cook, Europe) was successfully placed and retrieved in the superior vena cava for upper extremity deep venous thrombosis in a 56-year-old woman. Bilateral subclavian and internal jugular venous thromboses thought secondary to placement of multiple central venous catheters were present. There have been reports of the use of permanent Greenfield filters and a single case report of a temporary filter in the superior vena cava. As far as we are aware this is the first reported placement and successful retrieval of a filter in these circumstances

Anatomic variation of the deep venous system and its relationship with deep vein thrombosis found on the lower extremity venograms that were obtained after artificial joint replacements

International Nuclear Information System (INIS)

Lee, Min Sun; Lee, Jee Eun; Hwang, Ji Young; Shim, Sung Shine; Yoo, Jeong Hyun; Suh, Jeong Soo; Park, Jae Young

2006-01-01

artificial joint replacements. The total number of asymptomatic DVT cases was 43 (23.1%) and DVT was found in the calf in 39 of these cases. Post-operative venograms of the lower extremity showed 7 types of anatomic variation in the deep venous system. The incidence of silent post-operative DVT was not influenced by anatomic variations of the deep vein system, whether there were a small or large number of valves and the operation sites for artificial joint replacement. The most frequent site of DVT after artificial joint replacement was the calf

Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.

Science.gov (United States)

Meissner, Mark H; Gloviczki, Peter; Comerota, Anthony J; Dalsing, Michael C; Eklof, Bo G; Gillespie, David L; Lohr, Joann M; McLafferty, Robert B; Murad, M Hassan; Padberg, Frank; Pappas, Peter; Raffetto, Joseph D; Wakefield, Thomas W

2012-05-01

The anticoagulant treatment of acute deep venous thrombosis (DVT) has been historically directed toward the prevention of recurrent venous thromboembolism. However, such treatment imperfectly protects against late manifestations of the postthrombotic syndrome. By restoring venous patency and preserving valvular function, early thrombus removal strategies can potentially decrease postthrombotic morbidity. A committee of experts in venous disease was charged by the Society for Vascular Surgery and the American Venous Forum to develop evidence-based practice guidelines for early thrombus removal strategies, including catheter-directed pharmacologic thrombolysis, pharmacomechanical thrombolysis, and surgical thrombectomy. Evidence-based recommendations are based on a systematic review and meta-analysis of the relevant literature, supplemented when necessary by less rigorous data. Recommendations are made according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, incorporating the strength of the recommendation (strong: 1; weak: 2) and an evaluation of the level of the evidence (A to C). On the basis of the best evidence currently available, we recommend against routine use of the term "proximal venous thrombosis" in favor of more precise characterization of thrombi as involving the iliofemoral or femoropopliteal venous segments (Grade 1A). We further suggest the use of early thrombus removal strategies in ambulatory patients with good functional capacity and a first episode of iliofemoral DVT of venous outflow obstruction (Grade 1A). We suggest pharmacomechanical strategies over catheter-directed pharmacologic thrombolysis alone if resources are available and that surgical thrombectomy be considered if thrombolytic therapy is contraindicated (Grade 2C). Most data regarding early thrombus removal strategies are of low quality but do suggest patient-important benefits with respect to reducing postthrombotic morbidity. We

Detection of deep venous thrombosis with indium 111-labelled monoclonal antibody against tissue plasminogen activator

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Tromholt, N.; Hesse, B. (Hilleroed County Hospital (Denmark). Dept. of Clinical Physiology); Folkenborg, O. (Isotope-Pharmcy, Broenshoej (Denmark)); Selmer, J. (Novo Industri A/S, Bagsvaerd (Denmark)); Nielsen, N.T. (Hilleroed County Hospital (Denmark). Dept. of Radiology)

1991-05-01

The administration of a radiolabelled monoclonal antibody against tissue plasminogen activator allows detection of areas with increased fibrinolytic activity, i.e. those with an active thrombotic lesion. Eight patients with phlebographically verified deep venous thrombosis were examined. At the time of immunoscintigraphy study they were examined receiving anticoagulant therapy. Some 75-85 MBq {sup 111}In-labelled antibody were injected, and scintigrams were obtained after 30 min and after 24 h. The precise site of the thrombus could not be visualized after 30 min due to high background activity, whereas after 24 h it was detectable in all patients. The thrombus/background ratios achieved are twice as high as those observed in a human antifibrin antibody study. These preliminary data suggest a high sensitivity of our PA-specific antibody for the detection of active deep venous thrombosis in man, and our antibody seems to offer theoretical advantages over both platelet and fibrin-specific antibodies. (orig.).

Detection of deep venous thrombosis with indium 111-labelled monoclonal antibody against tissue plasminogen activator

International Nuclear Information System (INIS)

Tromholt, N.; Hesse, B.; Selmer, J.; Nielsen, N.T.

1991-01-01

The administration of a radiolabelled monoclonal antibody against tissue plasminogen activator allows detection of areas with increased fibrinolytic activity, i.e. those with an active thrombotic lesion. Eight patients with phlebographically verified deep venous thrombosis were examined. At the time of immunoscintigraphy study they were examined receiving anticoagulant therapy. Some 75-85 MBq 111 In-labelled antibody were injected, and scintigrams were obtained after 30 min and after 24 h. The precise site of the thrombus could not be visualized after 30 min due to high background activity, whereas after 24 h it was detectable in all patients. The thrombus/background ratios achieved are twice as high as those observed in a human antifibrin antibody study. These preliminary data suggest a high sensitivity of our PA-specific antibody for the detection of active deep venous thrombosis in man, and our antibody seems to offer theoretical advantages over both platelet and fibrin-specific antibodies. (orig.)

Computed tomography in deep venous thrombosis with limb oedema

International Nuclear Information System (INIS)

Seem, E.; Stranden, E.; Stiris, M.G.; Aker Sykehus, Oslo

1985-01-01

Computed tomography was used in 12 patients to investigate the distribution of oedema in the soft tissue compartments of lower limbs with deep venous thrombosis. Oedema was evenly distributed throughout the subcutis and the muscular compartments in tomograms obtained 25 cm proximal to the ankle. Significantly less swelling in the muscular compartments was found 10 cm proximal to the ankle. Interstitial fluid hydrostatic pressure was measured in the subcutis, and in anterior and posterior muscular compartments, and was significantly increased in all cases. Except for one case, the recorded pressures were well below 30 mmHg, which is considered the limit above which compartment syndromes occur. Tissue compliance was significantly lower in muscular compartments than in the subcutis. (orig.)

Anticoagulant therapy for venous thromboembolism detected by Doppler ultrasound in patients with metastatic colorectal cancer receiving bevacizumab

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Suenaga M

2015-01-01

Full Text Available Mitsukuni Suenaga, Nobuyuki Mizunuma, Eiji Shinozaki, Satoshi Matsusaka, Masato Ozaka, Mariko Ogura, Keisho Chin, Toshiharu Yamaguchi Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan Background: Doppler ultrasound imaging is useful for management of venous thromboembolism associated with a subclavicular implantable central venous access system in patients receiving bevacizumab (Bev. We investigated the efficacy and safety of our anticoagulant regimen based on Doppler findings.Methods: Patients aged ≤75 years with metastatic colorectal cancer, no history of thromboembolism, and no prior use of Bev received chemotherapy plus Bev. Doppler ultrasound imaging of the deep venous system to detect thrombosis was performed after the first course of Bev and repeated after the third course in patients with asymptomatic thrombosis. Indications for anticoagulant therapy in patients with asymptomatic thrombosis were as follows: enlarging thrombus (E, thrombus >40 mm in diameter (S, thrombus involving the superior vena cava (C, and decreased blood flow (V.Results: Among 79 patients enrolled in this study, asymptomatic thrombosis was detected in 56 patients (70.9% by Doppler ultrasound imaging after the first course of Bev and there was no thrombus in 23 patients (29.1%. Of these 56 patients, 11 (19.6% received anticoagulant therapy with warfarin, including eight after the first course and three after follow-up imaging. S + V was observed in four of 11 patients (36.4%, as well as V in two (18.2%, S + V + C in one (9.1%, E + S + V in one (9.1%, E + C in one (9.1%, E in one (9.1%, and C in one (9.1%. All patients resumed chemotherapy, including seven who resumed Bev. Improvement or stabilization of thrombi was achieved in ten patients (90.9%. Only one patient had symptomatic thromboembolism. Mild bleeding due to anticoagulant therapy occurred in six patients (54.5%, but there were no treatment

Computer identification of symptomatic deep venous thrombosis associated with peripherally inserted venous catheters.

Science.gov (United States)

Evans, R Scott; Linford, Lorraine H; Sharp, Jamie H; White, Gayle; Lloyd, James F; Weaver, Lindell K

2007-10-11

Peripherally inserted central catheters (PICCs) are considered a safe method to provide long-term antibiotic therapy, chemotherapy and nutrition support. Deep venous thrombosis (DVT) is a complication that requires early PICC removal, may extend hospitalization and can result in pulmonary embolism. PICC insertion teams strive to understand risk factors and develop methods to prevent DVTs. However, they can only manage what they can measure. At LDS Hospital, identification of PICC associated DVTs was dependent on verbal notification or manual surveillance of more than a thousand free-text vascular reports. Accurate DVT rates were not known which hindered prevention. We describe the development of a computer application (PICC-DVT monitor) to identify PICC associated DVTs each day. A one-year evaluation of the monitor by the PICC team and a review of 445 random vascular reports found a positive predictive value of 98%, sensitivity of 94%, specificity of 100% and a PICC team associated DVT rate of 2.8%.

Assessment of coagulation function and ultrasound features after reteplase and recombinant streptokinase thrombolysis of lower extremity deep venous thrombosis

Directory of Open Access Journals (Sweden)

Wei Xiong

2016-07-01

Full Text Available Objective: To assess coagulation function and ultrasound features after reteplase and recombinant streptokinase thrombolysis of lower extremity deep venous thrombosis. Methods: A total of 78 cases of patients with lower extremity deep venous thrombosis who were treated in our hospital were selected as research subjects and divided into observation group 39 cases and control group 39 cases according to different treatment regimens. Control group received recombinant streptokinase thrombolysis, observation group received reteplase thrombolysis, and then the effect of the two thrombolytic ways was evaluated by color Doppler ultrasonography and circulating blood test. Results: Ultrasound showed that complete recanalization rate of thrombus of observation group after treatment was higher than that of control group; plasma PT, APTT and TT values of observation group after thrombolysis were higher than those of control group, FIB, D-D, NO, ET, E-selectin, P-selectin, Hcy, CRP, IL-6, IL-8 and TNF-毩 values were lower than those of control group, and WBC, Nc and Mc cell number were less than those of control group. Conclusion: Reteplase for thrombolysis of lower extremity deep venous thrombosis has more distinguished effect on dissolving thrombus as well as optimizing body’s coagulation, inflammatory system state and other aspects, and is a more ideal thrombolytic drug.

Role of coexisting contralateral primary venous disease in development of post-thrombotic syndrome following catheter-based treatment of iliofemoral deep venous thrombosis.

Science.gov (United States)

Lee, John J; Al-Jubouri, Mustafa; Acino, Robin; Comerota, Anthony J; Lurie, Fedor

2015-10-01

It has been reported that early clot removal benefits patients with iliofemoral deep venous thrombosis (DVT) by removing obstruction and preserving valve function. However, a substantial number of patients who had successful clot removal develop post-thrombotic syndrome (PTS). Residual thrombus and rethrombosis play a part in this phenomenon, but the role of coexisting primary chronic venous disease (PCVD) in these patients has not been studied. All patients who underwent catheter-based techniques of thrombus removal for symptomatic acute iliofemoral DVT during a 5-year period compose the study group. These patients were assessed for PTS by the Villalta scale, the Venous Clinical Severity Score (VCSS), and the Venous Insufficiency Epidemiological and Economic Study on Quality of Life (VEINES-QOL) questionnaire. The presence of coexisting PCVD was determined by clinical and duplex ultrasound findings in the contralateral leg at the time of the initial DVT diagnosis. Patients who had coexisting PCVD were compared with those without PCVD. Forty patients (40 limbs) were included in the study group. At initial diagnosis, 15 patients (38%) had coexisting symptomatic primary valve reflux in the unaffected limb. After thrombolysis, 9 of 40 limbs (22%) had complete lysis, 29 (73%) had ≥ 50% to 99% lysis, and 2 (5%) had thrombus removal techniques. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Venous hemodynamic changes in lower limb venous disease

DEFF Research Database (Denmark)

Lee, Byung Boong; Nicolaides, Andrew N; Myers, Kenneth

2016-01-01

). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various...... forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic...... changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials...

Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis.

Science.gov (United States)

Rinat, Choni; Ben-Shalom, Efrat; Becker-Cohen, Rachel; Feinstein, Sofia; Frishberg, Yaacov

2014-11-01

Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome. We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications. In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.

Agenesia de veia cava inferior associada à trombose venosa profunda Agenesis of inferior vena cava associated with deep venous thrombosis

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Clovis Luis Konopka

2010-09-01

Full Text Available A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

Intermittent sequential pneumatic compression of the legs and thromboembolism-deterrent stockings in the prevention of postoperative deep venous thrombosis

International Nuclear Information System (INIS)

Nicolaides, A.N.; Miles, C.; Hoare, M.; Jury, P.; Helmis, E.; Venniker, R.

1983-01-01

One hundred fifty patients over the age of 30 who had undergone major abdominal operations were stratified according to the risk of deep venous thrombosis and randomized into three groups to receive different prophylactic regimens: group A, electrical calf stimulation; group B, low-dose subcutaneous heparin; group C, intermittent sequential compression and thromboembolism-deterrent (TED) stockings. All the patients were scanned with the 125 I-fibrinogen test for the whole stay in hospital. The incidence of 125 I-fibrinogen detected deep venous thrombi was 18% in group A, 9% in group B, and 4% in group C. The results indicate that the regimen of intermittent sequential compression and TED stockings is as effective as low-dose subcutaneous heparin. Electrical calf stimulation is less effective

An Incidentally Detected Venous Malformation of the Uterine Cervix: Case Report

Directory of Open Access Journals (Sweden)

Yeşim Bayoğlu Tekin

2016-01-01

Full Text Available Venous malformations of the uterine cervix are extremely rare. Most lesions are asymptomatic and incidental, however sometimes, they may present with abnormal vaginal bleeding. We aimed to describe a case of venous malformation of the uterine cervix and discuss the differential diagnosis and clinical management of this entity.

Venous pump of the calf: a study of venous and muscular pressures.

Science.gov (United States)

Alimi, Y S; Barthelemy, P; Juhan, C

1994-11-01

Little data are available concerning the relation between the muscular pumping mechanism and the variation of superficial and deep venous pressure during normal action of the calf pump; therefore we undertook this study to determine the pressure values in three compartments of the calf and in the deep and the superficial venous system and to establish correlation between muscular and venous pressure. Nine healthy young women with a mean age of 23 years (range 19 to 28 years) were examined. In the same calf, a muscular catheter was placed in the deep posterior compartment (DPC), in the superficial posterior compartment (SPC), and in the anterior tibial compartment (ATC), and a vascular catheter was placed in the popliteal vein and in the greater saphenous vein (GSV). The five lines of pressure were simultaneously recorded in the following situations: at rest, during Valsalva maneuver, foot flexion, and foot extension. The situation was studied with the patient in the following positions: decubitus, sitting, standing, and squatting. A final continuous recording was carried out after the patient had been walking for 5 minutes. Mean values with standard errors of muscular and venous pressure were established in each situation. At rest and during Valsalva maneuver, the muscular pressures did not vary, whereas venous pressures increased significantly when the patient was sitting and standing. On the other hand, squatting was associated with a rise in the muscular and vein pressures. Foot flexion entailed a significant increase in the ATC pressure and a rise in the GSV pressure, whereas foot extension caused the DPC pressure to rise without venous pressure modifications. Walking was associated with an alternating increase in the DPC, SPC, GSV and popliteal vein pressures when the foot was compressed to floor followed by a significant decrease when the foot pressure was released. The variations in the deep and superficial venous pressures when the patient is sitting and

Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

NARCIS (Netherlands)

Sloot, S.; Van Nierop, J.; Kootstra, J. J.; Wittens, C.; Fritschy, W. M.

Introduction Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer

Deep venous thrombosis: The valve cusp hypoxia thesis and its incompatibility with modern orthodoxy.

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Malone, P Colm; Agutter, Paul S

2016-01-01

The valve cusp hypoxia thesis (VCHT) of the aetiology of deep venous thrombosis (DVT) was adumbrated in this journal in 1977 and fully articulated in 2008, the original hypothesis having been strongly corroborated by experiments published in 1981 and 1984. It presents a unitary account of the pathogenesis of venous thrombosis and embolism that is rooted in the pathophysiological tradition of Hunter, Virchow, Lister, Welch and Aschoff, a tradition traceable back to Harvey. In this paper we summarise the thesis in its mature form, consider its compatibility with recent advances in the DVT field, and ask why it has not yet been assimilated into the mainstream literature, which during the past half century has been dominated by a haematology-orientated 'consensus model'. We identify and discuss seven ways in which the VCHT is incompatible with these mainstream beliefs about the aetiology of venous thrombosis, drawing attention to: (1) the spurious nature of 'Virchow's triad'; (2) the crucial differences between 'venous thrombus' and 'clot'; the facts that (3) venous thrombi form in the valve pockets (VVPs), (4) DVT is not a primarily haematological condition, (5) the so-called 'thrombophilias' are not thrombogenic per se; (6) the conflict between the single unitary aetiology of DVT and the tacit assumption that the condition is 'multicausal'; (7) the inability of anticoagulants to prevent the initiation of venous thrombogenesis, though they do prevent the growth of thrombi to clinically significant size. In discussing point (7), we show that the VCHT indicates new approaches to mechanical prophylaxis against DVT. These approaches are then formulated as experimentally testable hypotheses, and we suggest methods for testing them preclinically using animal trials. Copyright © 2015 Elsevier Ltd. All rights reserved.

Computer assisted strain-gauge plethysmography is a practical method of excluding deep venous thrombosis

International Nuclear Information System (INIS)

Goddard, A.J.P.; Chakraverty, S.; Wright, J.

2001-01-01

AIM: To evaluate a computed strain-gauge plethysmograph (CSGP) as a screening tool to exclude above knee deep venous thrombosis (DVT). METHODS: The first phase took place in the Radiology department. One hundred and forty-nine patients had both Doppler ultrasound and CSGP performed. Discordant results were resolved by venography where possible. The second phase took place in an acute medical admissions ward using a modified protocol. A further 173 patients had both studies performed. The results were collated and analysed. RESULTS: Phase 1. The predictive value of a negative CSGP study was 98%. There were two false-negative CSGP results (false-negative rate 5%), including one equivocal CSGP study which had deep venous thrombosis on ultrasound examination. Two patients thought to have thrombus on ultrasound proved not to have acute thrombus on venography. Phase 2. The negative predictive value of CSGP using a modified protocol was 97%. There were two definite and one possible false-negative studies (false-negative rate 4-7%). CONCLUSION: Computer strain-gauge plethysmograph can provide a simple, cheap and effective method of excluding lower limb DVT. However, its use should be rigorously assessed in each hospital in which it is used. Goddard, A.J.P., Chakraverty, S. and Wright, J. (2001)

Deep venous thrombosis and pulmonary embolism following physical restraint

DEFF Research Database (Denmark)

Laursen, S B; Jensen, T N; Bolwig, T

2005-01-01

. The literature on physical restraint, DVT, and PE was reviewed using a search of Medline and Psychinfo from 1966 to the present. RESULTS: Four other reported cases of DVT and PE were found in association with physically restrained patients. CONCLUSION: Risk of DVT and PE in association with immobilization during......OBJECTIVE: We describe a case of deep venous thrombosis (DVT) and pulmonary embolism (PE) following the use of physical restraint in a patient with a diagnosis of acute delusional psychotic disorder. METHOD: A new case report of DVT and PE associated with prolonged physical restraint is presented...... physical restraint may occur in spite of no pre-existing risk factors. Medical guidelines for the prevention of thrombosis following physical restraint are presented. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of DVT and PE warrants early and vigorous...

Maximal venous outflow velocity: an index for iliac vein obstruction.

Science.gov (United States)

Jones, T Matthew; Cassada, David C; Heidel, R Eric; Grandas, Oscar G; Stevens, Scott L; Freeman, Michael B; Edmondson, James D; Goldman, Mitchell H

2012-11-01

Leg swelling is a common cause for vascular surgical evaluation, and iliocaval obstruction due to May-Thurner syndrome (MTS) can be difficult to diagnose. Physical examination and planar radiographic imaging give anatomic information but may miss the fundamental pathophysiology of MTS. Similarly, duplex ultrasonographic examination of the legs gives little information about central impedance of venous return above the inguinal ligament. We have modified the technique of duplex ultrasonography to evaluate the flow characteristics of the leg after tourniquet-induced venous engorgement, with the objective of revealing iliocaval obstruction characteristic of MTS. Twelve patients with signs and symptoms of MTS were compared with healthy control subjects for duplex-derived maximal venous outflow velocity (MVOV) after tourniquet-induced venous engorgement of the leg. The data for healthy control subjects were obtained from a previous study of asymptomatic volunteers using the same MVOV maneuvers. The tourniquet-induced venous engorgement mimics that caused during vigorous exercise. A right-to-left ratio of MVOV was generated for patient comparisons. Patients with clinical evidence of MTS had a mean right-to-left MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTS patients who had undergone endovascular treatment had a poststent mean ratio of 1.2 (P = 0.011). Interestingly, computed tomography and magnetic resonance imaging results, when available, were interpreted as positive in only 53% of the patients with MTS according to both our MVOV criteria and confirmatory venography. After intervention, the right-to-left MVOV ratio in the MTS patients was found to be reduced similar to asymptomatic control subjects, indicating a relief of central venous obstruction by stenting the compressive MTS anatomy. Duplex-derived MVOV measurements are helpful for detection of iliocaval venous obstruction, such as MTS. Right-to-left MVOV ratios and

Asymptomatic Primary Isolated Pulmonary Vein Stenosis in an Adult: A Case Report

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Kim, Ji Hyun; Lee, Ho Sung; Choi, Jae Sung; Na, Ju Ock; Kim, Yong Hoon; Jou, Sung Shick; Seo, Ki Hyun [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

2010-08-15

A 31-year-old man without respiratory symptoms was transferred to our clinic with incidentally detected small nodular densities in both the upper lung zones on chest radiography. Chest computed tomography and pulmonary angiography demonstrated that the entrance of the right inferior pulmonary vein to the left atrium was completely blocked, and the venous return of the right lower lobe was achieved through the right superior pulmonary vein with a tortuous venous collateral complex in the venous phase. With echocardiography, mild pulmonary hypertension was detected. Here, we present an asymptomatic adult with isolated stenosis of the pulmonary vein with chronic compensation by venous collateral circulation in spite of mild pulmonary hypertension

Asymptomatic Primary Isolated Pulmonary Vein Stenosis in an Adult: A Case Report

International Nuclear Information System (INIS)

Kim, Ji Hyun; Lee, Ho Sung; Choi, Jae Sung; Na, Ju Ock; Kim, Yong Hoon; Jou, Sung Shick; Seo, Ki Hyun

2010-01-01

A 31-year-old man without respiratory symptoms was transferred to our clinic with incidentally detected small nodular densities in both the upper lung zones on chest radiography. Chest computed tomography and pulmonary angiography demonstrated that the entrance of the right inferior pulmonary vein to the left atrium was completely blocked, and the venous return of the right lower lobe was achieved through the right superior pulmonary vein with a tortuous venous collateral complex in the venous phase. With echocardiography, mild pulmonary hypertension was detected. Here, we present an asymptomatic adult with isolated stenosis of the pulmonary vein with chronic compensation by venous collateral circulation in spite of mild pulmonary hypertension

The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients

International Nuclear Information System (INIS)

Clarke-Pearson, D.L.; Synan, I.S.; Colemen, R.E.; Hinshaw, W.; Creasman, W.T.

1984-01-01

Three hundred eighty-two patients who underwent major operations for gynecologic malignancy were studied prospectively to determine the natural history of postoperative venous thromboemboli. Iodine 125-labeled fibrinogen leg counting, to diagnose deep venous thrombosis, was performed daily. Sixty-three patients (17%) developed postoperative venous thromboembolic complications. Deep venous thrombosis initially arose in the calf veins in 52 patients. Twenty-seven percent of these thrombi lysed spontaneously. Four percent of thrombi in the calf veins progressed to deep venous thrombosis in the femoral vein, and 4% resulted in pulmonary emboli. Nine other patients developed proximal deep venous thrombosis without prior thrombosis in the calf veins. One patient with proximal deep venous thrombosis also had a pulmonary embolus. Two patients with no evidence of deep venous thrombosis on prospective 125 I-labeled fibrinogen leg counting developed pulmonary emboli, including one fatal pulmonary embolus that was found at autopsy to have arisen from the internal iliac veins. Fifty percent of all venous thromboemboli were detected within 48 hours of operation, although two patients developed significant deep venous thrombosis and pulmonary emboli after discharge from the hospital. These results add important information to our understanding of this disease process, and raise issues related to appropriate treatment and prophylaxis of venous thromboembolism in patients after gynecologic operations

Endovascular Treatment of Phlegmasia Cerulea Dolens with Impending Venous Gangrene: Manual Aspiration Thrombectomy as the First-Line Thrombus Removal Method

International Nuclear Information System (INIS)

Oguzkurt, Levent; Ozkan, Ugur; Demirturk, Orhan S.; Gur, Serkan

2011-01-01

Purpose: Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens. Methods: Between October 2006 and May 2010, seven consecutive patients (5 women, 2 men; age range, 31–80 years) with the diagnosis of phlegmasia cerulea dolens secondary to acute iliofemoral deep venous thrombosis had endovascular treatment with manual aspiration thrombectomy. Catheter-directed thrombolysis and stent placement were used as adjunctive procedures. Phlegmasia was left-sided in five and right-sided in two patients. Results: All patients had associated great saphenous vein thrombosis in addition to iliofemoral deep vein thrombosis (DVT). Aspiration thrombectomy completely removed the thrombus from the popliteal vein to the inferior vena cava (IVC) in all cases. Three patients with May-Thurner syndrome had stent placement in the left common iliac vein. Two patients had early recurrences. Repeated aspiration thrombectomy was unsuccessful in one patient. There were no complications related to the procedure. One patient who had been successfully treated died of sepsis and another patient who had unsuccessful repeated interventions had below-the-knee amputation. Overall, the clinical success and survival rates of patients in this study were 86%. On follow-up, three patients with successful treatment were asymptomatic with no deep venous insufficiency. One of these patients died during the 4-month follow-up period. Two patients had mild ankle swelling with deep venous insufficiency. Conclusions: Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.

Ultrasound diagnosis of lower limb deep venous thrombosis.

Science.gov (United States)

Fletcher, J P; Kershaw, L Z; Barker, D S; Koutts, J; Varnava, A

1990-10-15

Venous ultrasound imaging was compared with ascending contrast venography for the diagnosis of suspected deep vein thrombosis (DVT) in the femoral, popliteal and calf vein segments of 44 limbs in 44 patients. One femoral and one calf vein segment could not be imaged (1.5% of the segments examined), but during the same period venography failed in six patients because of an inability to cannulate a swollen limb. Ultrasound imaging compared with venography as a means of diagnosing DVT showed an overall sensitivity of 95% and a specificity of 92%. The sensitivity and specificity of ultrasound imaging for the diagnosis of both femoral and popliteal vein thromboses were 100% and 97%, respectively, and for calf vein thrombosis were 85% and 83%, respectively. This study supports the recommendation that ultrasound imaging is now the investigation of choice for the diagnosis of DVT provided that the scan is performed by an experienced vascular technologist. Ultrasound imaging may also define other pathological conditions presenting in the differential diagnosis of DVT, such as superficial thrombophlebitis and Baker's cyst.

An unusual case of intrahepatic portosystemic venous shunt

African Journals Online (AJOL)

vena cava (IVC) (most common). Intrahepatic portosystemic venous shunts are rare vascular anomalies that may be detected in asymptomatic patients, given the recent advances in radiological imaging techniques. Accurate shunt evaluation and classification can be performed with ultrasound and multi-detector computed.

The programmed nursing care for lower extremity deep venous thrombus patients receiving interventional thrombolysis: its effect on living quality

International Nuclear Information System (INIS)

Qiao Cuiyun; Wang Zhujun; Lan Guiyun; Liang Zhiqiang; Shi Yonmin

2011-01-01

Objective: Tu study the effect of comprehensive programmed nursing intervention on the living quality in patients with lower extremity deep venous thrombus who receive interventional thrombolysis therapy. Methods: A total of 60 patients receiving interventional thrombolysis due to lower extremity deep venous thrombus were randomly and equally divided into two groups. Patients in study group (n=30) was treated with comprehensive programmed nursing intervention in addition to the conventional therapy and routine nursing care, while patients in control group (n=30) was treated with the conventional therapy and routine nursing care only. The conventional therapy and routine nursing care included the nursing assessment before the operation, observation of the vital signs and the cooperation psychological care during the operation, the performance of medication according to the doctor's orders after the operation, etc. The comprehensive programmed nursing intervention included the nursing assessment of the patient before operation and the scientifically making of the nursing plan, which mainly referred to the cognitive behavior, the psychological care and the health education. They were systematically carried out during the perioperative period. One month after discharge the patients were asked to pay a return visit. The living quality was evaluated with relevant standards, and the results were compared between the two groups. Results: The score of living quality in the study group was significantly higher than that in the control group (P<0.01). Conclusion: The comprehensive programmed nursing intervention can significantly improve the living quality of lower extremity deep venous thrombosis patients who receive interventional thrombolysis therapy. (authors)

Thrombus Size is Associated with Etiology of Deep Venous Thrombosis – A Cross-Sectional Study

OpenAIRE

Vučić, Nikša; Magdić, Tihana; Krnić, Anton; Včev, Aleksandar; Božić, Dubravko

2005-01-01

The aim of this study was to evaluate the impact of risk factors for deep vein thrombosis (DVT) on thrombus sizes in lower extremities. The size and extent of thrombus was scored according to International Consensus Committee for venous disease classification. After the diagnosis of DVT was established and its size scored, predominant risk factors for DVT in each patient were identified (malignant disease, thrombophilia, postoperative state, hormonal therapy, heredity, limb trauma, immobiliza...

Thrombin Avtivable Fibrinolysis Inhibitor in Venous and Arterial Thrombosis

NARCIS (Netherlands)

E.L.E. de Bruijne

2011-01-01

textabstractVenous and arterial thromboses are major causes of morbidity and mortality. Venous thrombosis is the result of pathological occlusive clot formation in the veins. It occurs mainly in the deep veins of the leg (deep vein thrombosis), from which parts of the clot frequently embolize to the

[CBO guideline 'Deep venous thrombosis and pulmonary embolism; revision of the earlier guidelines. Dutch Organization for Quality Assurance in Hospitals].

Science.gov (United States)

Büller, H R; van der Meer, J; Oudkerk, M

2000-08-05

Diagnosis of clinically suspected deep venous thrombosis is based on a clinical score, serial compression ultrasonography and D-dimer assay. For the diagnosis of pulmonary embolism perfusion scintigraphy, ventilation scintigraphy, echography of the leg veins and pulmonary angiography in that order lead to the lowest mortality, morbidity and costs. Diagnostics with spiral CT followed by pulmonary angiography leads to equal mortality and fewer angiography procedures. Decision rules based on anamnesis, physical examination, blood gas analysis and chest radiograph have proved to be insufficiently reliable. The present D-dimer assays have too little sensitivity and too much variability. Thrombo-prophylaxis with low-molecular-weight heparin is indicated for general surgery, joint replacement of the knee or hip, cranial and spinal surgery, subarachnoid haemorrhage after surgical treatment of an aneurysm, acute myocardial infarction, ischaemic stroke or spinal cord lesion, intensive care patients, patients with acute paralysis due to a neuromuscular disorder, and bedridden patients with a risk factor. Prophylaxis has to be continued as long as the indication exists. In the acute phase of deep venous thrombosis or pulmonary embolism treatment with (low-molecular-weight) heparin in an adequate dose is necessary. When started at the same time as coumarin derivatives the treatment with heparin has to be continued for at least 5 days. The risk of postthrombotic syndrome after deep venous thrombosis will be lowered by carrying compression stockings for at least 2 years after the event.

Partial anomalous pulmonary venous return in patients with pulmonary hypertension

International Nuclear Information System (INIS)

Sung, Won-kyung; Au, Virginia; Rose, Anand

2012-01-01

Anomalous pulmonary venous return is an uncommon congenital malformation, and may be partial or total. Partial anomalous pulmonary venous return (PAPVR) is more common than total anomalous pulmonary venous return, and is often associated with other congenital cardiac anomalies. Whilst many patients with PAPVR remain asymptomatic, some may present in later age with symptoms related to left-to-right shunt, right heart failure and pulmonary hypertension. We report two cases of PAPVR detected on Computed Tomography Pulmonary Angiogram (CTPA) for the work up of pulmonary hypertension. The cases demonstrate that, although uncommon, partial anomalous pulmonary venous return can be a contributing factor to pulmonary hypertension and pulmonary veins should be carefully examined when reading a CTPA study.

Duplex investigations in children: Are clinical signs in children with venous disorders relevant?

Science.gov (United States)

Birgitte Maessen-Visch, M; Smeets, L; van Vleuten, C

2015-12-01

Ultra sound colored duplex sonography is the preferred method in diagnosing chronic venous disease. Data in children on incidence, indications, and results are lacking. From the total of 9180 duplex investigations performed in our hospital from 2009 to 2012, data on indication and results of the investigation as well as patient characteristics were evaluated retrospectively for the proportion of pediatric patients. Duplex investigations were performed 49 times in 38 children (6-18 years), with an average of 1.3 times (1-6 times) per child. Forty percent showed abnormalities: 17 times deep venous thrombosis was suspected; deep venous thrombosis was objectified in 18%. In the 21 investigations performed for varicosis-related complaints, varicose veins or venous malformations were objectified in 57%. Edema was never a symptom of chronic venous disease. Duplex investigation is not often performed in children. In children with established deep venous thrombosis, a family history with deep venous thrombosis is common. In general, edema was not seen in children with varicose veins and, therefore, does not seem a reliable clinical sign at young age. © The Author(s) 2014.

Reduced deep regional cerebral venous oxygen saturation in hemodialysis patients using quantitative susceptibility mapping.

Science.gov (United States)

Chai, Chao; Liu, Saifeng; Fan, Linlin; Liu, Lei; Li, Jinping; Zuo, Chao; Qian, Tianyi; Haacke, E Mark; Shen, Wen; Xia, Shuang

2018-02-01

Cerebral venous oxygen saturation (SvO 2 ) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO 2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO 2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing . 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO 2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO 2 , clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO 2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P deep regional cerebral SvO 2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P deep regional cerebral SvO 2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO 2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.

Identification of intraluminal thrombus by ultrasonography in emergency department patients with acute deep venous thrombosis.

Science.gov (United States)

Mehta, Ninfa; Schecter, Joshua; Stone, Michael

2012-05-01

Traditionally, the diagnosis of deep venous thrombosis (DVT) using duplex ultrasonography (DU) has relied on the absence of venous compressibility. Visualization of an intraluminal thrombus is considered an uncommon finding. The purpose of this study is to determine the frequency of intraluminal thrombus in emergency department (ED) patients diagnosed with acute DVT. Retrospective chart review of adult ED patients with DU examinations demonstrating acute DVT. Patients with chronic DVT or patients in whom DU did not demonstrate DVT were excluded from data analysis. Study reports and ultrasound images were reviewed and analyzed for the presence of intraluminal thrombus. There were 189 patients who met inclusion criteria, of which 160 (85%) were found to have intraluminal thrombus. Intraluminal thrombi are present in the majority of patients in our ED in whom acute DVT is identified by DU. Copyright © 2012 Elsevier Inc. All rights reserved.

ENDOVASCULAR TREATMENT FOR DISORDERS OF THE VENOUS SYSTEM

Directory of Open Access Journals (Sweden)

A. G. Osiev

2015-01-01

Full Text Available The annual rate of deep vein thrombosis in general population is from 5 to 9 cases per 10 000, whereas for venous thromboembolism (deep vein thrombosis and pulmonary embolism taken together amounts to 14 cases per 10 000. To improve longterm results of therapy for thrombosis of deep veins of the lower extremities, it is important to restore venous function and outflow. Anticoagulant therapy with low weight or non-fractionated heparin preparations remains the most widely used method of management. However, total or partial thrombosis resolution under anticoagulant treatment is achieved only in 4 and 14% of cases, respectively. Thrombolysis allows for early resorption of the thrombus by means of a minimally invasive procedure with lower risk of complication. After the venous flow is restored, the aim of treatment is to prevent damage to the venous valves, venous hypertension and repeated thrombosis with development of the post-thrombotic syndrome. Compared to anticoagulation, systemic thrombolysis has the benefit of more rapid clot resorption and less damage to the venous valve. One of its serious limitations is a high bleeding risk related to higher doses of the drug administered through a peripheral vein catheter. Therefore, selective intra-clot administration of thombolytics (direct catheter thrombolysis has been suggested as an alternative. For more effective therapy with the use of lower doses of thrombolytics, the so called pharmaco-mechanical thrombectomy has been developed. Venous stenosis hindering the venous outflow is frequently seen after direct catheter or pharmaco-mechanical thrombolysis. Angioplasty with stent placement is recommended in the cases with residual venous abnormality after successful thrombolysis and thrombectomy. 

Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

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Mohamad Moussa

2017-07-01

Full Text Available History of present illness: A 70-year-old female with a history of breast cancer and smoking for 50 years presented to the emergency department with left-lower extremity pain and swelling for two days. The patient denied recent long-distance travel, history of hypercoagulable disorder, or recent surgery. Physical examination revealed a warm, erythematous, 3+ edematous left-lower extremity with mild tenderness extending into the proximal thigh. Her D-dimer level was 2307ng/mL and vital signs were significant for a heart rate of 110bpm, oxygen saturation of 90% on 2 liters of oxygen, and blood pressure of 153/102. Significant findings: As shown in the still image of the performed ultrasound, a transverse view of the proximal-thigh revealed a visible thrombus (green shading occluding the lumen of the left common femoral vein (blue ring, which was non-compressible when direct pressure was applied to the probe. Also visible is a patent and compressible branch of the common femoral vein (purple ring and the femoral artery (red ring, highlighted by its thick vessel wall and pulsatile motion. Discussion: Deep venous thrombosis (DVT affects 1 per 1,000 individuals each year and may lead to complications such as recurrent DVT, pulmonary embolism, and death.1 The utilization of bedside compression ultrasonography allows for rapid diagnosis of DVT and has virtually replaced other diagnostic methods due to its non-invasive and inexpensive nature. When performing compression ultrasonography, the patient should be positioned to maximize distention of the leg veins. The extremity in question should be flexed at the knee and externally rotated at the hip (this fully exposes of the common, superficial, and deep femoral veins as well as the popliteal fossa and the head of the bed elevated at a 30-45 degree angle.2 In patients with an elevated D-dimer and low-to-moderate clinical probability, negative compression imaging of a single proximal location of the femoral

Effect of exercise therapy on lower extremity deep venous thrombosis after total knee arthoplasty

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Zhong-Wu Huang

2016-11-01

Full Text Available Objective: To explore the effect of exercise therapy in preventing the lower extremity deep venous thrombosis (DVT after total knee arthoplasty (TKA. Methods: A total of 153 patients with osteoarthritis who were admitted in our hospital for TKA were included in the study and randomized into the observation group and the control group. The patients in the observation group were given continuous passive motion (CPM in combined with exercise therapy, while the patients in the control group were only given CPM. After 2-week treatment, the related coagulation indicators and femoral venous blood flow in the two groups were detected and compared. The occurrence rate of DVT in the two groups was calculated. Results: PT and APTT from 2 weeks to 2 months after operation in the two groups were shortened first and extended later when compared with before operation, while FIB and D-D contents were elevated first and reduced later, and the coagulation indicator levels 2 months after treatment in the two groups were significantly different from those before operation. The femoral venous blood flow peak and average velocity 1 week after operation in the two groups were significantly elevated when compared with before operation. The femoral venous blood flow peak and average velocity 1 week after operation in the observation group were significantly higher than those in the control group. The occurrence rate of DVT in the observation group was significantly lower than that in the control group. Conclusions: CPM in combined with exercise therapy for patients after TKA can effectively prevent the formation of DVT, with a significant effect.

The use of micro-/milli-fluidics to better understand the mechanisms behind deep venous thrombosis

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Schofield, Zoe; Alexiadis, Alessio; Brill, Alexander; Nash, Gerard; Vigolo, Daniele

2016-11-01

Deep venous thrombosis (DVT) is a dangerous and painful condition in which blood clots form in deep veins (e.g., femoral vein). If these clots become unstable and detach from the thrombus they can be delivered to the lungs resulting in a life threatening complication called pulmonary embolism (PE). Mechanisms of clot development in veins remain unclear but researchers suspect that the specific flow patterns in veins, especially around the valve flaps, play a fundamental role. Here we show how it is now possible to mimic the current murine model by developing micro-/milli-fluidic experiments. We exploited a novel detection technique, ghost particle velocimetry (GPV), to analyse the velocity profiles for various geometries. These vary from regular microfluidics with a rectangular cross section with a range of geometries (mimicking the presence of side and back branches in veins, closed side branch and flexible valves) to a more accurate venous representation with a 3D cylindrical geometry obtained by 3D printing. In addition to the GPV experiments, we analysed the flow field developing in these geometries by using computational fluid dynamic simulations to develop a better understanding of the mechanisms behind DVT. ZS gratefully acknowledges financial support from the EPSRC through a studentship from the Sci-Phy-4-Health Centre for Doctoral Training (EP/L016346/1).

Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum.

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Wilson, M G; Sharma, S; Carré, F; Charron, P; Richard, P; O'Hanlon, R; Prasad, S K; Heidbuchel, H; Brugada, J; Salah, O; Sheppard, M; George, K P; Whyte, G; Hamilton, B; Chalabi, H

2012-11-01

Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥ 2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.

Comparison of Venous Thromboembolism after Total Artificial Joint Replacement between Musculoskeletal Tumors and Osteoarthritis of the Knee by a Single Surgeon.

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Dong Fu

Full Text Available The purpose of this study was to compare and evaluate the event of VTE (Venous Thromboembolism Event after total artificial joint replacement between two groups diagnosed with either musculoskeletal tumors or osteoarthritis (OA of the knee. From 2004 to 2014, a total of 1,402 patients (308 in tumor group, 1,094 in OA group were involved in this study. The rate of asymptomatic DVT (Deep vein thrombosis was significantly higher in tumor group when compared with OA group. Though both the incidence of symptomatic DVT and PE (Pulmonary embolism were slightly higher in tumor group, no significant difference was detected. Tumor patients suffered an almost equal risk of VTE compared with OA patients except a higher rate of asymptomatic DVT after total artificial joint replacement. For patients with tumor, no significant association was observed between any potential risk factor and DVT.

Local thrombolysis for patients of severe cerebral venous sinus thrombosis during puerperium

International Nuclear Information System (INIS)

Guo, Xin-bin; Fu, Zhenqiang; Song, Lai-jun; Guan, Sheng

2013-01-01

Objective: To explore and evaluate the efficacy of intrasinus thrombolysis (IST) in patients with cerebral venous sinus thrombosis (CVST) during postpartum period. Methods: 11 patients during postpartum period with CVST who received IST during July 2007–November 2011 were included. Urokinase was infused into the sinuses via a microcatheter. Magnetic resonance venography (MRV) was performed to assess the recanalization of venous sinuses. Results: Before discharge, the intracranial pressure in 11 patients was under 200 mmH 2 O. MRV confirmed that venous sinus of 9 patients were smooth. The cortex venous and deep venous recovered to normal. Venous sinus of 2 patients recanalized partly, and cortex venous and deep venous had compensation. 9 patients had good outcome and 2 patients had only mild deficits. Conclusion: Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis during postpartum period

A differentiated approach to the diagnosis of pulmonary embolism and deep venous thrombosis using multi-slice CT

International Nuclear Information System (INIS)

Wildberger, J.E.; Mahnken, A.H.; Stargardt, A.; Haage, P.; Guenther, R.W.; Sinha, A.M.; Schaller, S.

2002-01-01

Purpose: To establish a differentiated protocol for multi-slice CT (MSCT) examinations in cases of clinically suspected pulmonary embolism (PE) using pulmonary CT-angiography (CTA) and indirect CT-phlebography (CTP). Materials and Methods: 161 patients with suspected PE were examined using an MSCT (SOMATOM Volume Zoom; Siemens, Forchheim, Germany). After intravenous administration of 120 ml of contrast material, a thin collimation chest-CT scan was performed (120 kV, 100 mAs, collimation: 4 x 1 mm). If PE was present, or previous examinations and clinical signs suggested deep venous thrombosis (DVT), a CTP was subsequently completed. CTPs were performed using a 4 x 5 mm protocol (120 kV, 170 mAs). Venous phase scanning, starting from the pelvic crest, was completed in the popliteal fossa three minutes after contrast material injection. In 73 extremities, CTP were compared to the results of ultrasound, phlebography and autopsy. Scan ranges were documented in all patients. Cumulative doses were calculated for male and female subgroups. Results: 62 patients in our series suffered from PE and in 47 of these patients deep venous thrombosis was seen additionally. Of the 99 patients without PE, 47 also received indirect CTP. CTP confirmed the suspicion and extent of DVT in 8 patients. Only in 2 of 39 patients (5.1%) was previously unknown DVT found, despite the exclusion of PE. Regarding DVT, sensitivity was 94.3% and specificity was 92.1% for indirect CTP. Cumulative chest CT doses averaged 3.3 mSv for males and 4.2 mSv for females, the calculated CTP dosage was 9.3 mSv (according to ICRP 60). Conclusions: the examination protocol presented its suitable for clinical usage in patients with suspected PE. If PE is confirmed, indirect CTP is justified, so that detailed information of the venous system can be obtained. However, the relatively high radiation dosage of an additional CTP requires a strict indication regiment in patients with a negative CTA. (orig.) [de

Efficacy and safety of venous thromboembolism prophylaxis with apixaban in major orthopedic surgery

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Werth S

2012-03-01

Full Text Available Sebastian Werth, Kai Halbritter, Jan Beyer-WestendorfCenter for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, GermanyAbstract: Over the last 15 years, low-molecular-weight heparins (LMWHs have been accepted as the “gold standard” for pharmaceutical thromboprophylaxis in patients at high risk of venous thromboembolism (VTE in most countries around the world. Patients undergoing major orthopedic surgery (MOS represent a population with high risk of VTE, which may remain asymptomatic or become symptomatic as deep vein thrombosis or pulmonary embolism. Numerous trials have investigated LMWH thromboprophylaxis in this population and demonstrated high efficacy and safety of these substances. However, LMWHs have a number of disadvantages, which limit the acceptance of patients and physicians, especially in prolonged prophylaxis up to 35 days after MOS. Consequently, new oral anticoagulants (NOACs were developed that are of synthetic origin and act as direct and very specific inhibitors of different factors in the coagulation cascade. The most developed NOACs are dabigatran, rivaroxaban, and apixaban, all of which are approved for thromboprophylaxis in MOS in a number of countries around the world. This review is focused on the pharmacological characteristics of apixaban in comparison with other NOACs, on the impact of NOAC on VTE prophylaxis in daily care, and on the management of specific situations such as bleeding complications during NOAC therapy.Keywords: major orthopedic surgery, apixaban, dabigatran, edoxaban, rivaroxaban, deep vein thrombosis, venous thromboembolism, VTE prophylaxis

Local thrombolysis for patients of severe cerebral venous sinus thrombosis during puerperium

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Guo, Xin-bin, E-mail: gxb3906080@sina.com [Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Fu, Zhenqiang, E-mail: fuzhenqiang1005@163.com [Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Song, Lai-jun, E-mail: laijunsong@sina.com [Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Guan, Sheng, E-mail: gsradio@126.com [Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China)

2013-01-15

Objective: To explore and evaluate the efficacy of intrasinus thrombolysis (IST) in patients with cerebral venous sinus thrombosis (CVST) during postpartum period. Methods: 11 patients during postpartum period with CVST who received IST during July 2007–November 2011 were included. Urokinase was infused into the sinuses via a microcatheter. Magnetic resonance venography (MRV) was performed to assess the recanalization of venous sinuses. Results: Before discharge, the intracranial pressure in 11 patients was under 200 mmH{sub 2}O. MRV confirmed that venous sinus of 9 patients were smooth. The cortex venous and deep venous recovered to normal. Venous sinus of 2 patients recanalized partly, and cortex venous and deep venous had compensation. 9 patients had good outcome and 2 patients had only mild deficits. Conclusion: Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis during postpartum period.

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review.

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Ro, Ayako; Kageyama, Norimasa; Mukai, Toshiji

2017-06-25

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

Medical management of venous ulcers.

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Pascarella, Luigi; Shortell, Cynthia K

2015-03-01

Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

[Venous thromboembolic disease: presentation of a case].

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Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

2013-01-01

Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm

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Levi Kitchen

2016-06-01

Full Text Available Introduction: Unilateral leg swelling with suspicion of deep venous thrombosis (DVT is a common emergency department (ED presentation. Proximal DVT (thrombus in the popliteal or femoral veins can usually be diagnosed and treated at the initial ED encounter. When proximal DVT has been ruled out, isolated calf-vein deep venous thrombosis (IC-DVT often remains a consideration. The current standard for the diagnosis of IC-DVT is whole-leg vascular duplex ultrasonography (WLUS, a test that is unavailable in many hospitals outside normal business hours. When WLUS is not available from the ED, recommendations for managing suspected IC-DVT vary. The objectives of the study is to use current evidence and recommendations to (1 propose a diagnostic algorithm for IC-DVT when definitive testing (WLUS is unavailable; and (2 summarize the controversy surrounding IC-DVT treatment. Discussion: The Figure combines D-dimer testing with serial CUS or a single deferred FLUS for the diagnosis of IC-DVT. Such an algorithm has the potential to safely direct the management of suspected IC-DVT when definitive testing is unavailable. Whether or not to treat diagnosed IC-DVT remains widely debated and awaiting further evidence. Conclusion: When IC-DVT is not ruled out in the ED, the suggested algorithm, although not prospectively validated by a controlled study, offers an approach to diagnosis that is consistent with current data and recommendations. When IC-DVT is diagnosed, current references suggest that a decision between anticoagulation and continued follow-up outpatient testing can be based on shared decision-making. The risks of proximal progression and life-threatening embolization should be balanced against the generally more benign natural history of such thrombi, and an individual patient’s risk factors for both thrombus propagation and complications of anticoagulation. [West J Emerg Med. 2016;17(4384-390.

Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm.

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Kitchen, Levi; Lawrence, Matthew; Speicher, Matthew; Frumkin, Kenneth

2016-07-01

Unilateral leg swelling with suspicion of deep venous thrombosis (DVT) is a common emergency department (ED) presentation. Proximal DVT (thrombus in the popliteal or femoral veins) can usually be diagnosed and treated at the initial ED encounter. When proximal DVT has been ruled out, isolated calf-vein deep venous thrombosis (IC-DVT) often remains a consideration. The current standard for the diagnosis of IC-DVT is whole-leg vascular duplex ultrasonography (WLUS), a test that is unavailable in many hospitals outside normal business hours. When WLUS is not available from the ED, recommendations for managing suspected IC-DVT vary. The objectives of the study is to use current evidence and recommendations to (1) propose a diagnostic algorithm for IC-DVT when definitive testing (WLUS) is unavailable; and (2) summarize the controversy surrounding IC-DVT treatment. The Figure combines D-dimer testing with serial CUS or a single deferred FLUS for the diagnosis of IC-DVT. Such an algorithm has the potential to safely direct the management of suspected IC-DVT when definitive testing is unavailable. Whether or not to treat diagnosed IC-DVT remains widely debated and awaiting further evidence. When IC-DVT is not ruled out in the ED, the suggested algorithm, although not prospectively validated by a controlled study, offers an approach to diagnosis that is consistent with current data and recommendations. When IC-DVT is diagnosed, current references suggest that a decision between anticoagulation and continued follow-up outpatient testing can be based on shared decision-making. The risks of proximal progression and life-threatening embolization should be balanced against the generally more benign natural history of such thrombi, and an individual patient's risk factors for both thrombus propagation and complications of anticoagulation.

Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study.

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Aslan, Ahmet; Barutca, Hakan; Ayaz, Ercan; Aslan, Mine; Kocaaslan, Cemal; Inan, Ibrahim; Sahin, Sinan; Yıkılmaz, Ali

2018-02-01

To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real-time elastography (RTE). Fifty-eight patients with acute or subacute DVT were prospectively evaluated by B-mode sonography (US), color Doppler US (CDUS), and RTE. Two radiologists evaluated the thrombus echogenicity, compressibility, and recanalization of the affected vein, and thrombus stiffness in consensus. The thrombi were classified into 3 groups as soft, intermediate, and hard on RTE images. The final study group consisted of 30 patients with acute DVT, among whom 10 were women (33%), and 19 patients with subacute DVT, among whom 6 were women (32%). The presence of hypoechoic thrombus, incompressible vein, and absence of recanalization on US and CDUS were significantly associated with acute DVT (P Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT. © 2017 Wiley Periodicals, Inc.

[Bilateral deep venous thrombosis and vena cava aplasia treated with local thrombolysis

DEFF Research Database (Denmark)

Pelta, A.M.; Jørgensen, Maja; Just, Sven Richardt Lundgren

2008-01-01

In this case report the treatment of a young man with bilateral iliaco-femoral DVT and vena cava aplasia is presented. The patient was treated with catheter-directed thrombolysis; the catheters were introduced in the thrombus of both legs via v. popliteae. The treatment led to almost complete thr...... thrombus resolution and no valvular incompetence at three months follow-up. In our opinion this treatment should be offered even in complex cases of acute proximal deep venous thrombosis Udgivelsesdato: 2008/5/19......In this case report the treatment of a young man with bilateral iliaco-femoral DVT and vena cava aplasia is presented. The patient was treated with catheter-directed thrombolysis; the catheters were introduced in the thrombus of both legs via v. popliteae. The treatment led to almost complete...

Factor VII-activating protease in patients with acute deep venous thrombosis

DEFF Research Database (Denmark)

Sidelmann, Johannes J; Vitzthum, Frank; Funding, Eva

2008-01-01

Factor VII-activating protease (FSAP) is involved in haemostasis and inflammation. FSAP cleaves single chain urokinase-type plasminogen activator (scu-PA). The 1601GA genotype of the 1601G/A polymorphism in the FSAP gene leads to the expression of a FSAP variant with reduced ability to activate scu......-PA, without affecting the ability to activate coagulation Factor VII (FVII). Previous studies have investigated the association of the 1601GA genotype with incidence and progression of carotid stenosis and deep venous thrombosis (DVT). The present study is the first to evaluate the potential association...... between the FSAP phenotype and DVT. We studied the association between the 1601G/A polymorphism, FSAP activity, FSAP antigen, Factor VIIa (FVIIa), prothrombin fragment 1+2 (F1+2), and C-reactive protein (CRP) in plasmas of 170 patients suspected for DVT. FSAP genotypes were equally distributed in patients...

Chronic Stress Facilitates the Development of Deep Venous Thrombosis

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Tao Dong

2015-01-01

Full Text Available The increasing pressure of modern social life intensifies the impact of stress on the development of cardiovascular diseases, which include deep venous thrombosis (DVT. Renal sympathetic denervation has been applied as one of the clinical approaches for the treatment of drug-resistant hypertension. In addition, the close relationship between oxidative stress and cardiovascular diseases has been well documented. The present study is designed to explore the mechanism by which the renal sympathetic nerve system and the oxidative stress affect the blood coagulation system in the development of DVT. Chronic foot shock model in rats was applied to mimic a state of physiological stress similar to humans. Our results showed that chronic foot shock procedure could promote DVT which may be through the activation of platelets aggregation. The aggravation of DVT and activation of platelets were alleviated by renal sympathetic denervation or antioxidant (Tempol treatment. Concurrently, the denervation treatment could also reduce the levels of circulating oxidation factors in rats. These results demonstrate that both the renal sympathetic nerve system and the oxidative stress contribute to the development of DVT in response to chronic stress, which may provide novel strategy for treatment of clinic DVT patients.

Protocol for the realization of venous mapping by chronic venous insufficiency in lower limbs under sonographic guide

International Nuclear Information System (INIS)

Blanco Rojas, Diego Jose

2013-01-01

The current state of knowledge is reviewed with respect to the realization of lower limbs venous mapping. Venous mapping is obtained by the use of color and spectral Doppler ultrasound. Doppler ultrasound has provided a precise graphical representation of the superficial and deep venous systems. The performance of the venous mapping is considered essential for the correct handling of venous diseases. The anatomical and pathophysiological basic concepts are defined to realize the sonographic assessment of the veins of the lower limbs. The required technical aspects are revised for the realization of sonographic exploration of the patient with venous insufficiency. Sonographic findings are characterized to support the diagnostic of venous insufficiency of the lower limbs. The CEAP (clinical-etiologic-anatomic-pathophysiologic) classification is utilized to differentiate forms and degrees of severity of the disorder, and has allowed an interinstitutional comparison in clinical studies, the evaluation of treatment and monitoring of patients. A proposal is designed to perform reports that have served of guide surgical to vascular surgeons [es

[Superficial venous thrombosis. A state of art].

Science.gov (United States)

Sándor, Tamás

2017-01-01

For a long time superficial thrombophlebitis has been thought to be a rather benign condition. Recently, when duplex ultrasound technique is used for the diagnosis more and more often, the disease is proved to be more dangerous than anticipated. Thrombosis propagates to the deep veins in 6-44% and pulmonary embolism was observed on the patients in 1,5-33%. We can calculate venous thromboembolic complications on every fourth patient. Diagnosis is clinical, but duplex ultrasound examination is mandatory, for estimation of the thrombus extent, for exclusion of the deep venous thrombosis and for follow up. Both legs should be checked with ultrasound, because simultaneous deep venous thrombosis can develop on the contralateral limb. Two different forms can be distinguished: superficial venous thrombosis with, or without varicose veins. In cases of spontaneous, non varicous form, especially when the process is migrating or recurrent, a careful clinical examination is necessery for exclusion of malignant diseases and thrombophilia. The treatment options are summarised on the basis of recent international consensus statements. The American and German guidelines are similar. Compression and mobilisation are cornerstones of the therapy. For a short segment thrombosis non steroidal antiinflammatory drugs are effective. For longer segments low molecular-weight heparins are preferred. Information on the effect of the novel oral anticoagulants for the therapy is lacking but they may appear to be effective in the future for this indication. When thrombus is close to the sapheno-femoral or sapheno-popliteal junction crossectomy (high ligation), or low molecular-weight heparin in therapeutic doses are indicated. The term superficial thrombophlebitis should be discouraged, because inflammation and infection is not the primary pathology. It should be called correctly superficial venous thrombosis in order to avoid the unnecessary administration of antibiotics and the misconception

Counteracting venous stasis during acute lower leg immobilization.

NARCIS (Netherlands)

Poelkens, F.; Thijssen, D.H.J.; Kersten, B.T.P.; Scheurwater, H.; Laarhoven, E.W. van; Hopman, M.T.E.

2006-01-01

AIM: During lower limb immobilization, patients are at risk to develop deep venous thrombosis. Recently, a water-pad was developed that should counteract venous stasis. The water-pad, located under the plaster, mobilizes water from the foot to the calf during weight bearing and, thereby, imitates

Prevalence of lower extremity venous duplication

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Simpson William

2010-01-01

Full Text Available Purpose: This retrospective study was performed to determine the prevalence of lower extremity venous duplication using duplex ultrasound in the patient population of a large urban medical center. Materials and Methods: The reports of all lower extremity venous ultrasound examinations performed at our institution between January 1, 2002 and December 31, 2002 were reviewed. Ultrasound examinations that were performed for purposes other than the detection of lower extremity deep vein thrombosis were excluded. The prevalence of duplication and its specific location were recorded. In addition, the prevalence of thrombus and its specific location were also recorded. Results: A total of 3118 exams were performed in 2664 patients. Of the 2664 patients, 2311 had only one examination performed during the study period; 353 patients had more than one examination performed. We found that 10.1% of patients (270/2664 had at least one venous segment duplicated and 5.4% of patients (143/2664 had a thrombus in at least one venous segment. There was a statistically significant difference in the prevalence of both duplication and thrombus with a change in venous segment. Only 0.4% of patients (11/2664 had thrombus within a duplicated segment. Of those who had more than one examination performed, 15.3% (54/353 had the same venous segment(s seen on one examination but not another. Conclusion: Lower extremity venous duplication is a frequent anatomic variant that is seen in 10.1% of patients, but it may not be as common as is generally believed. It can result in a false negative result for deep vein thrombosis.

Radiological evaluation of the chronic venous stasis syndrome

International Nuclear Information System (INIS)

Train, J.S.; Schanzer, H.; Peirce, E.C. II; Dan, S.J.; Mitty, H.A.

1987-01-01

Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as the postphlebitic syndrome, implying that thrombophlebitis is its sole etiology. To test this hypothesis, the authors performed ascending venography on 51 limbs of patients with the chromic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached

Toll-like receptor 9 gene expression in the post-thrombotic syndrome, residual thrombosis and recurrent deep venous thrombosis: A case-control study

NARCIS (Netherlands)

Cheung, Y. Whitney; Bouman, Annemieke C.; Castoldi, Elisabetta; Wielders, Simone J.; Spronk, Henri M. H.; ten Cate, Hugo; ten Cate-Hoek, Arina J.; ten Wolde, Marije

2016-01-01

Animal models suggest that toll-like receptor 9 (TLR9) promotes thrombus resolution after acute deep venous thrombosis (DVT). We hypothesized that TLR9 expression is lower in patients with post-thrombotic syndrome (PTS) and investigated the role of TLR9 in residual thrombosis (RT) and recurrence.

Diagnostic Indication for Venous Echo-Doppler of the Lower Limbs in the Diagnosis of Thromboembolic

International Nuclear Information System (INIS)

Bolado, A. G.; Barcena, M. V.; Cura, J. L. del; Gorrno, O.; Grande, D.

2003-01-01

To study the effectiveness of Doppler echography in the deep venous system of the lower limbs for deep venous thrombosis detection in patients suspected of having pulmonary thromboembolism. There were received 341 consecutive suspected pulmonary thromboembolism patients, all of whom were emergency room attended. All were submitted to CT pulmonary angiography in order to evaluate thrombus presence in the pulmonary tree. Without knowing the results of the previous exploration, we studied 301 of the patients using Doppler echography in deep venous system of the lower limbs in order to evaluate thrombus presence. In the group of CT-detected pulmonary thromboembolism patients, the percentage of Doppler echography-detected deep venous thrombosis was 46.3%, while in the group of non-detected patients this percentage decreased to 4.7%. Additional deep venous system exploration in clinically suspected pulmonary thiolcarbamate patients is useful, since it can increase the detection rate of venous thromboembolic disease, thereby leading to early treatment and prevention of the disease's manifestation in the lungs. Realization of Doppler echography is especially beneficial in those patients who exhibit no factors which predispose them to thromboembolic disease, as well as in patients who have previously had venous thrombosis. This exploration account for 4.7% of non-detected pulmonary embolism patients being added to the ranks of those with thromboembolic disease, an important percentage when taking into consideration the high pulmonary thromboembolism morbimortality rate. (Author) 30 refs

Pitfalls of radioisotope diagnosis of deep venous thromboses with 125I-fibrinogen in traumatology

International Nuclear Information System (INIS)

Novak, K.; Pestal, M.

1984-01-01

Experience is described with the examination of deep venous thromboses of the lower extremities using 125 I-fibrinogen. Intravenously administered labelled fibrinogen is taken up into the forming thrombus which may then be detected. Experience is presented with preparations of various makes. It was proved that in injured patients the biological half-life of 125 I-fibrinogen is reduced to 50 hrs and less as against the standard half-life of 96.2 hrs. This is caused by fibrinogen losses owing to the injury, increased intensity of metabolic processes and the quality of the preparation being used. Injured patients should be examined using a highest quality preparation without denaturation damage to the labelled protein. (Ha)

Combined oral contraceptives: venous thrombosis.

Science.gov (United States)

de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

2014-03-03

Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene

Value of platelet indices in identifying complete resolution of thrombus in deep venous thrombosis patients.

Science.gov (United States)

Sevuk, Utkan; Altindag, Rojhat; Bahadir, Mehmet Veysi; Ay, Nurettin; Demirtas, Ertan; Ayaz, Fırat

2015-03-01

We aimed to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) are helpful to identify complete thrombus resolution (CTR) after acute deep venous thrombosis (DVT). Patients who had first-time episode of acute proximal DVT were included in this retrospective study. 100 patients with DVT were divided into two groups according to absence (group 1; n = 68) or presence (group 2; n = 32) of CTR on doppler ultrasonography at month 6. There were no significant difference in admission MPV and PDW levels between group 1 and group 2. MPV (p = 0.03) and PDW (p venous thrombosis in DVT patients. Receiver operating characteristics analysis revealed that a 8.4 % decrease in admission MPV at month 6 provided 62 % sensitivity and 62 % specificity (AUC: 0.64) and a 15.4 % decrease in admission PDW at month 6 provided 87 % sensitivity and 94 % specificity (AUC: 0.89) for prediction of CTR in DVT patients. Percent change in admission MPV and PDW levels at month 6 may be used to identify the patients with CTR after a first episode of acute proximal DVT.

Patients with deep venous thrombosis and thrombophilia risk factors have a specific prolongation of the lag time in a chromogenic thrombin generation assay

NARCIS (Netherlands)

Haas, F.J.L.M.; Kluft, C.; Biesma, D.H.; Schutgens, R.E.G.

2011-01-01

The objective of the present study was to evaluate the influence of thrombophilia risk factors on variables of a chromogenic thrombin generation assay (ETP) in a setting with acute deep venous thrombosis (DVT) and non-DVT patients. In 152 outpatients suspected for DVT, the results of thrombophilia

Severity Stratification by Compression Ultrasound Examination in Lipodermatosclerosis and Diabetic Dermopathy Patients: a Report of Three Cases

Directory of Open Access Journals (Sweden)

Podoleanu Cristian

2017-06-01

Full Text Available Lipodermatosclerosis and diabetic dermopathy are low-risk skin lesions with many similar clinical features, except for venous abnormalities such as chronic venous insufficiency, but are rarely a reason for referring the patient to vascular ultrasound examination. We present 3 serial cases in which the compression ultrasound examination (CUS of the venous circulation of the affected limbs was of utmost importance in the severity stratification. Asymptomatic deep venous thrombosis (DVT was found in the first two cases, while in the third case the CUS excluded any type of vascular involvement, leading to a definite diagnosis of diabetic dermopathy. Lipodermatosclerosis may be associated with asymptomatic DVT due to chronic venous insufficiency, and early referral to CUS positively impacts further patient management.

Real-time magnetic resonance imaging of deep venous flow during muscular exercise-preliminary experience.

Science.gov (United States)

Joseph, Arun Antony; Merboldt, Klaus-Dietmar; Voit, Dirk; Dahm, Johannes; Frahm, Jens

2016-12-01

The accurate assessment of peripheral venous flow is important for the early diagnosis and treatment of disorders such as deep-vein thrombosis (DVT) which is a major cause of post-thrombotic syndrome or even death due to pulmonary embolism. The aim of this work is to quantitatively determine blood flow in deep veins during rest and muscular exercise using a novel real-time magnetic resonance imaging (MRI) method for velocity-encoded phase-contrast (PC) MRI at high spatiotemporal resolution. Real-time PC MRI of eight healthy volunteers and one patient was performed at 3 Tesla (Prisma fit, Siemens, Erlangen, Germany) using a flexible 16-channel receive coil (Variety, NORAS, Hoechberg, Germany). Acquisitions were based on a highly undersampled radial FLASH sequence with image reconstruction by regularized nonlinear inversion at 0.5×0.5×6 mm 3 spatial resolution and 100 ms temporal resolution. Flow was assessed in two cross-sections of the lower leg at the level of the calf muscle and knee using a protocol of 10 s rest, 20 s flexion and extension of the foot, and 10 s rest. Quantitative analyses included through-plane flow in the right posterior tibial, right peroneal and popliteal vein (PC maps) as well as signal intensity changes due to flow and muscle movements (corresponding magnitude images). Real-time PC MRI successfully monitored the dynamics of venous flow at high spatiotemporal resolution and clearly demonstrated increased flow in deep veins in response to flexion and extension of the foot. In normal subjects, the maximum velocity (averaged across vessel lumen) during exercise was 9.4±5.7 cm·s -1 for the right peroneal vein, 8.5±4.6 cm·s -1 for the right posterior tibial vein and 17.8±5.8 cm·s -1 for the popliteal vein. The integrated flow volume per exercise (20 s) was 1.9, 1.6 and 50 mL (mean across subjects) for right peroneal, right posterior tibial and popliteal vein, respectively. A patient with DVT presented with peak flow velocities of only

Diagnosing a popliteal venous aneurysm in a primary care setting: A case report

Directory of Open Access Journals (Sweden)

Symvoulakis Emmanouil K

2008-09-01

Full Text Available Abstract Introduction Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders. They can be symptomatic or asymptomatic, mimicking different conditions. Popliteal venous aneurysms are possible sources of embolism. Case presentation A 68-year-old woman presented at a rural primary health care unit in Crete, Greece, reporting local symptoms of discomfort in the right popliteal fossa with pain during palpation. Colour Doppler ultrasonography revealed local widening and saccular dilatation in the right distal popliteal vein. The diagnosis of a popliteal venous aneurysm was formulated. Conclusion Popliteal venous aneurysms are rare conditions, but are potentially more common than usually thought in daily practice. Physician awareness and access to ultrasound examination may allow for early diagnosis, before the occurrence of any thromboembolic or other major complication.

Diagnosis of venous disorders; A challenge for the radiologist. Die radiologische Diagnostik von Venenerkrankungen; Eine Herausforderung

Energy Technology Data Exchange (ETDEWEB)

Minar, E. (Abt. Angiologie, Universitaetsklinik fuer Innere Medizin 2, Vienna (Austria))

1993-09-01

Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.)

Angiokeratoma circumscriptum naeviforme with soft tissue hypertrophy and deep venous malformation: A variant of Klippel-Trenaunay syndrome?

Directory of Open Access Journals (Sweden)

Vaishali Wankhade

2014-01-01

Full Text Available Klippel-Trenaunay syndrome (KTS is a cutaneous capillary malformation on a limb in association with soft tissue swelling with or without bony hypertrophy and atypical varicosity. The capillary malformation associated with KTS is port wine stain. Angiokeratoma circumscriptum naeviforme (ACN is a congenital variant of angiokeratoma commonly present on the lower limb as a hyperkeratotic plaque. ACN is rarely associated with KTS. We report a case of ACN with soft tissue hypertrophy and deep venous malformation (possibly a variant of Klippel-Trenaunay in a 4-year-old male child.

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity.

Science.gov (United States)

Herrera, Santiago; Comerota, Anthony J; Thakur, Subhash; Sunderji, Shiraz; DiSalle, Robert; Kazanjian, Sahira N; Assi, Zakaria

2014-02-01

Extensive deep venous thrombosis (DVT) during pregnancy is usually treated with anticoagulation alone, risking significant post-thrombotic syndrome (PTS) in young patients. Catheter-directed thrombolysis (CDT) and operative venous thrombectomy have been safely and effectively used in nonpregnant patients, demonstrating significant reduction in post-thrombotic morbidity. This report reviews short- and long-term outcomes of 13 patients with extensive DVT of pregnancy treated with a strategy of thrombus removal. From 1999 to 2013, 13 patients with iliofemoral DVT during pregnancy were offered CDT, pharmacomechanical thrombolysis (PMT), and/or venous thrombectomy. Gestational age ranged from 8 to 34 weeks. Fetal monitoring was performed throughout hospitalization. Radiation exposure was minimized with pelvic lead shields, focal fluoroscopy, and limited angiographic runs. Follow-up included objective vein evaluation using venous duplex and PTS assessment using the Villalta scale. CDT and/or PMT were used in 11 patients. Two patients underwent venous thrombectomy alone, and one patient had operative thrombectomy as an adjunct to CDT and PMT. Each patient had complete or near-complete thrombus resolution and rapid improvement in clinical symptoms. Eight of 11 having CDT or PMT underwent venoplasty and stenting of the involved iliac veins. Twelve of the 13 delivered healthy infants at term. One patient opted for termination of her pregnancy. Mean patient and gestational ages were 26 years and 26 weeks, respectively. Mean follow-up was 1.3 years, with only one recurrence. Duplex ultrasonography demonstrated patent veins in all but one patient and normal valve function in 10 patients. Eleven patients had Villalta scores thrombus removal, resulting in a patent venous system, normal valve function in many, prevention of PTS, and reduction in recurrence. Copyright © 2014. Published by Mosby, Inc.

Contact thermography, 99mTc-plasmin scintimetry and 99mTc-plasmin scintigraphy as screening methods for deep venous thrombosis following major hip surgery

DEFF Research Database (Denmark)

Christensen, S W; Wille-Jørgensen, P; Kjaer, L

1987-01-01

Fifty-six patients scheduled for total hip alloplasty were screened for deep venous thrombosis by means of 99mTc-plasmin scintimetry, 99mTc-plasmin scintigraphy and contact thermography. Investigations were performed on the seventh postoperative day, and a total of 112 legs were examined. Bilateral...

Central Venous Occlusion in the Hemodialysis Patient.

Science.gov (United States)

Krishna, Vinay Narasimha; Eason, Joseph B; Allon, Michael

2016-11-01

Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

A survey of current practice of vascular surgeons in venous disease management.

Science.gov (United States)

Bush, Ruth L; Gloviczki, Peter

2013-01-01

Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

Diagnosis of deep venous thrombosis by phlebography and 99Tcsup (m)-Plasmin

International Nuclear Information System (INIS)

Edenbrandt, C-M.; Nilsson, J.; Ohlin, P.

1982-01-01

One hundred and thirty-four patients admitted to the medical emergency ward due to suspect deep venous thrombosis (DVT) were examined. The uptake of intravenously injected porcine 99 Tcsup (m)-plasmin was estimated in both legs. Thereafter, phlebography was performed using a high osmolar contrast medium. All phlebographies were evaluated independently. All patients with negative phlebography were examined after 3-5 days. The plasmin test and phlebography were repeated when called for. The sensivity of the plasmin test was 100% and the specificity 51% when compared to phlebography. The extension of the DVT as demonstrated by the plasmin test was similar to that determined by phlebography. Post-phlebographic trombosis was very rare. It is concluded that 99 Tcsup (m)-plasmin test is a rapid method, convenient to the patient and well suitable as a screening test. The results indicate that a negative plasmin test excludes DVT while a positive test necessitates additional examination by phlebography. (Authors)

Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

International Nuclear Information System (INIS)

Seabold, J.E.; Conrad, G.R.; Ponto, J.A.; Kimball, D.A.; Frey, E.E.; Ahmed, F.; Coughlan, J.D.; Jensen, K.C.

1987-01-01

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal

Pitfalls of radioisotope diagnosis of deep venous thromboses with /sup 125/I-fibrinogen in traumatology

Energy Technology Data Exchange (ETDEWEB)

Novak, K.; Pestal, M. (Vyzkumny Ustav Traumatologicky, Brno (Czechoslovakia))

1984-05-25

Experience is described with the examination of deep venous thromboses of the lower extremities using /sup 125/I-fibrinogen. Intravenously administered labelled fibrinogen is taken up into the forming thrombus which may then be detected. Experience is presented with preparations of various makes. It was proved that in injured patients the biological half-life of /sup 125/I-fibrinogen is reduced to 50 hrs and less as against the standard half-life of 96.2 hrs. This is caused by fibrinogen losses owing to the injury, increased intensity of metabolic processes and the quality of the preparation being used. Injured patients should be examined using a highest quality preparation without denaturation damage to the labelled protein.

Venous ulcers of the lower limb: Where do we stand?

Directory of Open Access Journals (Sweden)

Chatterjee S Sasanka

2012-01-01

Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

New oral antithrombotics: focus on dabigatran, an oral, reversible direct thrombin inhibitor for the prevention and treatment of venous and arterial thromboembolic disorders

Directory of Open Access Journals (Sweden)

Dahl OE

2012-01-01

Full Text Available Ola E Dahl1,21Department of Orthopaedics, Innlandet Hospital Trust, Elverum Central Hospital, Elverum, Norway; 2Thrombosis Research Institute, London, UKAbstract: Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, is a major challenge for health care systems. It is the third most common vascular disease after coronary heart disease and stroke, and many hospitalized patients have at least one risk factor. In particular, patients undergoing hip or knee replacement are at risk, with an incidence of asymptomatic deep vein thrombosis of 40%–60% without thromboprophylaxis. Venous thromboembolism is associated with significant mortality and morbidity, with patients being at risk of recurrence, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Arterial thromboembolism is even more frequent, and atrial fibrillation, the most common embolic source (cardiac arrhythmia, is associated with a five-fold increase in the risk of stroke. Strokes due to atrial fibrillation tend to be more severe and disabling and are more often fatal than strokes due to other causes. Currently, recommended management of both venous and arterial thromboembolism involves the use of anticoagulants such as coumarin and heparin derivatives. These agents are effective, although have characteristics that prevent them from providing optimal anticoagulation and convenience. Hence, new improved oral anticoagulants are being investigated. Dabigatran is a reversible, direct thrombin inhibitor, which is administered as dabigatran etexilate, the oral prodrug. Because it is the first new oral anticoagulant that has been licensed in many countries worldwide for thromboprophylaxis following orthopedic surgery and for stroke prevention in patients with atrial fibrillation, this compound will be the main focus of this review. Dabigatran has been investigated for the treatment of established venous thromboembolism and prevention of

Effects of walking in deep venous thrombosis: a new integrated solid and fluid mechanics model.

Science.gov (United States)

López, Josep M; Fortuny, Gerard; Puigjaner, Dolors; Herrero, Joan; Marimon, Francesc; Garcia-Bennett, Josep

2017-05-01

Deep venous thrombosis (DVT) is a common disease. Large thrombi in venous vessels cause bad blood circulation and pain; and when a blood clot detaches from a vein wall, it causes an embolism whose consequences range from mild to fatal. Walking is recommended to DVT patients as a therapeutical complement. In this study the mechanical effects of walking on a specific patient of DVT were simulated by means of an unprecedented integration of 3 elements: a real geometry, a biomechanical model of body tissues, and a computational fluid dynamics study. A set of computed tomography images of a patient's leg with a thrombus in the popliteal vein was employed to reconstruct a geometry model. Then a biomechanical model was used to compute the new deformed geometry of the vein as a function of the fiber stretch level of the semimembranosus muscle. Finally, a computational fluid dynamics study was performed to compute the blood flow and the wall shear stress (WSS) at the vein and thrombus walls. Calculations showed that either a lengthening or shortening of the semimembranosus muscle led to a decrease of WSS levels up to 10%. Notwithstanding, changes in blood viscosity properties or blood flow rate may easily have a greater impact in WSS. Copyright © 2016 John Wiley & Sons, Ltd.

Air travel and venous thrombosis : results of the WRIGHT study : Part I: Epidemiology

NARCIS (Netherlands)

Kuipers, Saskia

2009-01-01

In venous thrombosis, a blood clot develops in a vein, usually a deep vein of the leg, causing obstruction of the blood flow. Venous thrombosis is a multicausal disease, in which genes and environment interact. One of the environmental factors that increases the risk of venous thrombosis is long

Percutaneous aspiration thrombectomy with adjunctive venoplasty for iliac vein compression syndrome with lower extremity deep venous thrombosis

International Nuclear Information System (INIS)

Wang Yiping; Zhang Xiquan; Sun Yequan

2013-01-01

Objective: To investigate the clinical effect of mechanical aspiration thrombectomy with adjunctive PTA and stenting for iliac vein compression syndrome with lower extremity deep venous thrombosis. Materials and Methods: The clinical data of 184 patients who had iliac vein compression syndrome with lower extremity DVT were analyzed retrospectively. The healthy femoral vein was accessed, then a 12-14 F sheath was introduced via a guide wire to aspirate thrombus in the iliofemoral; For the cases with femoropopliteal thrombus, the thrombus was macerated and pulled by Fogarty balloon catheter, then performing mechanical aspiration thrombectomy. After thrombus removal, PTA and stenting were performed on stenosis or occlusion of common iliac vein that displayed on venography. Results: The thrombus removal rate: Grade Ⅲ 80.89% and Grade Ⅱ 19.02%. The circumference of affected limbs at 15 cm above and below knee joints were (43.9±4.7) cm and (31.5±4.1) cm, respectively, after being discharged from hospital, the differences were statistical significance (t=6.43, t=-5.79, both P=0.000)compared to be hospitalized. The follow -up result: the treatment efficiency was 97.75%. The stent patency rate of postoperation at 6, 12, and 24 months were 97.19%, 94.94%, 92.13%, respectively, on sonography or digital subtract angiography. Conclusion: Mechanical aspiration thrombectomy with adjunctive venoplasty for iliac vein compression syndrome with lower extremity deep venous thrombosis is an effective and safe therapy having notable therapeutic effect in short l middle-term follow-up and shorter hospitalization time. (authors)

An unusual cause of hydrocephalus: aqueductal developmental venous anomaly

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Yagmurlu, Banu; Fitoz, Suat; Atasoy, Cetin; Erden, ilhan [Ankara University School of Medicine, Department of Radiology, Ankara (Turkey); Deda, Gulhis; Unal, Ozlem [Ankara University School of Medicine, Division of Pediatric Neurology, Ankara (Turkey)

2005-06-01

Vascular malformations are infrequent causes of aqueductal stenoses, developmental venous anomaly (DVA) being the rarest among them. DVAs, also known as venous angiomas, are congenital in origin and characterized by dilatation of vessels in the superficial and deep venous system. Although they are usually clinically silent, they can be complicated by hemorrhage, seizures and neurologic deficits. Herein, we report MR imaging findings of a 7-year-old girl whose hydrocephalus was due to an abnormal vein coursing through the aqueduct. (orig.)

Prevention of venous thromboembolic disease after total hip and knee arthroplasty.

Science.gov (United States)

Lieberman, Jay R; Hsu, Wellington K

2005-09-01

Patients undergoing total hip and knee arthroplasty are at increased risk for the development of venous thromboembolic disease, and there is general agreement that these patients require prophylaxis. The selection of a prophylactic agent involves a balance between efficacy and safety and often needs to be individualized for specific patients and institutions. Despite extensive research, the ideal agent for prophylaxis against deep venous thrombosis has not been identified. The results of randomized trials indicate that low-molecular-weight heparin, warfarin, and fondaparinux are the most effective prophylactic agents after total hip arthroplasty and that low-molecular-weight heparin, warfarin, fondaparinux, and pneumatic compression boots are the most effective agents after total knee arthroplasty. The duration of prophylaxis against deep venous thrombosis after total hip and knee arthroplasty remains controversial. Prophylaxis should be continued beyond hospital discharge. In the future, the determination of the duration of prophylaxis will be based on the risk stratification of individual patients. The practice of discharging patients from the hospital without prophylaxis, even when the decision is based on negative results of procedures that screen for the presence of deep venous thrombosis, is not cost-effective.

A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: the relevance for an early intervention.

Science.gov (United States)

Medda, Pierpaolo; Fornaro, Michele; Fratta, Sara; Callari, Antonio; Manzo, Valerio; Ciaponi, Benedetta; Perugi, Giulio

2012-01-01

Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to venous stasis leading to life-threatening thrombosis and pulmonary embolism (PE). When this occurs, the prescription of electroconvulsive therapy (ECT), actually irreplaceable in most life-threatening cases, remains controversial essentially due to an increased risk for PE and cerebral haemorrhage, with timing clinical decisions being as crucial as difficult to take. We report the case of a catatonic patient affected by malnutrition, deep venous thrombosis, severe pressure ulcers and septic syndrome resulting from previous untimely management, successfully treated with 16 well-tolerated ECT applications upon intensive supportive care. Although anecdotal, cases like this remind the relevance of early ECT to reduce the risk for potentially life-threatening complications due to prolonged catatonic inactivity, especially to those clinicians substantially disregarding this practice. Copyright © 2012 Elsevier Inc. All rights reserved.

Venous thromboembolism: epidemiology and magnitude of the problem.

Science.gov (United States)

Goldhaber, Samuel Z

2012-09-01

Pulmonary embolism is the third most common cardiovascular disease after myocardial infarction and stroke. The death rate from pulmonary embolism exceeds the death rate from myocardial infarction, because myocardial infarction is much easier to detect and to treat. Among survivors of pulmonary embolism, chronic thromboembolic pulmonary hypertension occurs in 2-4 of every 100 patients. Post-thrombotic syndrome of the legs, characterized by chronic venous insufficiency, occurs in up to half of patients who suffer deep vein thrombosis or pulmonary embolism. We have effective pharmacological regimens using fixed low dose unfractionated or low molecular weight heparin to prevent venous thromboembolism among hospitalized patients. There remains the problem of low rates of utilization of pharmacological prophylaxis. The biggest change in our understanding of the epidemiology of venous thromboembolism is that we now believe that deep vein thrombosis and pulmonary embolism share similar risk factors and pathophysiology with atherothrombosis and coronary artery disease. Copyright © 2012 Elsevier Ltd. All rights reserved.

MRI in venous thromboembolic disease

International Nuclear Information System (INIS)

Sostman, H.D.; Debatin, J.F.; Spritzer, C.E.; Coleman, R.E.; Grist, T.M.; MacFall, J.R.

1993-01-01

We evaluated the ability of magnetic resonance (MR) imaging to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). MR venography was performed on 217 patients suspected of having DVT. Cine-MR imaging of the pulmonary arteries was performed in 14 other patients who were thought to have PE based on other imaging studies. In a third group of 5 patients, MR pulmonary angiograms were performed in the sagittal and coronal planes with a multislice fast gradient recalled echo technique. All but one of the 217 MR venograms were technically adequate. In 72 patients with correlative imaging studies (venography and ultrasound) MR venography was 99% sensitive and 95% specific. On the basis of follow-up (mean 8.3 months), no false-negative MR venograms were detected in an additional 64 patients. In 11 other patients MR revealed a diagnosis other than DVT. Cine-MR showed PE in all 14 patients evaluated. MR pulmonary arteriography demonstrated filling defects consistent with acute PE in 2 of 3 patients with acute PE; in the third patient only a questionable filling defect was seen. Coarctations or webs were found in the pulmonary arteries of both patients with chronic PE. These preliminary data suggest that MR imaging may be able to evaluate both the peripheral venous and the pulmonary arterial component of venous thromboembolic disease. Further technical refinement and more extensive clinical experience will be required to establish the role of this method in diagnosing pulmonary embolism, but MR venography is now used routinely in our hospital for the diagnosis of deep venous thrombosis. (orig.)

Deep venous thrombosis as the single sign of unexpected metastatic urinary tract cancer in a patient with a history of cutaneous melanoma: A case report

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Joachim Mikkelsen, MD

2016-01-01

Conclusion: This case highlights the importance of considering all possible causes and utilizing targeted diagnostic tools when assessing a patient with seemingly unprovoked deep venous thrombosis. A whole-body PET/CT scan ultimately proved significant in revealing occult metastatic cancer of a completely different origin than expected.

Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

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Michael Blaivas

2012-01-01

Full Text Available Background-Aim. Upper extremity deep vein thrombosis (UEDVT is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers. Results. Thirty-six (11.25% patients had UEDVT and a complete scan was performed. One (2.7% of these patients died, and 2 had pulmonary embolism (5.5%. Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR 2.716, P=0.007], malignancy (OR 1.483, P=0.036, total parenteral nutrition (OR 1.399, P=0.035, hypercoagulable state (OR 1.284, P=0.045, and obesity (OR 1.191, P=0.049. Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined. Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis.

Science.gov (United States)

Rahemi, Hadi; Chung, Jayer; Hinko, Vanessa; Hoeglinger, Simon; Martinek, Wendy A; Montero-Baker, Miguel; Mills, Joseph L; Najafi, Bijan

2018-03-01

Current prophylactic protocols fail to prevent deep venous thrombosis (DVT) in a significant minority of patients, and it remains one of the leading causes of preventable death. We therefore quantified the efficacy of novel game-based exercises (exergaming) to augment femoral venous parameters relative to ankle movement and muscle flexion. Healthy volunteers were recruited to perform a series of ankle and foot exercises using a wireless foot sensor (LEGSys; BioSensics LLC, Watertown, Mass) to navigate a computer cursor sequentially on a screen to the center of 200 circular targets. A single ultrasound technician (W.A.M.) measured each patient's mean flow volume, peak flow velocity, mean flow velocity, and cross-sectional area of the right femoral vein at baseline and obtained immediate postexercise (PEX), 5-minute PEX, and 15-minute PEX measurements. Electromyography (EMG) was performed at baseline and during the exercise. Baseline demographics and medical and surgical comorbidities were also recorded. The primary end point was the difference between baseline and immediate PEX mean flow volume estimates. We secondarily explored the association of baseline characteristics and EMG measurements with femoral vein parameters. Fifteen healthy subjects (53% male; 28.1 ± 4.6 years) completed the exergaming task within a mean of 4 minutes, 2 ± 21 seconds. Immediately after exercise, the femoral vein mean flow volume, mean velocity, and peak systolic velocity increased by 49%, 53%, and 48%, respectively (P  .05). Subgroup analysis revealed that women (P peak plantar flexion velocities (P peak systolic velocity within the femoral vein by approximately 50% above baseline. Exergaming represents a novel and potentially attractive method of DVT prevention by augmenting femoral vein mean volume flow and capitalizing on biofeedback. Less forceful but more uniform contractions were found to be most effective at augmenting venous blood flow. Exergaming will require further

Imaging of head and neck venous malformations

International Nuclear Information System (INIS)

Flis, Christine M.; Connor, Stephen E.

2005-01-01

Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

The role of interventional radiology in the management of deep venous thrombosis: advanced therapy.

LENUS (Irish Health Repository)

O'Sullivan, Gerard J

2011-06-01

Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer "single-session" techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.

The Role of Interventional Radiology in the Management of Deep Venous Thrombosis: Advanced Therapy

International Nuclear Information System (INIS)

O’Sullivan, Gerard J.

2011-01-01

Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This “usual treatment” is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer “single-session” techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.

Deep venous thrombosis associated with corporate air travel.

Science.gov (United States)

Dimberg, L A; Mundt, K A; Sulsky, S I; Liese, B H

2001-01-01

Deep venous thrombosis (DVT) is commonly seen among bedridden and postoperative patients. Its association with travel may also make DVT an occupational health risk to otherwise healthy business travelers. We estimated the incidence of and risk factors for DVT among 8,189 World Bank employees and a subset of 4,951 international business travelers. Occurrence of DVT between 1995 and 1998 was determined using 1) medical insurance claims; 2) Workers' Compensation claims; and 3) intra-office E-mail solicitation followed by interview. For each insurance claim case, 10 controls were randomly selected from among World Bank employees insured during the same month and year as the case's claim was filed, and case-control analyses were performed to identify potential predictors or risk factors for DVT. Thirty individuals filed claims for DVT of the legs (annual incidence rate: 0.9 per 1,000 employees); three of these claims were filed within 30 days after a travel mission. Two employees reported DVT as a Workers' Compensation injury, and five staff with verified DVT participated in interviews. After controlling for age and gender, no association with any travel-related covariate was seen. Results of analyses considering all thrombophlebitis and thromboembolism followed the same pattern. The average annual incidence of DVT occurring within 30 days of mission among traveling staff ranged from 0.10 per 1,000 to 0.25 per 1,000 travelers, depending on the case-finding method. No association between DVT and travel was observed after adjustment for gender and age. These results, however, are preliminary, and due to the rarity of DVT, based on small numbers.

Computer Identification of Symptomatic Deep Venous Thrombosis Associated with Peripherally Inserted Central Catheters

Science.gov (United States)

Evans, R. Scott; Linford, Lorraine H.; Sharp, Jamie H.; White, Gayle; Lloyd, James F.; Weaver, Lindell K.

2007-01-01

Peripherally inserted central catheters (PICCs) are considered a safe method to provide long-term antibiotic therapy, chemotherapy and nutrition support. Deep venous thrombosis (DVT) is a complication that requires early PICC removal, may extend hospitalization and can result in pulmonary embolism. PICC insertion teams strive to understand risk factors and develop methods to prevent DVTs. However, they can only manage what they can measure. At LDS Hospital, identification of PICC associated DVTs was dependent on verbal notification or manual surveillance of more than a thousand free-text vascular reports. Accurate DVT rates were not known which hindered prevention. We describe the development of a computer application (PICC-DVT monitor) to identify PICC associated DVTs each day. A one-year evaluation of the monitor by the PICC team and a review of 445 random vascular reports found a positive predictive value of 98%, sensitivity of 94%, specificity of 100% and a PICC team associated DVT rate of 2.8%. PMID:18693831

Diagnosis of deep venous thrombosis by phlebography and /sup 99/Tcsup (m)-Plasmin

Energy Technology Data Exchange (ETDEWEB)

Edenbrandt, C.M.; Nilsson, J.; Ohlin, P. (County Hospital, Helsingborg (Sweden). Dept. of Medicine, Diagnostic Radiology and Clinical Physology)

1982-01-01

One hundred and thirty-four patients admitted to the medical emergency ward due to suspected deep venous thrombosis (DVT) were examined. The uptake of intravenously injected porcine /sup 99/Tcsup (m)-plasmin was estimated in both legs. Thereafter, phlebography was performed using a high osmolar contrast medium. All phlebographies were evaluated independently. All patients with negative phlebography were examined after 3-5 days. The plasmin test and phlebography were repeated when called for. The sensivity of the plasmin test was 100% and the specificity 51% when compared to phlebography. The extension of the DVT as demonstrated by the plasmin test was similar to that determined by phlebography. Post-phlebographic trombosis was very rare. It is concluded that /sup 99/Tcsup (m)-plasmin test is a rapid method, convenient to the patient and well suitable as a screening test. The results indicate that a negative plasmin test excludes DVT while a positive test necessitates additional examination by phlebography.

A Novel Stretch Sensor to Measure Venous Hemodynamics

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Syrpailyne Wankhar

2018-07-01

Full Text Available Chronic venous insufficiency is a debilitating condition causing varicose veins and venous ulcers. The pathophysiology includes reflux and venous obstruction. The diagnosis is often made by clinical examination and confirmed by Venous Doppler studies. Plethysmography helps to quantitatively examine the reflux and diagnose the burden of deep venous pathology to better understand venous hemodynamics, which is not elicited by venous duplex examination alone. However, most of these tests are qualitative, expensive, and not easily available. In this paper, we demonstrate the potential use of a novel stretch sensor in the assessment of venous hemodynamics during different maneuvers by measuring the change in calf circumference. We designed the stretch sensor by using semiconductor strain gauges pasted onto a small metal bar to form a load cell. The elastic and Velcro material attached to the load cell form a belt. It converts the change in limb circumference to a proportional tension (force of distension when placed around the calf muscle. We recorded the change in limb circumference from arrays of stretch sensors by using an in-house data acquisition system. We calculated the venous volume (VV, venous filling index (VFI, ejection fraction (EF and residual venous volume (RVV on two normal subjects and on two patients to assess venous hemodynamics. The values (VV > 60 ml, VFI 60%, RVV 2ml/s, EF 35% in patients were comparable to those reported in the literature.

Stress-induced hyperglycaemia and venous thromboembolism following total hip or total knee arthroplasty Analysis from the RECORD trials

NARCIS (Netherlands)

Cohn, Danny M.; Hermanides, Jeroen; DeVries, J. Hans; Kamphuisen, Pieter-Willem; Kuhls, Silvia; Homering, Martin; Hoekstra, Joost B. L.; Lensing, Anthonie W. A.; Büller, Harry R.

2012-01-01

Stress-induced hyperglycaemia is common during orthopaedic surgery. In addition, hyperglycaemia activates coagulation. The aim of the study was to assess whether stress-induced hyperglycaemia is associated with symptomatic or asymptomatic venous thromboembolism (VTE) following orthopaedic surgery.

Incidence of symptomatic venous thromboembolism in oncological oral and maxillofacial operations: retrospective analysis

NARCIS (Netherlands)

Lodders, J.N.; Parmar, S.; Stienen, N.L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Forouzanfar, T.

2015-01-01

We retrospectively analysed the incidence of symptomatic venous thromboembolism (VTE) and associated risk factors in operations under general anaesthesia for cancer of the oral cavity. To identify symptoms related to deep venous thrombosis (DVT) and pulmonary embolism (PE), together with associated

Complication of venous thrombosis of the lower extremities with pulmonary embolism

International Nuclear Information System (INIS)

Suzuki, Teruyasu; Morita, Rikushi

1993-01-01

We studied the relationship between the complication of the pulmonary embolism and the localization of the venous thrombus in the lower extremities using Tc-99m macroaggregated albumin (MAA) venography. Tc-99m MAA venography clearly demonstrated most of the deep and superficial veins from the leg to the pelvis and the abdomen. The incidence of venous thrombosis was highest in the pelvic veins (28.8%), and second in the superficial leg veins (10.9%). The complication of pulmonary embolism was highest in the pelvic venous thrombosis (20.4%), and second in the femoral venous thrombosis (16.0%). (author)

Venous anomalies and abnormalities of the posterior fossa

International Nuclear Information System (INIS)

Goulao, A.; Alvarez, H.; Garcia Monaco, R.; Pruvost, P.; Lasjaunias, P.

1990-01-01

The authors report a series of 16 patients with venous anomalies or abnormalities of the posterior fossa studied by angiography, CT and/or MRI. We believe that so-called 'venous angioma' are extreme anatomic variants that drain normal territories, and we prefer to call them developmental venous anomalies (DVA). Posterior fossa DVA, like the supra-tentorial ones are classified according to their drainage into deep and superficial type. They are exclusively located in the cerebellum or tectum. In 4 cases DVA was an incidental finding, in 3 an associated cerebral venous malformation (CVM) was found and felt to be the cause of the symptoms and only in one (Trigeminal pain) was a link between both suspected. Cavernous venous malformation (CVM) were found in frequent association with DVA (27%). 4 cases were single and 2 multiple. 5 CVM were located in the brain stem and 3 in the cerebellum. The clinical and radiological files were reviewed and a direct relationship between symptoms and localization was found in all patients with CVM. In 2 cases venous dysplasia was found: 1 Sturge-Weber and 1 First branchial arch syndrome. Both posterior fossa venous abnormalities were incidental findings. (orig.)

Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography.

Science.gov (United States)

Lee, Sun Hee; Jung, Ji Mi; Song, Min Seob; Choi, Seok jin; Chung, Woo Yeong

2013-08-01

Turner syndrome is well known to be associated with significant cardiovascular abnormalities. This paper studied the incidence of cardiovascular abnormalities in asymptomatic adolescent patients with Turner syndrome using multidetector computed tomography (MDCT) instead of echocardiography. Twenty subjects diagnosed with Turner syndrome who had no cardiac symptoms were included. Blood pressure and electrocardiography (ECG) was checked. Cardiovascular abnormalities were checked by MDCT. According to the ECG results, 11 had a prolonged QTc interval, 5 had a posterior fascicular block, 3 had a ventricular conduction disorder. MDCT revealed vascular abnormalities in 13 patients (65%). Three patients had an aberrant right subclavian artery, 2 had dilatation of left subclavian artery, and others had an aortic root dilatation, aortic diverticulum, and abnormal left vertebral artery. As for venous abnormalities, 3 patients had partial anomalous pulmonary venous return and 2 had a persistent left superior vena cava. This study found cardiovascular abnormalities in 65% of asymptomatic Turner syndrome patients using MDCT. Even though, there are no cardiac symptoms in Turner syndrome patients, a complete evaluation of the heart with echocardiography or MDCT at transition period to adults must be performed.

Rastreio de trombofilia hereditária no contexto de trombose venosa profunda Screening of familiar trombophylia in patients with deep venous thrombosis

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Fernando Mota

2011-09-01

Full Text Available A trombose venosa profunda é uma doença frequente e importante que se manifesta em indivíduos com factores de risco conhecidos ou desconhecidos. A sua etiopatogenia é multifactorial incluindo factores adquiridos e factores genéticos. Dois tipos de defeitos genéticos podem causar trombose venosa: mutações que resultam em deficiência dos inibidores naturais da coagulação e mutações com aumento do nível/função dos factores da coagulação. O objectivo deste trabalho é referir e discutir as situações em que se deve rastrear a presença de trombofilia hereditária no contexto de um episódio de trombose venosa profunda. Foram relatadas como factor de risco para trombose venosa, por ordem cronológica, a deficiência de antitrombina, deficiência de proteína C e proteína S, factor V Leiden, mutação G20210A do gene da protrombina e os níveis elevados de factor VIII. Apesar da associação entre trombofilia hereditária e o risco de trombose venosa estar bem documentada, o mesmo não ocorre em relação ao risco de recorrência. A única situação em que o risco de recorrência foi documentado foi em doentes jovens com deficiência de inibidores naturais da coagulação no contexto de um primeiro episódio de trombose venosa e/ou uma história familiar positiva para trombose venosa. Actualmente não existe consenso sobre o rastreio de trombofilia hereditária no contexto de trombose venosa profunda. Seria importante que fossem seguidas as guidelines actuais, no sentido de uniformizar a abordagem aos doentes com trombose venosa profunda e facilitar a realização de estudos que permitam elaborar novas guidelines com recomendações baseadas em evidência de elevada qualidade.Deep vein thrombosis is a common and important disease that occurs in individuals with known or unknown risk factors. Its pathogenesis is multifactorial and includes genetic and acquired factors. Two types of genetic defects can cause venous thrombosis

Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism.

Science.gov (United States)

Berend, Keith R; Lombardi, Adolph V; Mallory, Thomas H; Dodds, Kathleen L; Adams, Joanne B

2004-10-01

Venous thromboembolic disease (VTD), deep venous thrombosis and pulmonary embolism, causes morbidity and mortality following total hip and total knee arthroplasties, while ileus complicates up to 4.0%. The clinical courses of 2,949 patients undergoing 3,364 consecutive primary and revision total hip and total knee arthroplasties, radical debridements, and reimplantations at one institution over a 2-year period were reviewed to examine the relationship between ileus and VTD. VTD prophylaxis consisted of aspirin and intermittent plantar pulse boots for all patients except those at high risk, who received parenteral chemical prophylaxis and boots. Ileus occurred in 62 patients (2.1%) and symptomatic DVT in 51 (1.7%). With ileus, the incidence of DVT was 8.1%: odds ratio 5.5 (P =.0036). Symptomatic pulmonary embolism occurred in 7 patients (0.24%); with ileus the incidence was 3.2%: odds ratio 19.6 (P =.0082). A significant increase was observed in rates of VTD with ileus. We recommend using parenteral chemical and mechanical prophylaxis in patients with ileus following total hip and total knee arthroplasties.

Central venous obstruction in the thorax

International Nuclear Information System (INIS)

Collin, G.; Jones, R.G.; Willis, A.P.

2015-01-01

Central venous stenosis and occlusion can occur secondary to a spectrum of conditions ranging from aggressive malignancy to benign extrinsic anatomical compression in otherwise healthy individuals. Irrespective of aetiology, significant morbidity in the acute setting and long term can occur unless prompt accurate diagnosis and appropriate management is initiated, the radiologist being central to both. The present review will provide radiologists with a thorough illustration and explanation of the range of central venous conditions in the thorax (including deep vein thrombosis, thoracic outlet syndrome, haemodialysis, and malignancy related causes), the salient imaging findings and interventional management using case examples from the authors' practice. - Highlights: • We show a range of causes of central venous disease in the thorax. • We provide information about different imaging and management strategies. • We show several cases with successes and complications of endovascular management

Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease: Case Report and Review of the Literature

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Igor Dumic

2017-01-01

Full Text Available Celiac disease (CD is a systemic, chronic autoimmune disease that occurs in genetically predisposed individuals following dietary gluten exposure. CD can present with a wide range of gastrointestinal and extraintestinal manifestations and requires lifelong adherence to a gluten-free diet [GFD]. Venous thromboembolism (VTE as a presentation of celiac disease is unusual and rarely reported. We present a case of a 46-year-old man who was admitted for shortness of breath and pleuritic chest pain and was found to have iron deficiency anemia, deep venous thrombosis, and bilateral pulmonary emboli (PE. After work-up for his anemia, the patient was diagnosed with CD. Comprehensive investigation for inherited or acquired prothrombotic disorders was negative. It is becoming increasingly recognized that CD is associated with an increased risk for VTE. PE, however, as a presentation of CD is exceedingly rare and to the best of our knowledge this is the third case report of such an occurrence and the only case report of a patient from North America. It is important to recognize that the first symptoms or signs of celiac disease might be extraintestinal. Furthermore, VTE as a presentation of CD is rare but life-threatening.

Hormonal contraception and risk of venous thromboembolism: national follow-up study

DEFF Research Database (Denmark)

Lidegaard, Øjvind; Løkkegaard, Ellen; Svendsen, Anne Louise

2009-01-01

-49 with no history of cardiovascular or malignant disease. MAIN OUTCOME MEASURES: Adjusted rate ratios for all first time deep venous thrombosis, portal thrombosis, thrombosis of caval vein, thrombosis of renal vein, unspecified deep vein thrombosis, and pulmonary embolism during the study period. RESULTS: 10...

Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism

DEFF Research Database (Denmark)

Ahlehoff, O; Wu, Jashin J; Raunsø, Jakob

2017-01-01

Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little...

Lower extremity venous thrombosis in patients younger than 50 years of age

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Kreidy R

2012-03-01

Full Text Available Raghid Kreidy1, Pascale Salameh2, Mirna Waked31Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, 2Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 3Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, LebanonAim: Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients.Methods: From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years. The control group included 217 patients (86 males and 131 females older than 50 years (range: 50–96 years; mean 72.9 years.Results: The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001, pregnancy (18.2% compared with 0.5%; P < 0.001, treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001, and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084.Conclusion: Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia

Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities

International Nuclear Information System (INIS)

Vik, Anders; Holme, Pal Andre; Singh, Kulbir; Dorenberg, Eric; Nordhus, Kare Christian; Kumar, Satish; Hansen, John-Bjarne

2009-01-01

Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.

Cerebral venous sinus thrombosis in HIV-infected patients: report of 2 cases.

Science.gov (United States)

Mwita, Julius Chacha; Baliki, Kgomotso; Tema, Ludo

2013-01-01

Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke.

[Venous thrombosis of atypical location in patients with cancer].

Science.gov (United States)

Campos Balea, Begoña; Sáenz de Miera Rodríguez, Andrea; Antolín Novoa, Silvia; Quindós Varela, María; Barón Duarte, Francisco; López López, Rafael

2015-01-01

Venous thromboembolism (VTE) is a complication that frequently occurs in patients with neoplastic diseases. Several models have therefore been developed to identify patient subgroups diagnosed with cancer who are at increased risk of developing VTE. The most common forms of thromboembolic episodes are deep vein thrombosis in the lower limbs and pulmonary thromboembolism. However, venous thrombosis is also diagnosed in atypical locations. There are few revisions of unusual cases of venous thrombosis. In most cases, VTE occurs in the upper limbs and in the presence of central venous catheters, pacemakers and defibrillators. We present the case of a patient diagnosed with breast cancer and treated with surgery, chemotherapy and radiation therapy who developed a thrombosis in the upper limbs (brachial and axillary). Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Radiologic findings of deep seated cerebral arteriovenous malformation with nonvisualization of straight sinus: focused on angiogram

International Nuclear Information System (INIS)

Won, Jong Boo; Park, Sung Ho; Hong, Jong Won; Kim, Yoo Kyoung; Shin, Mi Jeong; Baik, Seung Kuk; Choi, Han Yong; Kim, Bong Gi

1999-01-01

To analyze the radiologic-especially angiographic-findings of deep seated cerebral arteriovenous malformation(AVM) involving nonvisualized straight sinus. In six patients aged between 15 and 53 years with deep seated cerebral AVM, CT and MR images were retrospectively analyzed with regard to the following features : the presence of straight sinus, the location of AVM, and the occurrence of hemorrhage. Angiograms were analyzed for venous drainage routes of AVM, the appearance of veins, the presence of falcine sinus and venous drainage from normal deep brain parenchyme. In four patients who had undergone intravascular embolization therapy, pre- and post- embolization angiograms were compared. CT and MR images showed neither straight sinus nor thrombosis. AVMs were deeply seated in the brain, and in all cases there was cerebral hemorrhage. Angiograms disclosed that venous drainage of all AVMs occurred via the veins of Galen. In one case, venous flow via the falcine sinus to the superior sagittal sinus was noted, but in others, retrograde flow in the deep venous system was observed. Marked collateral routes followed in response to the obstruction of straight sinus included the basal vein of Rosenthal, the internal occipital, internal cerebral, and cerebellar hemispheric veins (which are Galenic afferents), and the inferior sagittal sinus. In all patients, contralateral routes were partially involved. Venous drainage from normal deep parenchyme through the transcerebral veins to the superficial venous system was noted, and in one case, straight sinus which had been observed on an angiogram five years earlier was no longer present. Angiography offers effective evaluation of the dynamic aspect of venous flow in cases involving deep-seated AVM, and of normal deep parenchyme in cases in which AVM involves nonvisualized straight sinus. Before intravascular treatment of AVM, venous flow must be carefully analyzed

Venous Thromboembolism: A Comparison of Chronic Spinal Cord Injury and General Surgery Patients in a Metropolitan Veterans Affairs Hospital.

Science.gov (United States)

Moore, Ryan M; Rimler, Jonathan; Smith, Brian R; Wirth, Garrett A; Paydar, Keyianoosh Z

2016-11-01

Venous thromboembolic events result in significant morbidity, mortality, and costly therapeutic interventions. As medical resource allocation strategies are becoming more pervasive, appropriate risk stratification and prophylactic regimens are essential. Previous studies have shown a decreased incidence of perioperative venous thromboembolism in the chronic spinal cord injury population. The question remains of whether chronic spinal cord injury is protective against venous thromboembolism. A retrospective review of all cases involving chronic spinal cord injury patients who underwent plastic and reconstructive surgery operations (n = 424) and general surgery patients (n = 777) with a primary outcome of deep venous thrombosis or pulmonary embolism within 90 days of surgery was performed. The incidence of postoperative deep venous thrombosis in the control and spinal cord injury groups was 1.7 percent and 0.2 percent, respectively (p = 0.027). However, such significance was not observed with regard to postoperative pulmonary embolism incidence (p = 0.070). Collectively, the incidence of postoperative venous thromboembolism-specifically, deep venous thrombosis or pulmonary embolism-was significantly greater in the general surgery population (p = 0.014). A nearly 10-fold increased risk of venous thromboembolism was seen among the control group (1.9 percent versus 0.2 percent) despite administration of optimal prophylaxis. This study demonstrates a profoundly low incidence of venous thromboembolism among chronic spinal cord injury patients compared with general surgery patients. Future efforts to elucidate how chronic spinal cord injury confers a protective mechanism may potentially influence the evolution of venous thromboembolism prevention guidelines, and spark the development of alternative prophylactic agents or customized application of prevention efforts.

Asymptomatic giant coronary aneurysm in an adolescent with Behcet's syndrome

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Kahn Philip J

2012-01-01

Full Text Available Abstract Objective Behcet's is an idiopathic multi-organ syndrome, which may have onset during childhood. Vascular involvement is uncommon, with rarely reported coronary aneurysm formation. We present a case report of a teenager girl who developed recalcitrant life-threatening Behcet's vasculitis, involving both small and large venous and arterial systems including a giant coronary aneurysm. Case report De-identified data were collected retrospectively in case report format. Although our sixteen year old female with Behcet's vasculitis had resolution of many arterial aneurysms, she had persistent venous thrombosis of large vessels, as well as persistent, giant arterial aneurysms requiring intra-arterial coiling of a lumbar artery and coronary bypass grafting despite intensive immunosuppression including glucocorticoids, cyclophosphamide, infliximab, methotrexate, azathioprine and intravenous immunoglobulin. Conclusions Vascular manifestations may be seen in Behcet's syndrome, including asymptomatic coronary aneurysm, which may be refractory to immunosuppression and ultimately require surgical intervention. Increased awareness is essential for prompt diagnosis and management.

ANKYLOSING SPONDYLITIS - AN ALARMING RISK OF VENOUS THROMBOEMBOLIC DISEASE

OpenAIRE

Dr. Darpanarayan Hazra; Dr. Shahid Mahdi; Dr. Amit Madan; Dr. Neeraj Bhalla

2017-01-01

Venous thrombo-embolic disease (VTE) is a potentially life threatening clinical event. Ankylosing spondylitis (AS) is a chronic inflammatory disease with a significantly increased risk of developing VTE. Management of acute proximal deep venous thrombosis (DVT) depends on the clinical status of the affected limb, extent of the thrombus and comorbidities of the patient. Semba and Dake introduced Catheter directed thrombolysis (CDT) to treat 21 patients of DVT in 1994. CDT is a life or limb sav...

AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya

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Yiming Gao

2011-01-01

Full Text Available AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.

deep venous thrombosis in patients with acute traumatic spinal cord ...

African Journals Online (AJOL)

endothelial injury (trauma) and immobility (venous stasis). DVT and ... pressure ulcers, spasticity and autonomic dysreflexia. (3). ... and its complications saves many lives. Accurate and ..... other chronic diseases and pre-existing risk factors.

Assessment of Venous Thrombosis in Animal Models.

Science.gov (United States)

Grover, Steven P; Evans, Colin E; Patel, Ashish S; Modarai, Bijan; Saha, Prakash; Smith, Alberto

2016-02-01

Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition. © 2015 American Heart Association, Inc.

Venous surgery in erectile dysfunction. The role of dorsal-penile-vein ligation and spongiosolysis for impotence.

Science.gov (United States)

Gilbert, P; Sparwasser, C; Beckert, R; Treiber, U; Pust, R

1992-01-01

We report here on our surgical experience with venous leakage of the cavernous bodies. Out of 159 patients operated on, 134 were available for long-term follow-up. Depending on the cavernosographic findings, one of three different surgical procedures was carried out: ligation of the deep dorsal vein of the penis, spongiosolysis, or ligation of the crura. 18% of the patients undergoing ligation of the deep dorsal vein, postoperatively attained spontaneous erections, while 35% needed adjuvant corpus cavernosum autoinjection therapy. Spongiosolysis gave a more favourable result: spontaneous erections in 30% and vasoactive drug-dependent erections in 35%. Crural ligation did not prove successful. No serious complications were encountered postoperatively. Our data suggest that venous surgery should only be offered to a selected group of patients comprising young impotent men with venous leakage, maybe in combination with arterial disease, and patients suffering from distal venous leakage. Old age, neurogenic disorders causing erectile dysfunction, and diabetes mellitus should represent exclusion criteria for venous surgery.

Radioisotopic phlebography in investigating venous diseases of lower limbs

International Nuclear Information System (INIS)

San-Galli, F.; Vendaud-Busquet, M.; Philippe, J.C; Leccia, F.; Beylot, C.; Ducassous, D.

1984-01-01

The aim of this study is to analyse the interest of isotope phlebography in diagnosis of deep thrombosis and of chronic venous disease in the lower extremity as well as its value in relation to contrast venography. Out of 30 patients, 17 underwent both examinations. With contrast venography as a means of testing, radioisotope phlebography has a sensitivity of 71%, a specificity of 100%, an accuracy of 88%. Thirteen patients only had isotope phlebography. Results were confirmed everybody by clinical developments. The main interest of isotope phlebography is the diagnosis of femoral and iliac thromboses with a sensitivity and specificity of 100% at this point. In chronic venous disease isotope phlebography only shows indirect signs but gives information on the permeability of deep veins, wich is enough to make a therapeutic decision [fr

Radioisotopic phlebography in investigating venous diseases of lower limbs

Energy Technology Data Exchange (ETDEWEB)

San-Galli, F.; Vendaud-Busquet, M.; Philippe, J.C; Leccia, F.; Beylot, C.; Ducassous, D. (Hopital du Haut-Leveque, 33 - Pessac (France))

1984-10-01

The aim of this study is to analyse the interest of isotope phlebography in diagnosis of deep thrombosis and of chronic venous disease in the lower extremity as well as its value in relation to contrast venography. Out of 30 patients, 17 underwent both examinations. With contrast venography as a means of testing, radioisotope phlebography has a sensitivity of 71%, a specificity of 100%, an accuracy of 88%. Thirteen patients only had isotope phlebography. Results were confirmed everybody by clinical developments. The main interest of isotope phlebography is the diagnosis of femoral and iliac thromboses with a sensitivity and specificity of 100% at this point. In chronic venous disease isotope phlebography only shows indirect signs but gives information on the permeability of deep veins, which is enough to make a therapeutic decision.

High risk of pulmonary embolism and deep venous thrombosis but not of stroke in granulomatosis with polyangiitis (Wegener's)

DEFF Research Database (Denmark)

Faurschou, Mikkel; Obel, Niels; Baslund, Bo

2014-01-01

OBJECTIVE: To assess the incidence of stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT) in granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: Patients diagnosed with GPA at a Danish tertiary care center during 1993-2011 were identified (n = 180). Each patient was matched...... 20.2 [95% CI 5.1-81] for DVT). The incidence of stroke was not increased during this time interval (IRR 1.4 [95% CI 0.3-5.7]). From 2 years after GPA diagnosis, an increased incidence was found for DVT (IRR 4.5 [95% CI 1.7-11.8]) but not for PE (IRR 1.3 [95% CI 0.2-9.6]) or stroke (IRR 1.4 [95% CI 0...

HTA of genetic testing for susceptibility to venous thromboembolism in Italiy

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Betti Silvia

2012-06-01

Full Text Available Venous thromboembolism (VTE is a condition in which a thrombus (a solid mass of blood constituents forms in a vein. VTE represents an extremely common medical problem manifested as either deep venous thrombosis (DVT or pulmonary embolism (PE affecting apparently healthy as well as hospitalized patients. Often PE is the physiopathological consequence of the DVT of low extremities vessels, in particular of the calve......

Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

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Juliana Deh Carvalho Machado

2009-12-01

. Sixty-eight percent of the catheters were infected: 72% of them were from Group 1 and 28% from Group 2 (asymptomatic patients. Systemic infection was diagnosed in 70% of the patients from Group 1. Positive blood culture was found in 17% of the patients from Group 2. The microorganisms found were: Staphylococcus sp. (48%, Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% and Proteus sp. (5%. CONCLUSION: Central venous catheter infection is common in hospitalized asymptomatic patients. Patients receiving total parenteral nutrition are most frequently infected with Candida sp. Therefore, the creation of barriers that block colonization in the central venous catheter is essential to decrease the morbidity and mortality among patients that depend on total parenteral nutrition.

Deep penetrating brain injury with 20 years asymptomatic survival. Case report

International Nuclear Information System (INIS)

Buczek, M.; Pieninski, A.

1993-01-01

Authors report the case of penetrating injury of the head with large metallic fragment embedded to the brain with 20 years asymptomatic survival. Patient sustained head injury during work, 20 years ago and for these period of time was not aware of having foreign body intracranially with excellent general condition and no signs of neurological deficit. Metal nail was detected incidentally by plain skull X-ray films( and subsequent CT scan) during routine procedures when patient was admitted for surgical procedure. In our opinion presented case is uncommon because of asymptomatic course. Most of penetrating head injuries are considered as life threatening due to sudden onset, severe general patient condition and possible deterioration according to the type of injury and extent of cerebral destruction. For those reasons earliest possible neurosurgical treatment is recommended. We emphasize the role of debridement for most of brain penetration injuries. (author)

The diagnostic value of indirect lower limb CT venography in the lower extremity deep venous thrombosis

International Nuclear Information System (INIS)

Zhu Li; Guo Youmin; Wang Jianguo; Guo Xiaojuan; Liu Min; Guo Yulin

2009-01-01

Objective: To evaluate indirect CT venography (CTV) in the diagnosis of deep venous thrombosis (DVT). Methods: A total of 516 acute pulmonary embolism patients proved by objective test were analyzed retrospectively. Using the results of lower limb compression sonography as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV were calculated. The agreement between lower extremity venous sonography and indirect CTV were assessed by Kappa analysis. Results: Among 516 patients with acute pulmonary thromboembolism (PTE), 110 patients underwent both CTV and CTPA and lower extremity sonography. DVT were detected by CTV and sonography simultaneously in 48 patients, while no DVT was detected in 39 patients by both examinations. Thirteen patients were diagnosed to have DVT by CTV without sonography detection, and DVT was detected in other 10 patients only by sonography. The sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV was 82.8% (48/58), 75.0% (39/52), 78.7% (48/61) and 79.6% (39/49). The agreement between lower extremity venous sonography and indirect CTV was good for femoropopliteal vein (Kappa value range from 0.874 to 0.914, P=0.000). Thrombi detected by CTV were 62 and 52 respectively, and for sonography were 67 and 51 respectively. For calf veins, the agreement decreased (Kappa value range from 0.464 to 0.584, P=0.000). Thrombi detected by CTV were 6, 25 and 13 respectively, and for sonography were 13, 38 and 19 respectively. The agreement for external iliac vein was poor (Kappa value range from 0.230 to 0.262, P=0.067 and 0.004, respectively). Thrombi detected by CTV were 33, and for sonography were 17. Conclusions: The indirect CTV has high accuracy in the diagnosis of DVT. Combined CTPA and CTV can image pulmonary arteries and lower extremity veins in one examination. Indirect CTV can reveal thrombus in large pelvic veins, which has an advantage

Venous function in the leg after postoperative thrombosis diagnosed with 125I-fibrinogen uptake test

International Nuclear Information System (INIS)

Lindhagen, A.; Bergqvist, D.; Hallboeoek, T.; Efsing, H.O.

1983-01-01

The 125 I-fibrinogen uptake test (FUT) has been widely used in the past decade to detect postoperative thrombosis. FUT has been shown to correlate well with phlebography, and positive FUT is associated with a high frequency of pulmonary embolism. The long-term venous function of the leg after FUT-detected postoperative thrombosis, however, is inadequately documented. In 179 patients who had been studied after operation with FUT, a follow-up evaluation of FUT as an indicator of risk for development of deep venous insufficiency was made four to five years later. The patients replied to a questionnaire, were clinically examined, and underwent venous strain-gauge plethysmography, venous pressure measurement, and, in some cases, phlebography. No statistically significant differences were found in any of the parameters between legs that had been FUT-positive and those that were FUT-negative at the time of the operation. The frequency of deep venous insufficiency thus was equal in FUT-positive and FUT-negative legs. It was also independent of the site of FUT-detected thrombus in the leg

Gas6 Promotes Inflammatory (CCR2hiCX3CR1lo) Monocyte Recruitment in Venous Thrombosis.

Science.gov (United States)

Laurance, Sandrine; Bertin, François-René; Ebrahimian, Talin; Kassim, Yusra; Rys, Ryan N; Lehoux, Stéphanie; Lemarié, Catherine A; Blostein, Mark D

2017-07-01

Coagulation and inflammation are inter-related. Gas6 (growth arrest-specific 6) promotes venous thrombosis and participates to inflammation through endothelial-innate immune cell interactions. Innate immune cells can provide the initiating stimulus for venous thrombus development. We hypothesize that Gas6 promotes monocyte recruitment during venous thrombosis. Deep venous thrombosis was induced in wild-type and Gas6-deficient (-/-) mice using 5% FeCl 3 and flow reduction in the inferior vena cava. Total monocyte depletion was achieved by injection of clodronate before deep venous thrombosis. Inflammatory monocytes were depleted using an anti-C-C chemokine receptor type 2 (CCR2) antibody. Similarly, injection of an anti-chemokine ligand 2 (CCL2) antibody induced CCL2 depletion. Flow cytometry and immunofluorescence were used to characterize the monocytes recruited to the thrombus. In vivo, absence of Gas6 was associated with a reduction of monocyte recruitment in both deep venous thrombosis models. Global monocyte depletion by clodronate leads to smaller thrombi in wild-type mice. Compared with wild type, the thrombi from Gas6 -/- mice contain less inflammatory (CCR2 hi CX 3 CR1 lo ) monocytes, consistent with a Gas6-dependent recruitment of this monocyte subset. Correspondingly, selective depletion of CCR2 hi CX 3 CR1 lo monocytes reduced the formation of venous thrombi in wild-type mice demonstrating a predominant role of the inflammatory monocytes in thrombosis. In vitro, the expression of both CCR2 and CCL2 were Gas6 dependent in monocytes and endothelial cells, respectively, impacting monocyte migration. Moreover, Gas6-dependent CCL2 expression and monocyte migration were mediated via JNK (c-Jun N-terminal kinase). This study demonstrates that Gas6 specifically promotes the recruitment of inflammatory CCR2 hi CX 3 CR1 lo monocytes through the regulation of both CCR2 and CCL2 during deep venous thrombosis. © 2017 American Heart Association, Inc.

[Endovascular treatment of acute iliofemoral deep venous thrombosis - our results with catheter-directed thrombolysis and AngioJet].

Science.gov (United States)

Berencsi, Anikó; Dósa, Edit; Nemes, Balázs; Hüttl, Kálmán; Legeza, Péter; Oláh, Zoltán; Kristóf, Vera; Acsády, György; Sótonyi, Péter

2017-03-01

Most of the patients with iliofemoral thrombosis treated with anticoagulants only are affected with postthrombotic syndrome (PTS) that worsens the patients' quality of life. In the acute phase of proximal deep venous thrombosis (DVT) catheter-directed (CDT) and pharmacomechanical thrombolysis may be a reasonable alternative therapeutic method. Our aim was to summarize our results using these methods. Since 2009 twenty-four patients with iliofemoral DVT were treated with these endovascular procedures and with stenting at our Institution. The median age of the patients was 35.83 ± 15.9 years, the female: male ratio was approximately 2:1. The mean time between the onset of the symptoms and the procedures was eleven days. CDT alone was performed in 8 patients, thrombus aspiration in addition to CDT using AngioJet device in 16 patients; in 19 cases the procedure was completed with venous stenting. During the follow-up we performed US examinations and estimated the severity of PTS by Villalta-scale. The total recanalization-rate was more than 50%, which even improved during the follow-up. The total lysis time and the amount of used recombinant tissue plasminogen activator decreased significantly by applying the AngioJet. We did not find any severe PTS among our patients during the follow-up visits. Our data suggests that these methods can be used efficiently and safely in the treatment of acute iliofemoral DVT.

Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

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Christine Hohl Moinat

2014-01-01

Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

Venous Thromboembolism and Risk of Idiopathic Interstitial Pneumonia A Nationwide Study

DEFF Research Database (Denmark)

Sode, Birgitte Margareta; Dahl, Morten; Nielsen, Sune Fallgaard

2010-01-01

Rationale: Idiopathic interstitial pneumonia is characterized by pulmonary fibrosis and high mortality. Objectives: We examined the association between ever-diagnosed venous thromboembolism and risk of incident idiopathic interstitial pneumonia. Venous thromboembolism was taken as a proxy...... Danish registries. Measurements and Main Results: Age-standardized incidence rates per 10,000 person-years for idiopathic interstitial pneumonia were higher among those ever diagnosed with venous thromboembolism (1.8; n = 158,676), pulmonary embolism (2.8; n = 70,586), and deep venous thrombosis only (1.......2; n = 88,090), than among control subjects (0.8; n = 7,260,278). Multivariate-adjusted hazard ratios for idiopathic interstitial pneumonia were 1.8 (95% confidence interval [Cl], 1.7-1.9) in those ever diagnosed with venous thromboembolism, 2.4 (95% CI, 2.3-2.6) in those ever diagnosed with pulmonary...

Pulmonary embolism and pelvic-lower limb deep venous thrombosis: initial experience with magnetic resonance angiography

International Nuclear Information System (INIS)

Jiang Tao; Qiu Chuanya; Jiang Hua

2004-01-01

Objective: To evaluate the usefulness of combined three-dimensional (3D) and two-dimensional (2D) contrast enhanced magnetic resonance angiography (CE-MRA) for checking the thrombus embolism of different positions within single examination on the pulmonary artery and pelvic-lower limb deep veins. Methods: Fifteen patients with suspected pulmonary embolism and pelvic-lower limb deep venous thrombosis (DVT) were evaluate with combined 3D MRA and 2D CE-MRA. 3D spoiled gradient-recalled-echo bolus chase MR angiograms were obtained in four stations from the pulmonary artery to the ankle. Thereafter, 3D CE MRA was reversely scanned from the ankle to the pelvic. 2D contrast-enhanced MRI was obtained in pelvis, thigh, and calf. Pulmonary CT angiography (CTA) and/or DSA were performed in 15 patients, and duplex ultrasonography of lower-limb vein was performed in 12 patients. Results: Of the 15 cases, acceptable imaging of pulmonary vessel was acquired with 3D CE-MRA in 12 cases. The signal intensity was lower in the deep iliac vein and lower extremities than that in the artery, but vein frame was distinct after post processing. The artery and deep vein were clearly revealed with contrast enhanced FSPGR sequence in 15 cases. 3D CD-MRA imaging disclosed pulmonary embolism in fourteen patients and pelvis-lower limb DVT with multi-place involvement in nine patients. 2D contrast-enhanced MR imaging proved DVT in pelvis-lower limb. 2D contrast-enhanced FSPGR sequence was a complementation of 3D CE-MRA and it had larger scan field. Thrombus presented as low signals and eccentral or intraluminal filling defect. Local caliber of vein thrombus in 6 cases was evidently broadened. Conclusion: Within only one MR examination procedure, it is capable of examining the pulmonary embolism and DVT of pelvis-lower limb with combined 3D MRA and 2D contrast enhanced MR. The results are promising as a non-invasion 'on-stop shopping' tool in the evaluation of thromboembolic disease

Developmental venous anomalies with capillary stain: a subgroup of symptomatic DVAs?

International Nuclear Information System (INIS)

Roccatagliata, Luca; Berg, Rene van den; Soderman, Michael; Boulin, Anne; Condette-Auliac, Stephanie; Rodesch, Georges

2012-01-01

Intracranial developmental venous anomalies (DVAs) are considered benign vascular dispositions; they are asymptomatic in the vast majority of cases. They represent extreme variations of the venous drainage and may rarely be responsible for focal venous ischemia leading to neurological dysfunction. The aim of the study is to analyze a group of patients with symptomatic DVAs with capillary stain at angiography. We retrospectively reviewed the clinical and radiological features of patients in which a DVA was considered the cause of a neurological event. In all the patients, the DVA was suspected by angio-CT or MRI and conventional angiography was performed to detail the angioarchitecture of the DVA. A total of 7 patients and 11 DVAs were identified; three patients had multiple DVAs. Three DVAs were frontal, two were parietal, two were thalamic, one was in the midbrain, and three were cerebellar. Patients presented with progressive neurological deficits, seizures, or cerebral hemorrhage. All these DVAs were associated with a peculiar capillary stain at angiography. Although being normal anatomical variations, DVAs may create, because of hemodynamic unbalance, venous ischemia that induces angiogenic phenomena. MRI shows the suffering of the brain and angiography witnesses this angiogenesis under the form of capillary stain. Conventional angiography can thus provide useful information to recognize ''atypical'' symptomatic DVAs. (orig.)

Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return

International Nuclear Information System (INIS)

Aminololama-Shakeri, Shadi; Wootton-Gorges, Sandra L.; Reyes, Melissa; Moore, Elizabeth H.; Pretzlaff, Robert K.

2007-01-01

The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava that drains into the right atrium via the coronary sinus. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA). This has been reported in approximately 20 patients with the diagnosis usually being made by cardiac catheterization. We report the case of a toddler with asymptomatic hypoxemia resulting from anomalous drainage of a normal RSVC into his LA. This was diagnosed non-invasively by contrast-enhanced chest CT. (orig.)

Prospective evaluation of 99mTc-labelled recombinant tissue plasminogen activator in the detection of lower limb deep venous thrombosis in asymptomatic high risk patients

International Nuclear Information System (INIS)

Butler, S.P.; Rahman, T.; Boyd, S.J.; Parkes, S.L.; Quinn, R.J.

1998-01-01

Full text: The purpose of this study was to compare the accuracy of this new technique against the accepted ''gold standard'' of contrast venography in 36 asymptomatic high risk patients. A kit formulation has been devised in which 99m Tc is labelled to rt- PA where the plasminogen binding site has been permanently inhibited but the fibrin binding site remained active. Kit preparation prior to injection takes five minutes. Scintigraphic imaging is performed at four hours post-injection (10 min/scan for thighs and calves). The results of scintigraphic imaging were then compared to those of contrast venography. 36 consecutive asymptomatic high risk patients (17 total hip, 19 total knee replacements) underwent both a contrast venogram on the operated leg and scintigraphic scan 7-10 days following operation. For the purpose of this analysis, each venogram was divided into a proximal and a distal segment. Venograms were interpreted as being positive, negative or uninterpretable in each segment. Similar analysis of the scintigraphic scans was performed except that all segments were considered to be of diagnostic quality. Fifty seven segments were able to be analysed. Of the 13 thrombosed segments (1 proximal, 12 calf ), 12 had positive scans; in the 44 non-thrombosed segments, 40 had negative scans. In detecting lower limb DVT, scanning had a sensitivity of 92% and a specificity of 91%. Scintigraphic scanning with inhibited 99m Tc rt-PA permits accurate detection of thrombus in high risk patients

Statin treatment and risk of recurrent venous thromboembolism

DEFF Research Database (Denmark)

Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo

2013-01-01

Objectives Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin ...

Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

International Nuclear Information System (INIS)

Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung

2003-01-01

To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

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Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

2003-10-01

To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

Deep venous thrombosis after saphenous endovenous radiofrequency ablation: is it predictable?

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Jacobs, Chad E; Pinzon, Maria Mora; Orozco, Jennifer; Hunt, Peter J B; Rivera, Aksim; McCarthy, Walter J

2014-04-01

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and

Asymptomatic bacteriuria.

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Nicolle, Lindsay E

2014-02-01

Asymptomatic bacteriuria is a common finding. Inappropriate antimicrobial treatment of asymptomatic bacteriuria has been identified as a major issue for antimicrobial stewardship programs. This review summarizes and evaluates recent studies which extend our knowledge of the occurrence, management, and outcomes of bacteriuria. The reported prevalence of bacteriuria is higher in some developing countries than generally reported for developed countries, but reasons for this remain unclear. Clinical studies of young women, renal transplant patients, and patients undergoing minor nontraumatic urologic procedures confirm that treatment of asymptomatic bacteriuria for these populations is not beneficial, and may be harmful. There is also no benefit for treatment of asymptomatic bacteriuria prior to orthopedic surgery to decrease postoperative surgical site infection. Studies continue to report substantial inappropriate antimicrobial use for treatment of asymptomatic bacteriuria. Recent publications confirm that asymptomatic bacteriuria is benign in most patients. Management strategies for pregnant women with recurrent bacteriuria require further clarification. There is a continuing problem with inappropriate treatment of asymptomatic bacteriuria, and sustainable strategies to optimize antimicrobial use for this problem are needed.

Cerebral venous thrombosis due to cryptogenic organising pneumopathy with antiphospholipid syndrome worsened by heparin-induced thrombocytopenia.

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Hsieh, J; Kuzmanovic, I; Vargas, M I; Momjian-Mayor, I

2013-07-09

Cerebral venous thrombosis (CVT) has usually been ascribed to prothrombotic conditions, oral contraceptives, pregnancy, malignancy, infection, head injury or mechanical precipitants. The case reported here illustrates two rare causes of CVT observed in the same patient: the presence of antiphospholipid antibodies associated with an asymptomatic cryptogenic organising pneumopathy (COP) which were considered the origin of the venous cerebral thrombosis and heparin-induced thrombocytopenia (HIT) which was responsible for the worsening of the thrombosis observed a few days after the introduction of treatment. Moreover, we provide here additional positive experience in the treatment of both, CVT and HIT, by fondaparinux with bridging to warfarin given their successful evolution under this anticoagulant option.

Anatomic and functional outcomes of pharmacomechanical and catheter-directed thrombolysis of iliofemoral deep venous thrombosis.

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Hager, Eric; Yuo, Theodore; Avgerinos, Efthymios; Naddaf, Abdullah; Jeyabalan, Geetha; Marone, Luke; Chaer, Rabih

2014-07-01

Pharmacomechanical thrombolysis (PMT) and catheter-directed thrombolysis (CDT) are commonly used for the treatment of iliofemoral deep venous thrombosis (DVT). The purpose of this study was to examine the short- and long-term venous patency and venous valvular function as well as clinical outcomes of patients treated for iliofemoral DVT by PMT and CDT. A retrospective review of all patients with symptomatic DVT treated between 2006 and 2011 with PMT or CDT was performed. All patients were treated by local tissue plasminogen activator delivered with PMT or CDT. Patients were divided into two groups on the basis of initial treatment modality: patients treated by PMT alone (group 1), and those who underwent PMT and CDT or CDT alone (group 2). Group comorbidities, initial presenting symptoms, and Clinical, Etiologic, Anatomic, and Pathologic (CEAP) classification scores were compared. Postprocedural duplex ultrasound was used to assess valve function and treated vein patency rates. At all visits, Villalta and CEAP scores were recorded and compared. Group demographic and procedural results were analyzed by Fisher exact test for dichotomous variables and Kruskal-Wallis equality-of-populations rank test for the ordinal and continuous data. Kaplan-Meier survival estimates were used to assess preserved valve function as well as primary and secondary patency rates. There were 79 patients with 102 limbs treated for extensive iliofemoral DVT (median age, 51.5 years; range, 16.6-83.8 years). There were 18 patients in group 1 and 61 patients in group 2 (PMT + CDT [n = 54] or CDT alone [n = 7]). There were no differences in demographics or comorbidities between groups aside from malignant disease, which was more common in group 1 (35.3% vs 11.5%; P = .03). A total of 102 limbs were analyzed, 24 in group 1 and 78 in group 2. Patients in group 1 had a shorter symptom duration compared with group 2 (7 days vs 16 days; P = .011). The median number of procedures in group 1

Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis.

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Lindsey, Philip; Echeverria, Angela; Poi, Mun J; Matos, Jesus; Bechara, Carlos F; Cheung, Mathew; Lin, Peter H

2018-05-01

This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an inferior vena cava (IVC) filter were included in the analysis. Trapped intrafilter thrombus was assessed for procedure-related thromboembolism. Clinical outcomes of thrombus management and thromboembolism risk were analyzed. A total 172 patients (mean age 57.4 years, 98 females) who underwent 174 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (64%), mechanical thrombectomy (n = 86%), pharmacomechanical thrombolysis (51%), balloon angioplasty (98%), and stent placement (28%). Thrombectomy device used included AngioJet (56%), Trellis (19%), and Aspire (11%). Trapped IVC filter thrombus was identified in 58 patients (38%) based on the IVC venogram. No patient developed clinically evident pulmonary embolism (PE). IVC filter retrieval was performed in 98 patients (56%, mean 11.8 months after implantation). Multivariate analysis showed that iliac vein occlusion (P = 0.04) was predictive for procedure-related thromboembolism. Iliac vein thrombotic occlusion is associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered when performing percutaneous thrombectomy in patients with iliac venous occlusion to prevent PE. Copyright © 2017 Elsevier Inc. All rights reserved.

Current prescribing patterns of elastic compression stockings post-deep venous thrombosis.

LENUS (Irish Health Repository)

Roche-Nagle, G

2012-02-01

OBJECTIVES: Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) characterized by chronic pain, swelling and heaviness, and may result in ulceration. Elastic compression stockings (ECS) worn daily after DVT appear to reduce the incidence and severity of PTS. The aims of our study were to investigate practices and perceptions of DVT patients and physicians regarding the use of ECS after DVT. METHODS: Two surveys were conducted. The first was sent to 225 staff and trainee clinicians and the second was administered to 150 DVT patients. RESULTS: The results demonstrated that the majority of senior staff (75%) believed that ECS were effective in preventing PTS and in managing venous symptoms. However, this was in contrast with junior trainees (21%) (P < 0.05). This resulted in only 63% of patients being prescribed ECS post-DVT. There was a lack of consensus as regards the optimal timing of initiation of ECS, duration of therapy and compression strength. Nearly all DVT patients who were prescribed ECS purchased them, 74% wore them daily, and most (61%) reported that ECS relieved swelling and symptoms. Physicians correctly predicted the main reasons for non-compliance, but misjudged the scale of patient compliance with ECS. CONCLUSIONS: Our findings suggest that there is a lack of consensus among doctors regarding ECS use after DVT and widespread education regarding the latest evidence of the benefit of ECS after DVT.

Risk of Cerebral Venous Thrombosis in Obese Women

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Zuurbier, Susanna M.; Arnold, Marcel; Middeldorp, Saskia; Broeg-Morvay, Anne; Silvis, Suzanne M.; Heldner, Mirjam R.; Meisterernst, Julia; Nemeth, Banne; Meulendijks, Eva R.; Stam, Jan; Cannegieter, Suzanne C.; Coutinho, Jonathan M.

2016-01-01

Obesity is a risk factor for deep vein thrombosis of the leg and pulmonary embolism. To date, however, whether obesity is associated with adult cerebral venous thrombosis (CVT) has not been assessed. To assess whether obesity is a risk factor for CVT. A case-control study was performed in

Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session

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Kim, Hyoung Ook; Kim, Jae Kyu; Park, Jin Gyoon; Yim, Nam Yeol; Kang, Yang Jun; Jung, Hye Doo

2016-01-01

PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention. PMID:27559713

Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome in a 14-Year-Old Child

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Sakshi Bami

2015-01-01

Full Text Available Agenesis of the inferior vena cava (IVC is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT. No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT.

Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

International Nuclear Information System (INIS)

Yamagami, Takuji; Kato, Takeharu; Iida, Shigeharu; Hirota, Tatsuya; Nishimura, Tsunehiko

2005-01-01

Purpose. To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity. Methods. We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology. Results. Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 ± 8.3 days (mean ± SD, range 4-37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment. Conclusion. The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary

Fish Intake and Venous Thromboembolism: A Systematic Literature Review.

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Mattiuzzi, Camilla; Cervellin, Gianfranco; Franchini, Massimo; Lippi, Giuseppe

2016-05-01

Diet plays an important role in modulating the risk of arterial and venous thrombosis. Several lines of evidence attest that consumption of fish and its compounds, especially omega-3 fatty acids, may be effective to decrease the cardiovascular risk. Since the pathogenesis of arterial and venous thrombosis share some common aspects, we performed a systematic review of published clinical studies that investigated the association between fish intake and venous thrombosis. An electronic search was carried out in Medline, Scopus, and ISI Web of Science using the key words "fish" OR "seafood" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism", with no language or date restriction. Overall, 6 studies (5 prospective and 1 case-control) were finally identified. In only 1 small case-control study, a larger intake of total fish was found to be negatively associated with the risk of venous thromboembolism. No association was found in 4 large prospective studies, whereas a positive association was observed in the remaining. No substantial difference was also noticed between intake of fatty or lean fish. Taken together, the current epidemiological evidence does not support the existence of a significant effect of total fish consumption on the risk of venous thromboembolism. © The Author(s) 2015.

Upper extremity deep vein thrombosis in a triathlete: Again intense endurance exercise as a thrombogenic risk.

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Sancho-González, Ignacio; Bonilla-Hernández, María Vicenta; Ibañez-Muñoz, David; Vicente-Campos, Davinia; Chicharro, José López

2017-05-01

Triathlon followers increase each year and long-distance events have seen major growth worldwide. In the cycling phase, athletes must maintain an aerodynamic posture on the bike for long periods of time. We report a case of a 38-year-old triathlete with symptoms of an axillary vein thrombosis 48h after a long triathlon competition. After 3days of hospitalization with a treatment consisted on enoxaparin anticoagulant and acenocumarol, the patient was discharged with instructions to continue treatment under home hospitalization with acetaminophen. Four weeks after the process, the patient was asymptomatic and the diameter of his arm was near normality. Due to the growing popularity of events based on endurance exercise, it is necessary more research to determine the etiopathogeny of deep venous thrombosis in athletes. Copyright © 2016 Elsevier Inc. All rights reserved.

Inflammation and peripheral venous disease. The San Diego Population Study.

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Cushman, M; Callas, P W; Allison, M A; Criqui, M H

2014-09-02

The inflammatory response to healing in venous thrombosis might cause vein damage and post-thrombotic syndrome. Inflammation may also be involved in venous insufficiency apart from deep-vein thrombosis. We studied the association of inflammation markers with venous insufficiency in a general population sample. We characterised 2,404 men and women in a general population cohort for peripheral venous disease and its severity using physical exam, symptom assessment, and venous ultrasound. Inflammation markers, C-reactive protein (CRP), fibrinogen, interleukin 1-beta (IL-1-beta), IL-8, IL-10, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, monocyte chemoattractant-1 (MCP-1) and vascular endothelial cell growth factor (VEGF) were compared in 352 case participants with peripheral venous disease and 352 controls with no venous abnormalities frequency matched to cases by age, sex and race. Associations were also evaluated including a subset of 108 cases of severe venous disease, as previously defined. Odds ratios (95% CI), for peripheral venous disease for biomarkers in the top quartile (adjusting for age, race, sex, body mass index and history of venous thrombosis) were 1.8 (1.1-3.0), 1.6 (1.0-2.5) and 1.5 (0.9-2.3) for CRP, fibrinogen and IL-10, respectively. Associations were larger considering cases of severe venous disease, with odds ratios for these three analytes of 2.6 (1.2-5.9), 3.1 (1.3-7.3) and 2.2 (1.1-4.4), and for IL-8: 2.4 (1.1-5.2). There was no association of IL-1-beta, ICAM-1, VCAM-1, E-selectin, MCP-1 or VEGF with overall cases or severe venous disease. In conclusion, a subset of inflammation markers were associated with increased risk of peripheral venous disease, suggesting potential therapeutic targets for treatment.

Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

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P Praveen Raj

2017-01-01

Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

Complication of venous thrombosis of the lower extremities with pulmonary embolism; Approach by radionuclide studies

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Suzuki, Teruyasu; Morita, Rikushi (Shiga Medical School, Otsu (Japan))

1993-07-01

We studied the relationship between the complication of the pulmonary embolism and the localization of the venous thrombus in the lower extremities using Tc-99m macroaggregated albumin (MAA) venography. Tc-99m MAA venography clearly demonstrated most of the deep and superficial veins from the leg to the pelvis and the abdomen. The incidence of venous thrombosis was highest in the pelvic veins (28.8%), and second in the superficial leg veins (10.9%). The complication of pulmonary embolism was highest in the pelvic venous thrombosis (20.4%), and second in the femoral venous thrombosis (16.0%). (author).

Venous and arterial thrombosis: Two aspects of the same disease?

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Paolo Prandoni

2009-01-01

Full Text Available Paolo PrandoniDepartment of Cardiothoracic and Vascular Sciences, Thromboembolism Unit, University Hospital of Padua Padua, ItalyAbstract: An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.Keywords: venous thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, atherosclerosis

VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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Bonno van BELLEN

2013-09-01

Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

Developmental venous anomalies with capillary stain: a subgroup of symptomatic DVAs?

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Roccatagliata, Luca [Hopital Foch, Service de Neuroradiologie Diagnostique et Therapeutique, Suresnes (France); University of Genoa, Department of Neurosciences, Ophthalmology and Genetics, Genoa (Italy); Berg, Rene van den [AMC, Department of Radiology, Amsterdam (Netherlands); Soderman, Michael [Karolinska University Hospital, Department of Neuroradiology, Stockholm (Sweden); Boulin, Anne; Condette-Auliac, Stephanie; Rodesch, Georges [Hopital Foch, Service de Neuroradiologie Diagnostique et Therapeutique, Suresnes (France)

2012-05-15

Intracranial developmental venous anomalies (DVAs) are considered benign vascular dispositions; they are asymptomatic in the vast majority of cases. They represent extreme variations of the venous drainage and may rarely be responsible for focal venous ischemia leading to neurological dysfunction. The aim of the study is to analyze a group of patients with symptomatic DVAs with capillary stain at angiography. We retrospectively reviewed the clinical and radiological features of patients in which a DVA was considered the cause of a neurological event. In all the patients, the DVA was suspected by angio-CT or MRI and conventional angiography was performed to detail the angioarchitecture of the DVA. A total of 7 patients and 11 DVAs were identified; three patients had multiple DVAs. Three DVAs were frontal, two were parietal, two were thalamic, one was in the midbrain, and three were cerebellar. Patients presented with progressive neurological deficits, seizures, or cerebral hemorrhage. All these DVAs were associated with a peculiar capillary stain at angiography. Although being normal anatomical variations, DVAs may create, because of hemodynamic unbalance, venous ischemia that induces angiogenic phenomena. MRI shows the suffering of the brain and angiography witnesses this angiogenesis under the form of capillary stain. Conventional angiography can thus provide useful information to recognize ''atypical'' symptomatic DVAs. (orig.)

Electrical foot stimulation and implications for the prevention of venous thromboembolic disease.

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Kaplan, Robert E; Czyrny, James J; Fung, Tat S; Unsworth, John D; Hirsh, Jack

2002-08-01

Venous stasis caused by immobility is an important risk factor for deep vein thrombosis following surgery and lower limb trauma, in bed-ridden medical patients, and in high-risk long distance air travelers. A safe and convenient method for reducing venous stasis would be useful in patients while in hospital and after discharge during their rehabilitation. 49 healthy subjects aged 51-76 were seated for 4 hours during which they received mild electrical stimulation of the calf, or sole of the foot (plantar muscles). Popliteal and femoral venous blood flow velocities were measured via doppler ultrasound. The non-stimulated lower extremity served as the simultaneous control. Subjects completed a questionnaire regarding their acceptance and tolerance of the electrical stimulation. There was a significant increase in venous femoral and popliteal blood flow for both calf (p < 0.035, p < 0.003), and plantar muscles (p < 0.0001, p < 0.009) on the stimulated side compared to the unstimulated side. The magnitude of the effect was similar for calf and plantar muscle stimulation. Subjects did not find the experience uncomfortable, and would use an electrical stimulator if told by their physician that they were at risk for developing blood clots. Mild electrical stimulation of the feet, as well as the calf, is a safe effective and convenient method for counteracting venous stasis and therefore has the potential to reduce the risk of deep vein thrombosis and pulmonary embolism for subjects who are immobilized.

Recanalization after acute deep vein thrombosis

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Gustavo Mucoucah Sampaio Brandao

2013-12-01

Full Text Available The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.

Venous Ligation: A Novel Strategy for Glans Enhancement in Penile Prosthesis Implantation

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Hsu, Geng-Long; Hill, James W.; Hsieh, Cheng-Hsing; Liu, Shih-Ping; Hsu, Chih-Yuan

2014-01-01

Although penile implantation remains a final solution for patients with refractory impotence, undesirable postoperative effects, including penile size reduction and cold sensation of the glans penis, remain problematic. We report results of a surgical method designed to avoid these problems. From 2003 to 2013, 35 consecutive patients received a malleable penile implant. Of these, 15 men (the enhancing group) were also treated with venous ligation of the retrocoronal venous plexus, deep dorsal...

Open heart surgery for management of right auricular thrombus related to central venous catheterization.

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Ribeiro, A F; Neto, I S; Maia, I; Dias, C

2018-04-19

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Enhanced venous thrombus resolution in plasminogen activator inhibitor type-2 deficient mice.

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Siefert, S A; Chabasse, C; Mukhopadhyay, S; Hoofnagle, M H; Strickland, D K; Sarkar, R; Antalis, T M

2014-10-01

The resolution of deep vein thrombosis requires an inflammatory response and mobilization of proteases, such as urokinase-type plasminogen activator (uPA) and matrix metalloproteinases (MMPs), to degrade the thrombus and remodel the injured vein wall. Plasminogen activator inhibitor type 2 (PAI-2) is a serine protease inhibitor (serpin) with unique immunosuppressive and cell survival properties that was originally identified as an inhibitor of uPA. To investigate the role of PAI-2 in venous thrombus formation and resolution. Venous thrombus resolution was compared in wild-type C57BL/6, PAI-2(-/-) , and PAI-1(-/-) mice using the stasis model of deep vein thrombosis. Formed thrombi were harvested, thrombus weights were recorded, and tissue was analyzed for uPA and MMP activities, PAI-1 expression, and the nature of inflammatory cell infiltration. We found that the absence of PAI-2 enhanced venous thrombus resolution, while thrombus formation was unaffected. Enhanced venous thrombus resolution in PAI-2(-/-) mice was associated with increased uPA activity and reduced levels of PAI-1, with no significant effect on MMP-2 and -9 activities. PAI-1 deficiency resulted in an increase in thrombus resolution similar to PAI-2 deficiency, but additionally reduced venous thrombus formation and altered MMP activity. PAI-2-deficient thrombi had increased levels of the neutrophil chemoattractant CXCL2, which was associated with early enhanced neutrophil recruitment. These data identify PAI-2 as a novel regulator of venous thrombus resolution, which modulates several pathways involving both inflammatory and uPA activity mechanisms, distinct from PAI-1. Further examination of these pathways may lead to potential therapeutic prospects in accelerating thrombus resolution. © 2014 International Society on Thrombosis and Haemostasis.

Prospective evaluation of {sup 99m}Tc-labelled recombinant tissue plasminogen activator in the detection of lower limb deep venous thrombosis in asymptomatic high risk patients

Energy Technology Data Exchange (ETDEWEB)

Butler, S.P.; Rahman, T.; Boyd, S.J.; Parkes, S.L.; Quinn, R.J. [St George Hospital, Kogarah, NSW (Australia)

1998-03-01

Full text: The purpose of this study was to compare the accuracy of this new technique against the accepted ``gold standard`` of contrast venography in 36 asymptomatic high risk patients. A kit formulation has been devised in which {sup 99m}Tc is labelled to rt- PA where the plasminogen binding site has been permanently inhibited but the fibrin binding site remained active. Kit preparation prior to injection takes five minutes. Scintigraphic imaging is performed at four hours post-injection (10 min/scan for thighs and calves). The results of scintigraphic imaging were then compared to those of contrast venography. 36 consecutive asymptomatic high risk patients (17 total hip, 19 total knee replacements) underwent both a contrast venogram on the operated leg and scintigraphic scan 7-10 days following operation. For the purpose of this analysis, each venogram was divided into a proximal and a distal segment. Venograms were interpreted as being positive, negative or uninterpretable in each segment. Similar analysis of the scintigraphic scans was performed except that all segments were considered to be of diagnostic quality. Fifty seven segments were able to be analysed. Of the 13 thrombosed segments (1 proximal, 12 calf ), 12 had positive scans; in the 44 non-thrombosed segments, 40 had negative scans. In detecting lower limb DVT, scanning had a sensitivity of 92% and a specificity of 91%. Scintigraphic scanning with inhibited {sup 99m}Tc rt-PA permits accurate detection of thrombus in high risk patients.

Does peroperative external pneumatic leg muscle compression prevent post-operative venous thrombosis in neurosurgery?

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Bynke, O; Hillman, J; Lassvik, C

1987-01-01

Post-operative deep venous thrombosis (DVT) is a frequent and potentially life-threatening complication in neurosurgery. In this field of surgery, with its special demands for exact haemostasis, prophylaxis against deep venous thrombosis with anticoagulant drugs has been utilized only reluctantly. Postoperative pneumatic muscle compression (EPC) has been shown to be effective, although there are several practical considerations involved with this method which limit its clinical applicability. In the present study per-operative EPC was evaluated and was found to provide good protection against DVT in patients with increased risk from this complication. This method has the advantage of being effective, safe, inexpensive and readily practicable.

The application of GxA8xB9nther Tulip retrievable inferior vena cava filter in interventional treatment for acute deep venous thrombosis of lower extremity

International Nuclear Information System (INIS)

Xiao Liang; Xu Ke; Shen Jing; Li Haiwei; Tong Jiajie; Zhang Xitong

2010-01-01

Objective: To discuss the therapeutic efficacy and manipulation skill of Gunther Tulip retrievable inferior vena cava filter in interventional treatment for acute deep venous thrombosis of lower extremity. Methods: From September 2007 to April 2008, a total of 36 patients with acute deep venous thrombosis of lower extremity were treated in our hospital. The time of the onset of disease ranged from 1 day to 12 days. The precipitation causes included prolonged lying in bed due to surgery or bone fracture (n = 18) and postpartum (n = 5), while no obvious precipitation causes could be found in 13 patients. Pulmonary embolism was coexisted in 12 cases. Clinically, the affected limb was swelling and painful, the skin was cyan-purple or pale in color with higher skin temperature. The circumferential length of the affected thigh was 3-10 cm longer than that of normal side. Patients with coexisted pulmonary embolism had the clinical presentation of dyspnea, chest pain, hemoptysis, etc. Gunther Tulip retrievable inferior vena cava filter was implanted via femoral venous access or via right internal jugular venous access, which was followed by intravenous transcatheter thrombolysis. Vascular ultrasonography and angiography were performed 45-75 days after the treatment to confirm that there was no fresh or free thrombus in the veins of lower limb or in the pulmonary arteries. When it was confirmed, Gunther Tulip retrievable inferior vena cava filter was taken out via right internal jugular venous access, which was followed by inferior venacavography. After the procedure anticoagulation and antibiotic medication were employed for 3-5 days. A follow-up for 4-10 months was made. Results: A total of 36 Gunther Tulip retrievable inferior vena cava filters were successfully implanted by one procedure, the average time cost for the filter delivery was 1.5 minutes (0.5-5 minutes). During the delivery procedure, the amplitude of elastic displacement of filter was less than 2 mm. One

The value of combined strain gauge plethysmography and radioactive iodine fibrinogen scan of the leg in the diagnosis of deep vein thrombosis

International Nuclear Information System (INIS)

AbuRahma, A.F.; Lawton, W.E. Jr.; Osborne, L.

1983-01-01

The fallibility of the clinical diagnosis of deep venous thrombosis has led to a variety of noninvasive diagnostic methods, for example, Doppler ultrasound, plethysmography, 125 I fibrinogen and radionuclide phlebography. This study was undertaken to analyze the value of combined strain gauge plethysmography and 125 I fibrinogen scan of the leg in the diagnosis of deep venous thrombosis. The study was carried out upon 368 patients with suggestive findings of venous thrombosis. Four hundred and fifty strain gauge plethysmograms were reviewed. Venograms were done upon 106 limbs and 125 I fibrinogen leg scans, on 136 limbs. Of the 64 limbs with normal strain gauge plethysmograms which had venograms, 58 were normal, five had incompetent perforators and one limb had deep venous thrombosis. Of the 42 legs with abnormal strain gauge plethysmograms which had venograms, 25 had deep venous thrombosis, 15 had incompetent perforators and two were normal. Twenty-three of 24 legs having both abnormal strain gauge plethysmograms and leg scans were confirmed to have deep venous thrombosis at venography. Fourteen of 18 legs with abnormal strain gauge plethysmograms but normal scans were found to have incompetent perforators. We conclude, that the strain gauge plethysmogram is a reliable test in excluding deep venous thrombosis and, when combined with the fibrinogen leg scan, is reliable in its diagnosis

D-Dimer and prothrombin fragment 1 + 2 in urine and plasma in patients with clinically suspected venous thromboembolism.

Science.gov (United States)

Wexels, Fredrik; Seljeflot, Ingebjørg; Pripp, Are H; Dahl, Ola E

2016-06-01

Increased levels of urine prothrombin fragment 1 + 2 was recently reported to be associated with imaging-verified venous thromboembolism. In this study we evaluated the relationship between plasma D-dimer and plasma and urine prothrombin fragment 1 + 2 in patients with suspected venous thromboembolism. Urine and blood samples were collected from patients with suspected pulmonary embolism or deep vein thrombosis. The samples were analysed with commercially available ELISA kits. The diagnosis of venous thromboembolism was verified with contrast-enhanced computer tomography of the pulmonary arteries or lower extremity deep vein compression ultrasound and venography as appropriate. Venous thromboembolism was diagnosed in 150 of 720 patients. Significantly higher levels of plasma D-dimer and prothrombin fragment 1 + 2 in plasma and urine were found in those with imaging-confirmed venous thromboembolism versus those without (P fragment 1 + 2 in plasma. Further development of ELISA analyses for urine testing of prothrombin fragment 1 + 2 may improve its diagnostic accuracy.

Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

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Mohammad Ali Akbarzadeh

2016-08-01

Full Text Available Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication is not known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated.

Evaluation of venous congestion in dural arteriovenous fistulae using the acetazolamide test

International Nuclear Information System (INIS)

Deguchi, Jun; Yamada, Makoto; Kobata, Hitoshi; Kuroiwa, Toshihiko

2002-01-01

The pattern of venous drainage determines the clinical presentation of dural arteriovenous fistulas (AVFs). We assessed the degree of venous congestion in dural AVFs using acetazolamide test and stable Xenon-CT. In 11 patients (8 sigmoid-transverse dural AVFs, 3 cavernous dural AVFs) before treatment and in 8 patients 6 months after treatment, cerebral hemodynamics were studied by stable Xenon-CT. Regions of interest (ROI) were placed in the temporo-occipital region in cases of sigmoid-transverse AVFs, and in the frontal operculum in cases of cavernous AVFs. Patients were classified into 5 groups according to Cognard's classification. In the groups without venous reflux (Cognard type I) and reflux only to the venous sinus (type IIa), regional cerebral blood flow (rCBF) at rest and after acetazolamide challenge were normal. In the group showing reflux to the cortical vein (type IIb), the increase in rCBF after acetazolamide challenge on the lesion side was less than that on the opposite side. In the group showing reflux to both cortical vein and sinus (type IIa+b), rCBF did not increase after acetazolamide challenge. The CBF and increase in rCBF after acetazolamide in the symptomatic group were significantly lower than those in the asymptomatic group. After embolization, the increase in rCBF by acetazolamide improved in all except for type III cases. Cerebral venous hypertension in dural AVFs causes weak response to acetazolamide challenge. The degree of venous hypertension can be evaluated quantitatively by acetazolamide challenge and stable Xenon-CT. Therefore acetazolamide challenge is useful for determination of the embolization of dural AVFs. (author)

[Clinical scores for the venous thromboembolic disease: an aid for the diagnosis and the treatment?].

Science.gov (United States)

Junod, A

2015-03-04

The venous thromboembolic disease includes a wide range of conditions from well defined medical entities (pulmonary embolism, deep venous thrombosis), their diagnosis and prognosis, as well as the risk of developping a venous thromboembolic disease in association with hospitalisation for acute medical illness and with cancer. The assessment of the risk of treatment with anticoagulants is also itaken into account. For all these medical situations, numerous (approximately 50) clinical scores have been reported. They will be presented and critically analysed in the next series of 6 articles.

Aortic pseudoaneurysm detected on external jugular venous distention following a Bentall procedure 10 years previously.

Science.gov (United States)

Fukunaga, Naoto; Shomura, Yu; Nasu, Michihiro; Okada, Yukikatsu

2010-11-01

An asymptomatic 49-year-old woman was admitted for the purpose of surgery for aortic pseudoaneurysm. She had Marfan syndrome and had undergone an emergent Bentall procedure 10 years previously. About six months previously, she could palpate distended bilateral external jugular veins, which became distended only in a supine position and without any other symptoms. Enhanced computed tomography revealed an aortic pseudoaneurysm originating from a previous distal anastomosis site. During induction of general anesthesia in a supine position, bilateral external jugular venous distention was remarkable. Immediately after a successful operation, distention completely resolved. The present case emphasizes the importance of physical examination leading to a diagnosis of asymptomatic life-threatening diseases in patients with a history of previous aortic surgery.

Extensive deep vein thrombosis following prolonged gaming ('gamer's thrombosis'): a case report.

Science.gov (United States)

Chang, Hsien-Cheng Leon; Burbridge, Hayley; Wong, Conroy

2013-10-08

The average time spent playing video games is increasing. Prolonged immobility associated with gaming may therefore be an important risk factor for venous thromboembolism. We report a case of deep vein thrombosis associated with prolonged playing of PlayStation® games. A 31-year-old Caucasian man, an exterior painter, presented with a three-day history of left leg pain and swelling after playing PlayStation® games for almost eight hours a day for four consecutive days. Doppler ultrasound of the left leg confirmed extensive left leg deep venous thrombosis requiring thrombolysis and anticoagulation. Video gaming should be considered a risk factor for venous thromboembolism. Further studies are needed to estimate the degree of risk associated with prolonged periods of playing video games, and education for preventing venous thrombosis should be provided to gamers.

The use of natural language processing on pediatric diagnostic radiology reports in the electronic health record to identify deep venous thrombosis in children.

Science.gov (United States)

Gálvez, Jorge A; Pappas, Janine M; Ahumada, Luis; Martin, John N; Simpao, Allan F; Rehman, Mohamed A; Witmer, Char

2017-10-01

Venous thromboembolism (VTE) is a potentially life-threatening condition that includes both deep vein thrombosis (DVT) and pulmonary embolism. We sought to improve detection and reporting of children with a new diagnosis of VTE by applying natural language processing (NLP) tools to radiologists' reports. We validated an NLP tool, Reveal NLP (Health Fidelity Inc, San Mateo, CA) and inference rules engine's performance in identifying reports with deep venous thrombosis using a curated set of ultrasound reports. We then configured the NLP tool to scan all available radiology reports on a daily basis for studies that met criteria for VTE between July 1, 2015, and March 31, 2016. The NLP tool and inference rules engine correctly identified 140 out of 144 reports with positive DVT findings and 98 out of 106 negative reports in the validation set. The tool's sensitivity was 97.2% (95% CI 93-99.2%), specificity was 92.5% (95% CI 85.7-96.7%). Subsequently, the NLP tool and inference rules engine processed 6373 radiology reports from 3371 hospital encounters. The NLP tool and inference rules engine identified 178 positive reports and 3193 negative reports with a sensitivity of 82.9% (95% CI 74.8-89.2) and specificity of 97.5% (95% CI 96.9-98). The system functions well as a safety net to screen patients for HA-VTE on a daily basis and offers value as an automated, redundant system. To our knowledge, this is the first pediatric study to apply NLP technology in a prospective manner for HA-VTE identification.

Homocysteine and venous thrombosis : studies into risk and therapy

NARCIS (Netherlands)

Willems, Huub Pieter Jan

2006-01-01

Homocysteine is a risk factor for venous thrombosis. Elevated concentrations can be treated with folic acid, vitamin B6 and vitamin B12. The main study (chapter 9) in this thesis is a randomized placebo-controlled trial in which patients with a first event of deep-vein thrombosis or pulmonary

Urinary hemosiderin: role in evaluation of chronic venous insufficiency

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Ashish Lal Shrestha

2012-08-01

Full Text Available Chronic venous insufficiency (CVI leads to skin changes with dermal hemosiderin deposition. We studied the presence of hemosiderin in the urine to assess if this could be used as a biochemical marker for CVI. Hereby we present a case control study conducted in a tertiary care centre in South India. There were 100 cases with evidence of advanced CVI (the Clinical-Etiology-Anatomy-Pathophysiology classification: C5, C6 confirmed by duplex scanning. Controls were 50 patients with leg ulcers due to other etiologies. All patients were subjected to urinary hemosiderin testing. In all 100 patients with CVI (C5 and C6 disease axial venous reflux was confirmed by duplex ultrasound. Superficial venous reflux was noted in 71% of patients and deep venous reflux in 54.%. Primary venous insufficiency was the etiology in 81% of patients. Only 4/100 patients had detectable amounts of hemosiderin in the urine. Urine hemosiderin testing to determine presence or absence of CVI yielded the following values: positive predictive value-80%; negative predictive value-33%; sensitivity-4% and specificity-98%. The test could not be recommended as a marker of CVI. In Indian patients urinary hemosiderin is not a useful screening test in CVI.

O papel do mapeamento dúplex no diagnóstico da trombose venosa profunda assintomática dos membros inferiores Role of duplex scanning in the diagnosis of asymptomatic lower-extremity deep vein thrombosis

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Mariangela Giannini

2005-09-01

Full Text Available O diagnóstico da trombose venosa profunda sintomática está bem estabelecido com o uso do mapeamento dúplex, que apresenta sensibilidade de 100% e especificidade de 98%, para trombose venosa profunda proximal, e sensibilidade de 94% e especificidade de 75%, para distal. Na trombose venosa profunda recente e assintomática, o diagnóstico com o mapeamento dúplex ainda não está bem estabelecido, mostrando uma queda na acurácia desse método diagnóstico. Essa queda é devida ao fato de o trombo recente não ser oclusivo, apresentar a mesma ecogenicidade do sangue e uma consistência diminuída, prejudicando o teste da compressibilidade, que é o mais sensível para diagnóstico da trombose venosa profunda. Nesta revisão, serão revistos artigos publicados que avaliaram a acurácia do mapeamento dúplex no diagnóstico da trombose venosa profunda assintomática.The diagnosis of symptomatic deep vein thrombosis is well established using duplex scanning, with a sensitivity of 100% and specificity of 98% for proximal deep vein thrombosis, and 94% sensitivity and 75% specificity for distal deep vein thrombosis. In the early and asymptomatic deep vein thrombosis, diagnosis by duplex scanning is not well established yet, which shows a decrease in the accuracy of this diagnostic method. This is because the fresh thrombus is not occlusive, has the same echogenicity as blood and a reduced consistency, jeopardizing the compressibility test, which is the most sensitive test for deep vein thrombosis. This article will review published articles, which evaluated the accuracy of the duplex scanning in the diagnosis of asymptomatic deep vein thrombosis.

Epidemiological study of venous thromboembolism in a big Danish cohort

DEFF Research Database (Denmark)

Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim

Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... were probable cases (1.7%) whereas for 449 (41.6%) the diagnosis could be excluded. The incidence rate was 1 per 1000 personyears. Out of the 632 cases 60% were DVT and 40% PE. 315 VT were considered idiopathic (49.8%), 311 were secondary (49.2%) and 15 were unclassifiable. 122 patients had cancer, 87...

The role of molecular imaging in diagnosis of deep vein thrombosis

DEFF Research Database (Denmark)

Houshmand, Sina; Salavati, Ali; Hess, Søren

2014-01-01

Venous thromboembolism (VTE) mostly presenting as deep venous thrombosis (DVT) and pulmonary embolism (PE) affects up to 600,000 individuals in United States each year. Clinical symptoms of VTE are nonspecific and sometimes misleading. Additionally, side effects of available treatment plans for D...

Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain.

Science.gov (United States)

Pichi, Francesco; Freund, K Bailey; Ciardella, Antonio; Morara, Mariachiara; Abboud, Emad B; Ghazi, Nicola; Dackiw, Christine; Choudhry, Netan; Souza, Eduardo Cunha; Cunha, Leonardo Provetti; Arevalo, J Fernando; Liu, T Y Alvin; Wenick, Adam; He, Lingmin; Villarreal, Guadalupe; Neri, Piergiorgio; Sarraf, David

2018-04-01

Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain. To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations. In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017. Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available. Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%). Our study has

The effect of ankle joint immobilization on lower limb venous flow.

Science.gov (United States)

Craik, Johnathan D; Clark, Amanda; Hendry, James; Sott, Andrea H; Hamilton, Paul D

2015-01-01

Below-knee cast immobilization is associated with an increased risk of developing deep vein thrombosis secondary to venous stasis. We investigated the effect of weight-bearing in a below-knee cast or pneumatic walking boot on lower limb venous blood flow. Duplex ultrasonography was used to measure venous blood flow in the popliteal vein of 10 healthy volunteers. Venous blood flow was measured while at rest, ambulating non-weight-bearing, partial weight-bearing, and full weight-bearing. Measurements were performed without ankle joint immobilization, with the ankle immobilized in a neutral cast, and with the ankle immobilized in a pneumatic walking boot in both neutral and equinus. There was no significant reduction in venous blood flow measurements between full weight-bearing without ankle joint immobilization and full weight-bearing in a neutral cast or neutral pneumatic walking boot. However, venous blood flow was reduced when partial weight-bearing (50%) and when full weight-bearing in a pneumatic walking boot in equinus. These results demonstrate that venous blood flow returned to normal levels when the subjects were permitted to fully bear weight in below-knee casts or walking boots, provided that the ankle joint was not in equinus. Weight-bearing status and ankle joint position should be appreciated during decisions for the provision of chemical thromboprophylaxis. © The Author(s) 2014.

Deep vein thrombus formation induced by flow reduction in mice is determined by venous side branches.

Science.gov (United States)

Brandt, Moritz; Schönfelder, Tanja; Schwenk, Melanie; Becker, Christian; Jäckel, Sven; Reinhardt, Christoph; Stark, Konstantin; Massberg, Steffen; Münzel, Thomas; von Brühl, Marie-Luise; Wenzel, Philip

2014-01-01

Interaction between vascular wall abnormalities, inflammatory leukocytes, platelets, coagulation factors and hemorheology in the pathogenesis of deep vein thrombosis (DVT) is incompletely understood, requiring well defined animal models of human disease. We subjected male C57BL/6 mice to ligation of the inferior vena cava (IVC) as a flow reduction model to induce DVT. Thrombus size and weight were analyzed macroscopically and sonographically by B-mode, pulse wave (pw) Doppler and power Doppler imaging (PDI) using high frequency ultrasound. Thrombus size varied substantially between individual procedures and mice, irrespective of the flow reduction achieved by the ligature. Interestingly, PDI accurately predicted thrombus size in a very robust fashion (r2 = 0.9734, p thrombus weight (r2 = 0.5597, p thrombus formation. Occlusion of side branches prior to ligation of IVC did not increase thrombus size, probably due to patent side branches inaccessible to surgery. Venous side branches influence thrombus size in experimental DVT and might therefore prevent thrombus formation. This renders vessel anatomy and hemorheology important determinants in mouse models of DVT, which should be controlled for.

[Clinical analysis of patients with lower extremity deep venous thrombosis complicated with inferior vena cava thrombus].

Science.gov (United States)

Dong, Dian-ning; Wu, Xue-jun; Zhang, Shi-yi; Zhong, Zhen-yue; Jin, Xing

2013-06-04

To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences. The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively. All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases. Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

An unusual case of repeated venous air embolism during awake ...

African Journals Online (AJOL)

Keywords: awake craniotomy, burr hole, deep brain stimulation, neurosurgery, venous air embolism. Introduction ... surgery started with the right burr hole and after the dura mater was opened, the ... opened. The patient was initially comfortable but then developed ... The surgery for the insertion of DBS on the left side was.

Identificação pelo eco-Doppler colorido de fístula arteriovenosa na trombose venosa profunda Arteriovenous fistula in deep venous thrombosis identified by color-flow Doppler ultrasonography

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Fanilda Souto Barros

2006-09-01

Full Text Available Os três casos são referentes a pacientes em tratamento para trombose venosa profunda encaminhados ao laboratório vascular para avaliação da recanalização e/ou progressão do processo trombótico. Durante o estudo pelo eco-Doppler colorido, foram identificados sinais ecográficos compatíveis com fístula arteriovenosa no interior do trombo e adjacente à parede venosa.We report on a case series of three patients undergoing treatment for deep venous thrombosis, referred to our vascular laboratory for evaluation of recanalization and/or progression of the thrombotic process. During the color-flow Doppler ultrasonography, we identified ultrasound signs typical of arteriovenous fistula flow pattern within the thrombus and adjacent to the venous wall.

In-111 platelet scintigraphy for detection of lower-extremity deep venous thrombophlebitis: Are 4-hour delayed images sufficient

International Nuclear Information System (INIS)

Seabold, J.E.; Conrad, G.R.; Ponto, J.A.; Kimball, D.A.; Frey, E.E.; Coughlan, J.D.; Ahmed, F.; Jensen, K.C.

1986-01-01

Twenty-one nonheparinized patients suspected of having lower-extremity deep venous thrombosis underwent 4- and 24-hour In-111-labeled platelet scintigraphy (PS) and lower-extremity contrast venography (CV). Eleven of the 21 patients (52%) had one or more intraluminal filling defects on CV, indicating active thrombophlebitis. In seven of these 11 patients (64%) In-PS was abnormal at 4 hours, and in ten (91%) at 24 hours. All patients with abnormal studies at 4 hours showed greater uptake of more abnormal sites at 24 hours. Of the ten patients with CV-negative studies, two had abnormal bilateral lower pelvis/upper thigh uptake in In-PS at 24 hours. These two In-PS studies were considered to be false positive. Twenty-four-hour In-PS images are necessary if 4-hour images show faint focal uptake of asymmetric blood pool activity, or are normal

Lower extremity arterial and venous ulcers.

Science.gov (United States)

Sieggreen, Mary

2005-06-01

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.

Venous thromboembolism during hip plaster cast immobilisation: review of the literature

NARCIS (Netherlands)

Struijk-Mulder, M. C.; Ettema, H. B.; Heyne, R. A. J.; Rondhuis, J. J.; Büller, H. R.; Verheyen, C. C. P. M.

2014-01-01

There is a paucity of data regarding the risk of deep vein thrombosis during hip plaster cast immobilisation. The purpose of this article was to review the available evidence regarding the incidence of symptomatic venous thromboembolism (VTE) during hip plaster cast immobilisation. All papers

Method for determining the schematic presentation for the cortical sulci and venous system

International Nuclear Information System (INIS)

Tatemichi, Nobuhiro; Nakano, Hirotake; Inoue, Yoshiharu.

1994-01-01

To realize the corticogram of major sulci and venous system, two different image modalities must be superposed with a minimum error : MRI, MRA and X-Ray angiography. The precise schema of cortical sulci have to become possible with the aid of the IR method of MRI that could clearly identify the sulcal system of the outer and internal surface of the hemisphere. The correspondence of the major venous system of MRI with that of angiography was carried out using several skin markers, bone structures and a deep major venous system. This corticogram was used by the neurosurgeons of the hospital for the electrode placement, the topographical identification of the cortical paroxysms and epilepsy surgery. The best argument for the accuracy of sulcal and venous schema could be offered by somato-sensory evoked potential identifying the central sulcus on the corticogram. (author)

Venous compression syndromes: Causes, diagnosis, and therapy from the radiological point of view

International Nuclear Information System (INIS)

Alfke, H.; Ishaque, N.; Froehlich, J.J.; Klose, K.J.

1997-01-01

Venous compression is a clinical entity distinct from deep vein thrombosis although the clinical signs may be indistinguishable. Reasons for venous compression are tumors, scars, hematomas, postoperative changes and anatomic variations. The differential diagnosis between compression and thrombosis is important because therapy and prognosis differ markedly between the two patient groups. Ultrasound, computed tomography and magnetic resonance tomography are the diagnostic tools of choice because they offer not only information about the intraluminal situation but also about the extraluminal pathology. (orig.) [de

The influence of meteorological variables on the development of deep venous thrombosis.

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Brown, Helen K; Simpson, A John; Murchison, John T

2009-10-01

The influence of weather on deep venous thrombosis (DVT) incidence remains controversial. We aimed to characterize the temporal association between DVT and meteorological variables including atmospheric pressure. Data relating to hospital admissions with DVT in Scotland were collected retrospectively for a 20 year period for which corresponding meteorological recordings were available. Weather variables were calculated as weighted daily averages to adjust for variations in population density. Seasonal variation in DVT and short-term effects of weather variables on the relative risk of developing DVT were assess using Poisson regression modelling. The models allowed for the identification of lag periods between variation in the weather and DVT presentation. A total of 37,336 cases of DVT were recorded. There was significant seasonal variation in DVT with a winter peak. Seasonal variation in wind speed and temperature were significantly associated with seasonal variation in DVT. When studying more immediate meteorological influences, low atmospheric pressure, high wind speed and high rainfall were significantly associated with an increased risk of DVT approximately 9-10 days later. The effect was most strikingly demonstrated for atmospheric pressure, every 10 millibar decrease in pressure being associated with a 2.1% increase in relative risk of DVT. Alterations in weather have a small but significant impact upon the incidence of DVT. DVT is particularly associated with reduction in atmospheric pressure giving weight to the hypothesis that reduced cabin pressure in long haul flights contributes to DVT. These findings have implications for our understanding of the pathogenesis of DVT.

Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

DEFF Research Database (Denmark)

Stender, Mogens; Frøkjaer, Jens Brøndum; Hagedorn Nielsen, Tina Sandie

2008-01-01

The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low...... preoperative DVT in colorectal cancer patients admitted for surgery. Preoperative D-dimer test and compression ultrasonography for DVT were performed in 193 consecutive patients with newly diagnosed colorectal cancer. Diagnostic accuracy indices of the D-dimer test were assessed according to the PTP score...... in ruling out preoperative DVT in colorectal cancer patients admitted for surgery....

Asymptomatic Primary Hyperparathyroidism

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Silverberg, Shonni J.; Walker, Marcella D.; Bilezikian, John P.

2014-01-01

The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term “asymptomatic primary hyperparathyroidism” was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease. PMID:23374736

Acute deep venous thrombosis of lower extremity: anatomical distribution, comparison of anticoagulation, thrombolysis and interventional therapy

International Nuclear Information System (INIS)

Zhuang; Naijun; Che Guoping; Gu Jianping; Lou Wensheng; He Xu; Chen Liang; Su Haobo; Song Jinhua; Wang Tao; Xu Ke

2011-01-01

Objective: To investigate the anatomical distribution of acute deep venous thrombosis (DVT) of the lower extremity, and compare different therapeutic methods including anticoagulation alone, thrombolysis through dorsal vein and interventional therapy. Methods: The clinical data, venography and therapies of 204 acute DVT patients were retrospectively studied According to the distribution, DVT were classified into three types including peripheral, central and mixed types. According to the difference of the therapeutic method, each type of DVT was divided into three groups, Group A (37 patients) anticoagulation alone: Group B (55 patients) thrombolysis through dorsal vein: and Group C (112 patients) interventional therapy. The results of different kind of treatment method in each type of DVT were evaluated before the patients were discharged and the Chi-square test was used for statistical analysis. Results: There were 132 patients with DVT in the left lower extremity, 62 in right lower extremity, and 10 in both extremities.. The complication of pulmonary embolism (PE) occurred in 4, 5 and 2 cases respectively, and the morbidity was 3.0%, 8.1% and 20.0% (χ 2 =6.494, P=0.039) respectively. There was significant statistical difference among them. There were 23 cases of peripheral type of DVT, 48 central type and 133 mixed type. The complication of PE were observed in 2, 5 and 4 cases respectively in each type. The morbidity was 8.7%, 10.4% and 3.0% respectively (χ 2 =4.350, P=0.114). There were no statistical significance among them. In the 23 cases of peripheral type DVTs, 2 of 5 in group A and 11 of 18 in group B had excellent therapeutic response. In the 48 cases of central type of DVTs, 1 of 10 in group A, 2 of 5 in in group B and 26 of 33 in group C had excellent therapeutic response. There were statistically significant differences among groups A, B and C (χ 2 =16.157, P=0.000). In the 133 cases of mixed type DVTs, 1 of 22 in group A, 10 of 32 in group B and 65

Retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep venous thrombosis in perinatal period

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Koecher, Martin [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)], E-mail: martin.kocher@seznam.cz; Krcova, Vera [Department of Hematooncology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Cerna, Marie [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Prochazka, Martin [Department of Obstetrics and Gynaecology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)

2009-04-15

Objectives: To evaluate the feasibility and efficacy of the retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep vein thrombosis in the perinatal period and to discuss the technical demands associated with the filter's implantation and retrieval. Methods: Between 1996 until 2007, eight women (mean age 27.4 years, range 20-42 years) with acute deep iliofemoral venous thrombosis in the perinatal period of pregnancy and increased risk of pulmonary embolism during delivery were indicated for retrievable Guenther Tulip Vena Cava Filter implantation. All filters were inserted and removed under local anesthesia from the jugular approach. Results: The Guenther Tulip Vena Cava Filter was implanted suprarenally in all patients on the day of caesarean delivery. In follow-up cavograms performed just before planned filter removal, no embolus was seen in the filter in any patient. In all patients the filter was retrieved without complications on the 12th day after implantation. Conclusions: Retrievable Guenther Tulip Vena Cava Filters can be inserted and removed in patients during the perinatal period without major complications.

Retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep venous thrombosis in perinatal period

International Nuclear Information System (INIS)

Koecher, Martin; Krcova, Vera; Cerna, Marie; Prochazka, Martin

2009-01-01

Objectives: To evaluate the feasibility and efficacy of the retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep vein thrombosis in the perinatal period and to discuss the technical demands associated with the filter's implantation and retrieval. Methods: Between 1996 until 2007, eight women (mean age 27.4 years, range 20-42 years) with acute deep iliofemoral venous thrombosis in the perinatal period of pregnancy and increased risk of pulmonary embolism during delivery were indicated for retrievable Guenther Tulip Vena Cava Filter implantation. All filters were inserted and removed under local anesthesia from the jugular approach. Results: The Guenther Tulip Vena Cava Filter was implanted suprarenally in all patients on the day of caesarean delivery. In follow-up cavograms performed just before planned filter removal, no embolus was seen in the filter in any patient. In all patients the filter was retrieved without complications on the 12th day after implantation. Conclusions: Retrievable Guenther Tulip Vena Cava Filters can be inserted and removed in patients during the perinatal period without major complications.

CT findings of posterior fossa venous angiomas

International Nuclear Information System (INIS)

Satoh, Toru; Kinugasa, Kazushi; Nishimoto, Akira; Nishimoto, Ken.

1986-01-01

Three cases of posterior fossa venous angiomas were reported, with some comments on the CT findings. Case 1: A 53-year-old woman was admitted for the further examination of a viral meningitis which had appeared three months before. Neurological examination revealed no abnormality. Vertebral angiography, however, demonstrated numerous fine medullary veins, with an enlarged intraparenchymal draining vein, in the right cerebellum; they drained into the petrosal vein, which was characteristic of venous angioma. On the plain CT, part of the draining vein was identified as a slightly high-density node. A curvilinear draining vein was demonstrated by the enhanced CT. Case 2: A 29-year-old man was admitted complaining of headache, vomiting, and atxia. Neurological examination disclosed truncal ataxia. The enhanced CT demonstrated two distinct nodules on the anterior border of the hematoma in the deep median cerebellum, probably corresponding to the draining veins. On the angiogram, a venous angioma was found in the bilateral cerebellum; it drained into the precentral cerebellar veins and ultimately joined the straight sinus via the precentro-vermo-rectal vein. Case 3: A 4-year-old boy was admitted suffering from headache, vomiting, and ataxia. Neurological examination disclosed a co-ordination disturbance of the left side. The enhanced CT demonstrated a curvilinear structure inside the hematoma. Angiography showed a venous angioma in the left cerebellum which drained into the petrosal vein. Computerized angiotomography delineated the characteristic venous structure on the angiogram as many fine, high-density lines (medullary veins) converging to a large intraparenchymal linear structure (central medullary vein) and then to a superficial cortical vein. In all cases, large intraparenchymal draining veins were identified by the conventional CT. (J.P.N.)

Traditional Chinese and western medicine for the prevention of deep venous thrombosis after lower extremity orthopedic surgery: a meta-analysis of randomized controlled trials.

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Zhu, Shibai; Song, Yi; Chen, Xi; Qian, Wenwei

2018-04-10

Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery. Relevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis. A total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the D-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0

Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature.

Science.gov (United States)

Johansson, Eva; Hammarskjöld, Fredrik; Lundberg, Dag; Arnlind, Marianne Heibert

2013-06-01

The use of central venous lines carries a significant risk for serious complications and high economic costs. Lately, the peripherally inserted central venous catheter (PICC) has gained in popularity due to presumed advantages over other central venous lines. The aim of this systematic literature review was to identify scientific evidence justifying the use of PICC. The literature review was performed according to the principles of Cochrane Collaboration. The electronic literature search included common databases up to March 2011. Only those studies rated as high or moderate quality were used for grading of evidence and conclusions. The search resulted in 827 abstracts, 48 articles were read in full text, and 11 met the inclusion criteria. None of the articles was classified as high quality and two had moderate quality. The results of these two studies indicate that PICC increases the risk for deep venous thrombosis (DVT), but decreases the risk for catheter occlusion. The quality of scientific evidence behind these conclusions, however, was limited. Due to the lack of studies with sufficiently high quality, questions such as early complications, patient satisfaction and costs could not be answered. We conclude that although PICCs are frequently used in oncology, scientific evidence supporting any advantage or disadvantage of PICC when comparing PICC with traditional central venous lines is limited, apart from a tendency towards increased risk for DVT and a decreased risk for catheter occlusion with PICC.

Intervention radiology for venous thrombosis: early thrombus removal using invasive methods.

Science.gov (United States)

Casanegra, Ana I; McBane, Robert D; Bjarnason, Haraldur

2017-04-01

The post thrombotic syndrome is one of the most dreaded complications of proximal deep vein thrombosis. This syndrome leads to pain and suffering with leg swelling, recalcitrant ulceration and venous claudication which greatly impairs mobility and quality of life. The prevalence can be high in patients with iliofemoral venous involvement particularly in the setting of a proximal venous stenosis, such as occurs in May Thurner syndrome. Anticoagulation alone does not reduce the likelihood of this outcome. Compression therapy may be effective but garment discomfort limits its implementation. Pharmacomechanical thrombectomy, which combines catheter-directed thrombolysis with mechanical thrombus dissolution, provides an attractive treatment strategy for such patients. The rationale and delivery of pharmacomechanical thrombectomy, including patient selection and adjunctive antithrombotic therapy, will be reviewed in addition to tips and tricks for managing difficult patient scenarios. © 2017 John Wiley & Sons Ltd.

Asymptomatic bacteriuria in pregnancy.

Science.gov (United States)

Smaill, Fiona

2007-06-01

Screening for asymptomatic bacteriuria is a standard of obstetrical care and is included in most antenatal guidelines. There is good evidence that treatment of asymptomatic bacteriuria will decrease the incidence of pyelonephritis. All pregnant women should be screened for asymptomatic bacteriuria, and there are no new data that would indicate otherwise. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of preterm delivery or low birth weight, but the methodological quality of the studies means any conclusion about the strength of this association needs to be drawn cautiously. A better understanding of the mechanism by which treatment of asymptomatic bacteriuria could prevent preterm delivery is needed. While several rapid screening tests have been evaluated, none perform adequately to replace urine culture for detecting asymptomatic bacteriuria. Until there are data from well-designed trials that establish the optimal duration of therapy for asymptomatic bacteriuria, standard treatment courses are recommended.

Treatment of Pelvic Venous Spur (May-Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

International Nuclear Information System (INIS)

Binkert, Christoph A.; Schoch, Eric; Stuckmann, Gerd; Largiader, Jon; Wigger, Pius; Schoepke, Wolfdietrich; Zollikofer, Christoph L.

1998-01-01

Purpose: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. Methods: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. Results: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. Conclusion: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur

Return to normal of sup(99m)Tc-plasmin test after deep venous thrombosis and its relationship to vessel wall fibrinolysis

Energy Technology Data Exchange (ETDEWEB)

Edenbrandt, C.M.; Hedner, U.; Tengborn, L.; Nilsson, J.; Ohlin, P.

1986-08-01

Fourteen patients with deep venous thrombosis (DVT) and a positive sup(99m)Tc-plasmin test were followed up to determine how soon a negative test was obtained. Localization and extension of the thrombi were determined by phlebography. Plasminogen activator activity in vein walls and local fibrinolytic activity after venous occlusion were measured in order to find out what the prerequisites for impaired thrombolysis are. The time required to obtain a negative sup(99m)Tc-plasmin test showed considerable variation, ranging from less than 1 week to more than 6 months. The sup(99m)Tc-plasmin test had returned to normal in 64% of the patients after 6 months. No relationship was found between vessel wall fibrinolysis and time to normalization. Instead, we found an association between the time to normalization of the sup(99m)Tc-plasmin test and the size of the thrombus, according to phlebography, as well as between the time to normalization of the sup(99m)Tc-plasmin test and the extension of leg points with a positive sup(99m)Tc-plasmin test at admission. The finding of abnormal sup(99m)Tc-plasmin test results more than 6 months after acute DVT is of practical importance and warrants caution when evaluating patients with symptoms and signs suggestive of acute recurrent DVT.

Idiopathic versus secondary venous thromboembolism. Findings of the RIETE registry.

Science.gov (United States)

Pedrajas, J M; Garmendia, C; Portillo, J; Gabriel, F; Mainez, C; Yera, C; Monreal, M

2014-10-01

The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor). We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation. A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (p<.001). The initial treatment was similar for the 2 groups, but more inferior vena cava filters were placed in the SVT group (p<.001). In the long term, low-molecular-weight heparin was used more often in the SVT group than in the IVT group. At 90days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95%CI, 0.50-0.61; p<.001) and fatal (OR, 0.41; 95%CI, 0.29-0.62; p<.001) bleedings, fewer relapses (OR, 0.58; 95%CI, 0.39-0.78; p<.001) and fewer fatal pulmonary embolisms (OR, 0.29; 95%CI, 0.12-0.52; p<.001). These differences were maintained in patients whose venous thromboembolism started with a pulmonary embolism or with deep vein thrombosis. IVT has a better prognosis than SVT at 90days of the diagnosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Extensive deep vein thrombosis following prolonged gaming (‘gamer’s thrombosis’): a case report

Science.gov (United States)

2013-01-01

Introduction The average time spent playing video games is increasing. Prolonged immobility associated with gaming may therefore be an important risk factor for venous thromboembolism. We report a case of deep vein thrombosis associated with prolonged playing of PlayStation® games. Case presentation A 31-year-old Caucasian man, an exterior painter, presented with a three-day history of left leg pain and swelling after playing PlayStation® games for almost eight hours a day for four consecutive days. Doppler ultrasound of the left leg confirmed extensive left leg deep venous thrombosis requiring thrombolysis and anticoagulation. Conclusions Video gaming should be considered a risk factor for venous thromboembolism. Further studies are needed to estimate the degree of risk associated with prolonged periods of playing video games, and education for preventing venous thrombosis should be provided to gamers. PMID:24192285

Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

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Pooja Binnani

2012-01-01

Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

Pancreatic endocrine tumor with neoplastic venous thrombus and bilobar liver metastasis. A case report.

Science.gov (United States)

Barbier, L; Turrini, O; Sarran, A; Delpero, J-R

2010-02-01

We report the case of an asymptomatic 56-year-old woman with a metastatic pancreatic endocrine tumor, fortuitously discovered by abdominal imaging. A CT-scan showed a large mass in the pancreatic tail invading the spleen and stomach; in addition, there was neoplastic thrombus within the spleno-mesentericoportal venous confluence and bilobar liver metastases. Surgical resection was performed in two stages. The first procedure was an extended left pancreatectomy with venous thrombectomy and "clearance" of the left hepatic lobe. During the interval, embolization of the right portal vein was carried out. Right hepatectomy and radiofrequency destruction of residual metastases was then performed. On the basis of completeness of the resection and the histopathological data, the patient did not undergo any adjuvant therapy, in accordance with French guidelines. At 1 year of follow-up, there was no evidence of recurrence. (c) 2010 Elsevier Masson SAS. All rights reserved.

The application of bilateral femoral vein approaches in interventional treatment of deep venous thrombosis of left lower extremity

International Nuclear Information System (INIS)

Wang Xiuping; Liu Jian; Wang Bin; Yao Zhongqiang; Zhang Yan; Li Chen

2011-01-01

Objective: To investigate the feasibility of interventional catheterization with bilateral femoral vein approaches for performing the thrombolytic treatment of acute deep venous thrombosis of left lower extremity. Methods: Antegrade puncturing into the left femoral vein was carried out in eighteen patients with acute deep vein thrombosis in the left lower extremity after left iliac-femoral vein catheterization via the right femoral vein or the right jugular vein access failed. When the puncturing of the left femoral vein was successfully done and was confirmed by angiography, the guide wire was inserted into the inferior vena cava and was pulled out through the right femoral vein or right jugular vein, and a wire track was thus established. Then, retrograde insertion of the catheter was conducted along the wire from the right to the left until the catheter was placed into the left iliac-femoral vein for thrombolysis. Results: Of 18 cases,successful puncturing into the left femoral vein was achieved in 16, and an effective wire track was established between the left and right femoral veins, based on which the catheter was smoothly inserted into the left iliac-femoral vein via the right femoral vein or jugular vein. Catheter thrombolysis was employed for 3 to 14 days, the thrombus was completely dissolved and the lower extremity swelling subsided. During the course of thrombolysis, no obvious congestion or hematoma occurred at the puncturing site of the left femoral vein. Conclusion: For patients with deep vein thrombosis of left lower extremity, when left iliac-femoral vein catheterization via the right femoral vein or the right jugular vein access failed, the establishment of wire track by using bilateral femoral vein approaches for further catheterization of left iliac-femoral vein and subsequent thrombolysis is feasible in clinical practice. This technique is safe and minimally-invasive with higher success rate. (authors)

Diagnostic Indication for Venous Echo-Doppler of the Lower Limbs in the Diagnosis of Thromboembolic; Indicacion de eco-Doppler venosa de extremidades inferiores en el diagnostico de la enfermedad tromboembolica ante una sospecha de tromboembolismo pulmonar

Energy Technology Data Exchange (ETDEWEB)

Bolado, A. G.; Barcena, M. V.; Cura, J. L. del; Gorrno, O.; Grande, D. [Hospital de Basurto. Bilbao (Spain)

2003-07-01

To study the effectiveness of Doppler echography in the deep venous system of the lower limbs for deep venous thrombosis detection in patients suspected of having pulmonary thromboembolism. There were received 341 consecutive suspected pulmonary thromboembolism patients, all of whom were emergency room attended. All were submitted to CT pulmonary angiography in order to evaluate thrombus presence in the pulmonary tree. Without knowing the results of the previous exploration, we studied 301 of the patients using Doppler echography in deep venous system of the lower limbs in order to evaluate thrombus presence. In the group of CT-detected pulmonary thromboembolism patients, the percentage of Doppler echography-detected deep venous thrombosis was 46.3%, while in the group of non-detected patients this percentage decreased to 4.7%. Additional deep venous system exploration in clinically suspected pulmonary thiolcarbamate patients is useful, since it can increase the detection rate of venous thromboembolic disease, thereby leading to early treatment and prevention of the disease's manifestation in the lungs. Realization of Doppler echography is especially beneficial in those patients who exhibit no factors which predispose them to thromboembolic disease, as well as in patients who have previously had venous thrombosis. This exploration account for 4.7% of non-detected pulmonary embolism patients being added to the ranks of those with thromboembolic disease, an important percentage when taking into consideration the high pulmonary thromboembolism morbimortality rate. (Author) 30 refs.

Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

International Nuclear Information System (INIS)

Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah

2009-01-01

To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease

Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

Energy Technology Data Exchange (ETDEWEB)

Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah [Chonnam National University Hospital, Gwangju (Korea, Republic of)

2009-07-15

To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease.

Management of cancer-associated upper extremity deep vein thrombosis with and without venous catheters at a tertiary care center.

Science.gov (United States)

ALKindi, Said Y; Chai-Adisaksopha, Chatree; Cheah, Matthew; Linkins, Lori-Ann

2018-04-03

Data on management of upper extremity deep vein thrombosis (UEDVT) in patients with cancer is limited. The objective of this study was to determine risk factors for UEDVT and the rates of recurrence and bleeding in a real-world setting. Retrospective review of consecutive patients assessed for cancer-associated UEDVT. Outcome measures were recurrent venous thromboembolism (VTE), and major and clinically relevant non-major bleeding (CRNMB). Risk factors for recurrent VTE and bleeding were assessed. Mean duration of follow-up was 7.2 months. Two hundred cases were identified; 69% were associated with a central line. Non-line associated UEDVT occurred more frequently in the setting of breast cancer, lung cancer and documented local mass effect. The incidence of recurrent VTE was 18.5%, of which 14 (37.8%) were ipsilateral UEDVT. The risk of recurrence is higher with male gender (HR 2.0, 95% CI; 1.0-4.0). Major and CRNMB occurred in 1% and 11.5%, respectively. Concurrent use of an antiplatelet agent was associated with a higher risk of CRNMB compared to anticoagulant therapy alone (HR 3.9, 95% CI; 1.4-10.7). Presence of a venous catheter was the primary risk factor for UEDVT, however, extrinsic compression by local tumour may be just as important for some cancer types. Furthermore, the majority of recurrent events did not occur in the same upper limb suggesting that UEDVT may be predictive of increased thrombotic risk rather than just a local effect of catheters. Copyright © 2018. Published by Elsevier Ltd.

Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis

NARCIS (Netherlands)

Bleker, S. M.; van Es, N.; Kleinjan, A.; Buller, H. R.; Kamphuisen, P. W.; Aggarwal, A.; Beyer-Westendorf, J.; Camporese, G.; Cosmi, B.; Gary, T.; Ghirarduzzi, A.; Kaasjager, K.; Lerede, T.; Marschang, P.; Meijer, Karina; Otten, H. -M.; Porreca, E.; Righini, M.; Verhamme, P.; van Wissen, S.; Di Nisio, M.

Background: There is scant information on the optimal management and clinical outcome of deep and superficial vein thrombosis of the upper extremity (UEDVT and UESVT). Objectives: To explore treatment strategies and the incidence of recurrent venous thromboembolism (VTE), mortality, postthrombotic

Platelet endothelial cell adhesion molecule 1 deficiency misguides venous thrombus resolution.

Science.gov (United States)

Kellermair, Joerg; Redwan, Bassam; Alias, Sherin; Jabkowski, Joerg; Panzenboeck, Adelheid; Kellermair, Lukas; Winter, Max P; Weltermann, Ansgar; Lang, Irene M

2013-11-07

Platelet endothelial cell adhesion molecule 1 (PECAM-1) is involved in leukocyte migration and angiogenesis, which are key components of venous thrombus resolution. This study investigated the effect of PECAM-1 deficiency on thrombus resolution in FVB/n mice and the extent to which levels of soluble PECAM-1 (sPECAM-1) correlate with delayed thrombus resolution in humans after acute symptomatic deep vein thrombosis (DVT). In a mouse stagnant flow venous thrombosis model Pecam-1(-/-) thrombi were larger, persisted for longer periods of time, and displayed attenuated macrophage invasion and decreased vessel formation in the presence of increased fibrosis. In humans, higher levels of truncated plasma sPECAM-1 possibly cleaved from cell surfaces, were found in patients with delayed thrombus resolution (assessed via duplex-based thrombus scoring) relative to those whose thrombi resolved (median, 25th/75th percentile): 92.5 (87.7/103.4) ng/mL vs 71.5 (51.1/81.0) ng/mL; P deep vein thrombus specimens stained positively with antibodies specific for the extracellular, but not the cytoplasmic domain of PECAM-1, consistent with accumulation of cleaved PECAM-1. Our data suggest a regulatory role of PECAM-1 in venous thrombus resolution and suggest a predictive value of sPECAM-1 for postthrombotic syndrome (PTS) after acute DVT.

Trans-jugular catheter-directed thrombolysis combined with trans-dorsalis pedis vein thrombolysis for the treatment of deep venous thrombosis of the lower limbs

International Nuclear Information System (INIS)

Qian Jiesheng; Li Zhengran; Jiang Zaibo; Zhu Kangshun; Guan Shouhai; Zhou Bing; Xu Changmou; He Keke; Shang Hong

2009-01-01

Objective: To investigate the feasibility and efficacy of trans-jugular catheter-directed thrombolysis (CDT) together with trans-dorsalis pedis vein thrombolysis for the treatment of deep venous thrombosis (DVT) of the lower limbs. Methods: Jugular vein puncture, indwelling catheter and placement of IVC filter were performed in 18 patients with DVT (study group) followed by continuous trans-jugular CDT together with trans-dorsalis pedis vein thrombolysis. During the corresponding period, 16 patients with DVT (control group) received trans-dorsalis pedis vein thrombolysis only. Results: The thrombolytic time and total dose of urokinase in study group and control group were (6.6 ± 2.3) days, (5.52 ± 2.24) x 106 units and (8.2 ± 1.4) days, (7.00 ± 1.66) x 106 units respectively. The thrombolytic time and total dose of urokinase in study group were significantly lower than that in control group (P < 0.05). After the treatment the thigh circumference and calf circumference in study group showed a reduction of (4.6 ± 2.1) cm and (4.0 ± 2.1) cm respectively, which were (3.2 ± 1.7) cm and (2.7 ± 1.5) cm respectively in control group, the difference between two groups was statistically significant (P < 0.05). The complete patent of the veins was 66.7% in study group and 31.3% in control group, the difference between two groups was significant (P < 0.05). In four cases of the study group, the filters were withdrawn through the original puncture site after the thrombus was completely dissolved. Conclusion: Trans-jugular CDT combined with trans-dorsalis pedis vein thrombolysis is an effective and safe therapeutic technique for the treatment of deep venous thrombosis of the lower extremities, moreover, the filter can be taken back via the original puncture site when the thrombus is completely dissolved. (authors)

Asymptomatic bacteriuria in adults.

Science.gov (United States)

Colgan, Richard; Nicolle, Lindsay E; McGlone, Andrew; Hooton, Thomas M

2006-09-15

A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic bacteriuria unless there is evidence of potential benefit. Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated, if positive. Treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.

Computerized strain-gauge plethysmography - An alternative method for the detection of lower limb deep venous thrombosis?

Energy Technology Data Exchange (ETDEWEB)

Elford, Julian; Wells, Irving; Cowie, Jim; Hurlock, Carol; Sanders, Hilary

2000-01-01

AIM: To test the ability of computerized strain-gauge plethysmography to act as a screening test for lower limb deep venous thrombosis (DVT). MATERIALS AND METHODS: Over an 8-month period, all patients referred to our Medical Assessment Unit with suspected lower limb DVT were considered for inclusion in the study. Each patient underwent both plethysmography and ascending venography within 24 h, and the presence or absence of thrombus in the popliteal, superficial femoral or iliac veins was noted. The results of the two tests were then used to determine the accuracy of computerized strain-gauge plethysmography in detecting above knee DVT. RESULTS: The screening tests and venograms of 239 patients referred with clinically suspected lower limb DVT were compared. The false negative rate of plethysmography was 15.4%, which is significantly different from the 4.8% claimed by the manufacturers of this device (P = 0.00003). CONCLUSIONS: In a population of acute admissions with suspected lower limb DVT, computerized strain-gauge plethysmography is not suitable for use as a screening test due to an unacceptably high proportion of false negative screens. J. Elford (2000)

Prophylactic IVC Filter Placement during Endovascular Treatment of Deep Venous Thrombosis of the Lower Extremities

International Nuclear Information System (INIS)

Roh, Byung Suk; Cho, Han Il; Lee, Yeum Sik; Bang, Dong Ho; Park, Seong Hoon; Lee, Young Hwan

2009-01-01

To evaluate the efficacy of an IVC filter implantation in the prevent of a pulmonary embolism (PE) during endovascular treatment for a deep venous thrombosis (DVT) of the lower extremities. We implanted IVC filters in 43 patients (22 females, 21 males, average age: 63 years) with DVT and who had undergone treatments including thrombolysis, aspiration and mechanical thrombectomy, as well as stent placement. We evaluated the incidence of PE by capturing the thrombus within the IVC filters, as well as the amount of captured thrombus. New developing PE or aggravating of PE in patients with existing PE was avoided in all patients. No thrombus was evident in the IVC filter of 19 (44%) of the patients, whereas any thrombus was captured in 24 (56%) of the patients. Small amounts of thrombus were captured in 10 patients, whereas large amounts of thrombus were captured in 14 patents within the IVC filter. We performed a retrieval of the IVC filters in 17 patients within an average period of 15.3 days (range 6-45 days). The captured incidence of migrated thrombus in the IVC filters was high in 56% of cases. As a result, PE was effectively prevented by IVC filters during the interventional treatment of DVT in the lower extremities

Prophylactic IVC Filter Placement during Endovascular Treatment of Deep Venous Thrombosis of the Lower Extremities

Energy Technology Data Exchange (ETDEWEB)

Roh, Byung Suk; Cho, Han Il; Lee, Yeum Sik; Bang, Dong Ho; Park, Seong Hoon; Lee, Young Hwan [Wonkwang University Hospital, Iksan (Korea, Republic of)

2009-09-15

To evaluate the efficacy of an IVC filter implantation in the prevent of a pulmonary embolism (PE) during endovascular treatment for a deep venous thrombosis (DVT) of the lower extremities. We implanted IVC filters in 43 patients (22 females, 21 males, average age: 63 years) with DVT and who had undergone treatments including thrombolysis, aspiration and mechanical thrombectomy, as well as stent placement. We evaluated the incidence of PE by capturing the thrombus within the IVC filters, as well as the amount of captured thrombus. New developing PE or aggravating of PE in patients with existing PE was avoided in all patients. No thrombus was evident in the IVC filter of 19 (44%) of the patients, whereas any thrombus was captured in 24 (56%) of the patients. Small amounts of thrombus were captured in 10 patients, whereas large amounts of thrombus were captured in 14 patents within the IVC filter. We performed a retrieval of the IVC filters in 17 patients within an average period of 15.3 days (range 6-45 days). The captured incidence of migrated thrombus in the IVC filters was high in 56% of cases. As a result, PE was effectively prevented by IVC filters during the interventional treatment of DVT in the lower extremities.

Are pulmonary embolism and deep-vein thrombosis always one disease?

NARCIS (Netherlands)

Langevelde, Kirsten van

2012-01-01

Pulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of one disease: venous thrombosis. The incidence of deep-vein thrombosis in the population is twice as

The diagnosis and assessment of venous disorders in the office and laboratory

International Nuclear Information System (INIS)

Needham, T.N.

1984-01-01

Clinical diagnosis of venous disorders, particularly deep venous thrombosis, has not proved adequate. Venography is invasive, expensive, and thrombogenic, and these facts have encouraged the use of other techniques. Nevertheless, all three diagnostic methods (clinical, venographic, and noninvasive) are complementary. Because the noninvasive approach does not neglect the patient's history and physical examination, the results of noninvasive tests can be more easily interpreted and false-positive examinations avoided. The authors prefer the simple Doppler examinations, although they require great attention to detail and are not learned easily. Nevertheless, they are the basis of noninvasive assessment and should be thoroughly familiar to vascular diagnosticians

Statin treatment and risk of recurrent venous thromboembolism: a nationwide cohort study

NARCIS (Netherlands)

Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo; Gjesing, Anne; Schjerning Olsen, Anne-Marie; Malta Hansen, Carolina; Büller, Harry; Torp-Pedersen, Christian; Gislason, Gunnar H.

2013-01-01

Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin therapy and

Retrievable Günther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep venous thrombosis in perinatal period.

Science.gov (United States)

Köcher, Martin; Krcova, Vera; Cerna, Marie; Prochazka, Martin

2009-04-01

To evaluate the feasibility and efficacy of the retrievable Günther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep vein thrombosis in the perinatal period and to discuss the technical demands associated with the filter's implantation and retrieval. Between 1996 until 2007, eight women (mean age 27.4 years, range 20-42 years) with acute deep iliofemoral venous thrombosis in the perinatal period of pregnancy and increased risk of pulmonary embolism during delivery were indicated for retrievable Günther Tulip Vena Cava Filter implantation. All filters were inserted and removed under local anesthesia from the jugular approach. The Günther Tulip Vena Cava Filter was implanted suprarenally in all patients on the day of caesarean delivery. In follow-up cavograms performed just before planned filter removal, no embolus was seen in the filter in any patient. In all patients the filter was retrieved without complications on the 12th day after implantation. Retrievable Günther Tulip Vena Cava Filters can be inserted and removed in patients during the perinatal period without major complications.

Suprascarpal fat pad thickness may predict venous drainage patterns in abdominal wall flaps.

Science.gov (United States)

Bast, John; Pitcher, Austin A; Small, Kevin; Otterburn, David M

2016-02-01

Abdominal wall flaps are routinely used in reconstructive procedures. In some patients inadequate venous drainage from the deep vein may cause fat necrosis or flap failure. Occasionally the superficial inferior epigastric vessels (SIEV) are of sufficient size to allow for microvascular revascularization. This study looked at the ratio of the sub- and suprascarpal fat layers, the number of deep system perforators, and SIEV diameter to determine any correlation of the fat topography and SIEV. 50 abdominal/pelvic CT angiograms (100 hemiabdomens) were examined in women aged 34-70 years for number of perforators, SIEV diameter, and fat pad thickness above and below Scarpa's fascia. Data was analyzed using multivariate model. The average suprascarpal and subscarpal layers were 18.6 ± 11.5 mm and 6.2 ± 7.2 mm thick, respectively. The average SIEV diameter was 2.06 ± 0.81 mm and the average number of perforators was 2.09 ± 1.03 per hemiabdomen. Hemiabdomens with suprascarpal thickness>23 mm had greater SIEV diameter [2.69 mm vs. 1.8 mm (P fat layer thickness did not correlate with the number of perforators. Neither subscarpal fat thickness nor suprascarpal-to-subscarpal fat layer thickness correlated significantly with SIEV caliber or number of perforators in multivariate model. Suprascarpal fat pad thicker than 23 mm had larger SIEVs irrespective of the number of deep system perforators. This may indicate a cohort of patients at risk of venous congestion from poor venous drainage if only the deep system is revascularized. We recommend harvesting the SIEV in patients with suprascarpal fat pad >23 mm to aid in superficial drainage. © 2015 Wiley Periodicals, Inc.

Observer agreement of lower limb venous reflux assessed by duplex ultrasound scanning using manual and pneumatic cuff compression in patients with chronic venous disease and controls

DEFF Research Database (Denmark)

Broholm, R; Kreiner, S; Bækgaard, Niels

2011-01-01

The study aimed to evaluate observer agreement between two experienced ultrasound operators examining deep venous reflux assessed by duplex ultrasound (DU) using either manual or pneumatic cuff compression. In addition, the two methods were compared with each other with regard to immediate "eyeba...... "eyeballing" and direct measurements of reflux time from Doppler flow curves....

Reliable rapid blood test for the exclusion of venous thromboembolism in symptomatic outpatients

NARCIS (Netherlands)

Turkstra, F.; van Beek, E. J.; ten Cate, J. W.; Büller, H. R.

1996-01-01

In this study we assessed the reliability of a rapid bed-side whole blood D-dimer assay prospectively in patients with clinically suspected venous thromboembolism, referred to the Academic Medical Centre, Amsterdam. In consecutive outpatients with clinically suspected deep vein thrombosis or

Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature

Directory of Open Access Journals (Sweden)

Amitesh Gupta

2017-01-01

Full Text Available One-third of patients with symptomatic venous thromboembolism (VTE manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT. Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.

Asymptomatic bacteriuria during pregnancy.

Science.gov (United States)

Sheiner, Eyal; Mazor-Drey, Efrat; Levy, Amalia

2009-05-01

The present study was aimed to test the association between asymptomatic bacteriuria during pregnancy, among patients in whom antibiotic treatment was recommended, and perinatal outcome. Our study was also designed to characterize common bacteria and risk factors associated with asymptomatic bacteriuria during pregnancy. A retrospective population-based study comparing all singleton pregnancies of women with and asymptomatic bacteriuria was conducted. Patients with urinary tract infection were excluded from the analysis. Multiple logistic regression model was used to control for confounders. Out of 199,093 deliveries, 2.5% (n = 4890) were in patients with asymptomatic bacteriuria. E. coli was the most common pathogen associated with asymptomatic bacteriuria, representing 78.6% of the cultures with specified growth. Patients with asymptomatic bacteriuria were more likely to deliver preterm (PTD, 13.3%vs. 7.6%, odd ratio (OR) = 1.9, 95% confidence interval CI 1.7-2.0; P Asymptomatic bacteriuria was independently associated with PTD (adjusted OR = 1.6; 95% CI 1.5-1.7; P treatments, hypertensive disorders, recurrent abortions, diabetes mellitus, intrauterine growth restriction, polyhydramnion and oligohydramnion, premature rupture of membranes and labour induction, in a multivariable analysis with backwards elimination. Perinatal mortality rates (1.5%vs. 1.4%; P = 0.707) as well as low 5 min Apgar scores (0.8%vs. 0.6%; P = 0.065) were comparable between the groups. Asymptomatic bacteriuria is an independent risk factor for preterm delivery.

Deep venous thrombosis after office vasectomy: a case report

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Zazove Philip

2010-08-01

Full Text Available Abstract Introduction Postoperative pulmonary embolism is considered a complication of major surgery. However, thromboembolism can also occur following minor procedures. We report a case of a major embolic event following a straightforward office vasectomy. Case presentation A healthy 35-year-old Asian man underwent an uncomplicated office vasectomy. Soon after, he noticed vague chest pain and dyspnea. Lower extremity Doppler ultrasound revealed acute venous thrombosis. A computer-assisted tomography angiogram revealed extensive bilateral pulmonary emboli. Extensive laboratory work-up failed to identify thrombophilia. He has not had any recurrences in the eight years since the initial presentation. Conclusion This case highlights that major embolic events can follow minor office procedures. Patients with suggestive findings should be investigated aggressively.

Interventional treatment for old thrombus in iliofemoral deep veins

International Nuclear Information System (INIS)

Qian Jun; Jiang Hong; Yang Yang

2009-01-01

Objective: To evaluate interventional management in treating old thrombus in iliofemoral deep veins. Methods: The clinical data and the interventional treatment results of 32 patients with chronic iliofemoral deep venous thrombosis were retrospectively reviewed and analyzed. Results: Technical success was achieved in 30 patients (93.8%). Twenty-nine endovascular stents were successfully placed in 25 patients. Postoperative therapeutic effects were as follows: grade I was obtained in 4 cases (12.5%), grade II in 16 cases (50.0%), grade III in 10 cases (31.3%) and grade IV in 2 cases (6.3%). Twenty-nine patients were followed-up for a mean period of 13.0 ± 6.8 months, and three patients were lost in touch. The follow-up results were as follows: grade I was seen in 3 cases (10.3%), grade II in 14 cases (48.3%) and grade III in 12 cases (41.4%). Conclusion: Interventional management is a minimally-invasive, safe and effective treatment for chronic iliofemoral deep venous thrombosis. (authors)

The investigation of complete blood counting parameters in deep venous thrombosis

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Ahmet Çalışkan

2014-03-01

Full Text Available Objective: The role of inflammation in the deep venous thrombosis (DVT process has been explained in various studies. Hence, the role of inflammatory markers in this illness has been researched previouslyin the literature. Recent years, such as parameters, neutrophil lymphocyte ratio (NLR and platelet lymphocyte ratio (PLR, among complete blood count have been frequently started to use as an expression of inflammatory marker. In the current study, the relation between complete blood count parameters and DVT was investigated. Methods: 50 patients admitted to our clinic with the diagnosis of acute DVT (28 female, 22 male were included in the study. The patients were diagnosed by clinical symptoms and Doppler USG. Patients with additional illness that can form an inflammatory response were excluded. 30 healthy volunteers were included as a control group. Routine complete blood counts of these patients were examined retrospectively. Routine complete blood counts and nonselective inflammatory markers, red cell distribution width (RDW, white cells (WBC, NLR, and PLR measurements were examined statistically. Results: The mean age of patients included in study was 46.2±14.2 and 53% of them were female. When the groups were examined in terms of hematological parameters, lymphocyte (2.6±0.8 and 2.1±0.7, p=0.003 and platelet (322±144 and 264±66, p=0.042 values were detected to be higher. Hemoglobin (13.2±2.0 and 14.6±1.5, p=0.002 and hematocrit (38.7±5.1 and 42.8±6.9, p<0.001 values were detected to be less while the WBC, neutrophil, NLR, RDW and PLR were similar. Regarding the two groups with and without anticoagulant therapy, in the DVT group, there were no significant differences detected in terms of age, gender, and hematological parameters. Conclusion: In this study, there were no significant differences between healthy volunteers blood count parameters of patients taken into consideration with pure DVT. There is no significant change shown.

The Ovine Cerebral Venous System: Comparative Anatomy, Visualization, and Implications for Translational Research

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Nitzsche, Björn; Lobsien, Donald; Seeger, Johannes; Schneider, Holm; Boltze, Johannes

2014-01-01

Cerebrovascular diseases are significant causes of death and disability in humans. Improvements in diagnostic and therapeutic approaches strongly rely on adequate gyrencephalic, large animal models being demanded for translational research. Ovine stroke models may represent a promising approach but are currently limited by insufficient knowledge regarding the venous system of the cerebral angioarchitecture. The present study was intended to provide a comprehensive anatomical analysis of the intracranial venous system in sheep as a reliable basis for the interpretation of experimental results in such ovine models. We used corrosion casts as well as contrast-enhanced magnetic resonance venography to scrutinize blood drainage from the brain. This combined approach yielded detailed and, to some extent, novel findings. In particular, we provide evidence for chordae Willisii and lateral venous lacunae, and report on connections between the dorsal and ventral sinuses in this species. For the first time, we also describe venous confluences in the deep cerebral venous system and an ‘anterior condylar confluent’ as seen in humans. This report provides a detailed reference for the interpretation of venous diagnostic imaging findings in sheep, including an assessment of structure detectability by in vivo (imaging) versus ex vivo (corrosion cast) visualization methods. Moreover, it features a comprehensive interspecies-comparison of the venous cerebral angioarchitecture in man, rodents, canines and sheep as a relevant large animal model species, and describes possible implications for translational cerebrovascular research. PMID:24736654

Secondary venous aneurysm following intravenous drug abuse: A case report

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Marković Miroslav

2016-01-01

Full Text Available Introduction. Venous aneurysm (VA is a rare condition that can be presented in both superficial and deep venous system. Secondary VAs as well as pseudoaneurysms are usually caused by external spontaneous or iatrogenic trauma. They are often misdiagnosed and inadequately treated. Complications include thrombosis, phlebitis, eventual pulmonary embolism and rupture. Case report. We presented a case of secondary VA of the great saphenous vein developed in a young addict following chronic intravenous drug application in the groin region. Aneurysm required urgent surgical treatment due to bleeding complication as it was previously misdiagnosed for hematoma (or abscess and punctuated by a general surgeon. Complete resection of VA with successful preservation of continuity of the great saphenous vein was performed. Postoperative course was uneventful. Regular venous flow through the great saphenous vein was confirmed on control ultrasound examination. Conclusion. VAs are uncommon, among them secondary VA being extremely rare. In cases with a significant diameter or threatening complications surgical treatment is recommended. [Projekat Ministarstva nauke Republike Srbije, br. ON175008 i br. III41007

Direct oral anticoagulants and venous thromboembolism

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Massimo Franchini

2016-09-01

Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

Risk of deep venous thrombosis (DVT) in bedridden or wheelchair-bound multiple sclerosis patients: a prospective study.

Science.gov (United States)

Arpaia, G; Bavera, P M; Caputo, D; Mendozzi, L; Cavarretta, R; Agus, G B; Milani, M; Ippolito, E; Cimminiello, C

2010-04-01

Multiple sclerosis (MS) often causes progressive loss of mobility, leading to limb paralysis. Venous and lymphatic stasis is a risk condition for venous thromboembolism (VTE). There is, however, no data on the frequency of VTE complicating the progression of MS. The aim of this study was to assess the frequency of deep vein thrombosis (DVT) in patients with late-stage MS attending a neurology center for rehabilitation. A total of 132 patients with MS were enrolled, 87 women and 45 men, mean age 58+/-11 years. The disease had started on average 18.7 years before; patients reported 9.6 hours bedridden per day or 14.3 hours wheelchair-bound. Only 25 patients reported a residual ability to walk alone or with help. Lower limb edema was present in 113 patients, bilateral in 41 cases. At admission all patients underwent extended compression ultrasonography. Their plasma D-dimer levels were measured. No antithrombotic prophylaxis was given. DVT was found in 58 patients (43.9%); 32 had a history of VTE. Forty of these patients (69%) had chronic lower limb edema, in 19 cases bilateral. D-dimer levels in the DVT patients were significantly higher than in patients without DVT (553+/-678 vs. 261+/-152 ng/mL, p=0.0112, Mann-Whitney Test). Nearly half the DVT patients (26, 45%) had high D-dimer levels (701+/-684 ng/mL). Of the 74 patients without DVT, 48 had normal D-dimer (193.37+/-67.28 ng/mL) and 26 high (387.61+/-187.42 ng/mL). The frequency of DVT in late-stage MS may be over 40%. The long history of the disease means the onset of each episode cannot be established with certainty. A number of patients with positive CUS findings had negative D-dimer values, suggesting a VTE event in the past. However, the level of DVT risk in this series should lead physicians to consider the systematic application of long-term preventive measures. (c) 2009 Elsevier Ltd. All rights reserved.

The incidence and characterization of deep vein thrombosis following ultrasound-guided foam sclerotherapy in 1000 legs with superficial venous reflux.

Science.gov (United States)

Kulkarni, Sachin R; Messenger, David E; Slim, Fiona J A; Emerson, Lorraine G; Bulbulia, Richard A; Whyman, Mark R; Poskitt, Keith R

2013-07-01

The incidence of deep vein thrombosis (DVT) following ultrasound-guided foam sclerotherapy (UGFS) ranges from 0% to 5.7%. The aim of this study was to assess the incidence of DVT following UGFS in a single vascular center. Patients undergoing UGFS between December 2005 and September 2011 underwent quality control duplex imaging within 2 weeks of treatment. This was performed by an independent senior vascular technologist, and data were entered on a prospectively maintained database. Deep venous segments assessed included common femoral vein, femoral vein, above- and below-knee popliteal veins, gastrocnemius, and tibial veins. DVT when present was labeled as endovenous foam-induced thrombosis (EFIT) type 1 when thrombus was lining <25% of the lumen of the deep vein; type 2 when thrombus extension was 25% to 50%; type 3 when thrombus extension was 50% to 99%; and type 4 when the deep vein was occluded. A total of 1166 UGFS treatments were performed in 1000 legs (776 patients). Complete occlusion of the treated veins was seen in 84.5% of the legs after one session of treatment. Overall, 17 DVTs were detected (1.5%) with no DVTs detected in legs undergoing multiple treatments. Of the 17 episodes of DVT, 16 legs had DVT following treatment for truncal reflux (658 legs; 2.43%). Seven DVTs were EFIT type 1, two were type 2, two were type 3, and five were type 4. One DVT was seen in the gastrocnemius vein alone. Two of 1166 treatments (0.2%) resulted in a symptomatic DVT, both of which were EFIT type 4. On regression analysis, there was an increase in the risk of DVT when ≥10 mL of foam was injected (odds ratio, 4.63; 95% confidence interval, 1.44-14.9; P = .01). The incidence of duplex-detected DVT following foam sclerotherapy is low and may be associated with the injection of ≥10 mL of foam. Copyright © 2013 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Venous thromboembolism and coffee: critical review and meta-analysis.

Science.gov (United States)

Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo

2015-07-01

Among the various risk factors of venous thromboembolism (VTE), nutrients seem to play a significant role in the pathogenesis of this condition. This study aimed to clarify the relationship between coffee intake and venous thrombosis, and we performed a critical review of clinical studies that have been published so far. An electronic search was carried out in Medline, Scopus and ISI Web of Science with the keywords "coffee" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism" in "Title/Abstract/Keywords", with no language and date restriction. According to our criteria, three studies (two prospective and one case-control) were finally selected (inter-study heterogeneity: 78%; P<0.001). Cumulative data suggests that a modest intake of coffee (i.e., 1-4 cups/day) may be associated with an 11% increased risk of VTE compared to abstainers, whereas a larger intake (i.e., ≥5 coffee/day) may be associated with a 25% decreased risk. Our analysis of published data seemingly confirm the existence of a U-shape relationship between coffee intake and VTE, thus exhibiting a trend that overlaps with that previously reported for cardiovascular disease (CVD).

The causes of skin damage and leg ulceration in chronic venous disease.

Science.gov (United States)

Smith, Philip Coleridge

2006-09-01

Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in their deep and superficial veins in the lower limb. Leucocytes become "trapped" in the circulation of the leg during periods of venous hyper-tension produced by sitting or standing. Studies of the plasma levels of neutrophil granule enzymes shows that these are increased during periods of venous hypertension, suggesting that this causes activation of the neutrophils. Investigation of the leucocyte surface ligands CD11b and CD62L shows that the more activated neutrophils and monocytes are sequestered during venous hypertension. Measurement of plasma levels of the soluble parts of the endothelial adhesion molecules VCAM, ICAM, and ELAM show that these are all elevated in patients with chronic venous disease compared to controls. Following 30 minutes of venous hypertension produced by standing, these levels are further increased. These data suggest that venous hypertension causes neutrophil and monocyte activation, which in turn causes injury to the endothelium. Chronic injury to the endothelium leads to a chronic inflammatory condition of the skin that we know clinically as lipodermatosclerosis. This is mediated by perivascular inflammatory cells, principally macrophages, in the skin microcirculation. These stimulate fibroblasts in the skin leading to tissue remodeling and laying down of fibrous tissue. Vascular endothelial growth factor stimulates proliferation of capillaries within the skin. Skin in this state has the potential to ulcerate in response to minor injury.

Direct venous thrombolysis and venous angioplasty in the upper extremity

International Nuclear Information System (INIS)

Hollmann, J.P.; Guenther, R.W.

1987-01-01

Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients. (orig.) [de

Analysis of the vertebral venous system in relation to cerebral venous drainage on MR angiography

International Nuclear Information System (INIS)

Baik, Seung Kug; Sohn, Chul Ho; Kim, Gab Chul; Kim, Yong Sun

2004-01-01

In the supine position, cerebral venous drainage occurs primarily through the internal jugular veins, as seen on venous phase cerebral angiography. However, in the erect position, the vertebral venous system represents the major alternative pathway of cerebral venous drainage, while outflow through the internal jugular veins is absent or negligible. The purpose of this study is to evaluate the vertebral venous system and its relationship between the surrounding venous structures using magnetic resonance angiography (MRA) in the case of subjects in the supine position. We retrospectively reviewed the results of 65 patients (M:F = 31: 34, mean age 61.6 years) who underwent multi-phase contrast-enhanced carotid MRA. The imaging studies were performed using a 3.0 T MR unit (TR: 5.2, TE: 1.1, FA: 20, 3.8 thickness, EC: 1). We analyzed the appearance and extent of the vertebral venous system (vertebral venous plexus and vertebral artery venous plexus) and the internal jugular vein on the venous phase images. We also evaluated the main drainage pattern of the cerebral venous drainage and the drainage pattern of the vertebral venous system. The visualized vertebral venous system was defined as either poor, vertebral venous plexus dominant, vertebral artery venous plexus dominant or mixed. In the vertebral venous system, the vertebral artery venous plexus was visualized in 54 cases (83%). The appearance of the visualized vertebral artery venous plexus was symmetrical in 39 cases (72%) and asymmetrical in 15 cases (28%). The extent of the visualized vertebral artery venous plexus was partial in 26 cases (48%) and complete in 28 cases (52%). The vertebral venous plexus was visualized in 62 cases (95%). The appearance of the visualized vertebral artery venous plexus was symmetrical in 43 cases (69%) and asymmetrical in 19 cases (31%). The extent of the visualized vertebral artery venous plexus was partial in 35 cases (56%) and complete in 27 cases (44%). The appearance of the

Computed tomographic characteristics of collateral venous pathways in dogs with caudal vena cava obstruction.

Science.gov (United States)

Specchi, Swan; d'Anjou, Marc-André; Carmel, Eric Norman; Bertolini, Giovanna

2014-01-01

Collateral venous pathways develop in dogs with obstruction or increased blood flow resistance at any level of the caudal vena cava in order to maintain venous drainage to the right atrium. The purpose of this retrospective study was to describe the sites, causes of obstruction, and configurations of venous collateral pathways for a group of dogs with caudal vena cava obstruction. Computed tomography databases from two veterinary hospitals were searched for dogs with a diagnosis of caudal vena cava obstruction and multidetector row computed tomographic angiographic (CTA) scans that included the entire caudal vena cava. Images for each included dog were retrieved and collateral venous pathways were characterized using image postprocessing and a classification system previously reported for humans. A total of nine dogs met inclusion criteria and four major collateral venous pathways were identified: deep (n = 2), portal (n = 2), intermediate (n = 7), and superficial (n = 5). More than one collateral venous pathway was present in 5 dogs. An alternative pathway consisting of renal subcapsular collateral veins, arising mainly from the caudal pole of both kidneys, was found in three dogs. In conclusion, findings indicated that collateral venous pathway patterns similar to those described in humans are also present in dogs with caudal vena cava obstruction. These collateral pathways need to be distinguished from other vascular anomalies in dogs. Postprocessing of multidetector-row CTA images allowed delineation of the course of these complicated venous pathways and may be a helpful adjunct for treatment planning in future cases. © 2014 American College of Veterinary Radiology.

Recurrent Iliofemoral Venous Thrombosis in the Setting of May-Thurner Syndrome as the Presenting Symptom of Behcet's Disease.

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Lakha, Sameer; Png, Chien Yi Maximilian; Chun, Kevin; Ting, Windsor

2018-02-23

Vascular manifestations including pulmonary artery aneurysms and venous thrombosis are seen in up to 14% of patients with Behcet's disease. We report a patient who had recurrent deep vein thrombosis (DVT) as the presenting symptom of Behcet's Disease. A 19-year-old male who presented with acute iliofemoral DVT, confirmed by intravascular ultrasound (IVUS) and venogram. May-Thurner syndrome was also observed. Repeated catheter-based pharmacomechanical thrombolysis, thrombectomy, and subsequent iliac vein stenting were performed. The patient was then discharged on rivaroxaban and aspirin. Five months later, the patient experienced left calf pain. In the interim, he had been diagnosed with Behcet's disease by a rheumatologist who was consulted due to oral ulcers and skin lesions and accordingly started on prednisone, colchicine, and azathioprine. At this time, IVUS and venogram revealed thrombotic occlusion of the previously placed stent. Tissue plasminogen activator was infused into the stent, and pharmacomechanical thrombectomy restored flow through the left iliac veins. Follow-up laboratory workup revealed that subtherapeutic azathioprine dosing, and after appropriate adjustment, the patient has been asymptomatic for 12 months. Acute refractory DVT is a possible presenting symptom of Behcet's disease, which may be complicated by May-Thurner syndrome. Such patients should receive therapeutic immunosuppression in addition to anticoagulation. Copyright © 2018 Elsevier Inc. All rights reserved.

Prevalence of deep venous thrombosis in the lower limbs and the pelvis and pulmonary embolism in patients with positive antiphospholipid antibodies

International Nuclear Information System (INIS)

Kinuya, Keiko; Kakuda, Kiyoshi; Matano, Sadaya; Sato, Shigehiko; Sugimoto, Tatsuho; Asakura, Hidesaku; Kinuya, Seigo; Michigishi, Takatoshi; Tonami, Norihisa

2001-01-01

Antiphospholipid antibodies (AA) are immunoglobulins that cross-react with phospholipid on cell membrane, and are therefore associated with a hypercoagulable state manifested by arterial/venous thromboses. We aimed to determine the prevalence of deep venous thrombosis in the lower limbs and the pelvic region (DVT) and pulmonary embolism (PE) in patients with positive AA. Sixty-six patients (48 female, 18 male) with positive lupus anticoagulant (LA) and/or positive anticardiolipin antibody (aCL) underwent radionuclide (RN) venography with 370 MBq of 99m Tc-MAA. Pulmonary perfusion scintigraphy was performed in 58 patients. Fifteen patients had positive LA and positive aCL (LA+/aCL+), 33 patients had positive LA only (LA+/aCL-) and 18 patients had positive aCL only (LA-/aCL+). Forty-three patients were diagnosed with primary antiphospholipid syndrome (APS) and 19 were diagnosed with APS associated with SLE. DVT was detected in 21 of 66 patients (32%). Patients with LA+/aCL+ showed higher prevalence of DVT (53%) as compared to LA+/aCL- (27%) and LA-/aCL+ (22%). PE was found in 13 of 58 patients (22%). The prevalence of PE was higher in patients with positive aCL (33% in LA+/aCL+; 36% in LA-/aCL+) than in patients with negative aCL (10%). Because of the high prevalence of DVT and PE in patients with AA, RN scintigraphy must be recommended in screening for these clinical troubles. These results indicate that the prevalence of DVT and PE may vary in subgroups of AA. (author)

Prevalence of deep venous thrombosis in the lower limbs and the pelvis and pulmonary embolism in patients with positive antiphospholipid antibodies

Energy Technology Data Exchange (ETDEWEB)

Kinuya, Keiko; Kakuda, Kiyoshi; Matano, Sadaya; Sato, Shigehiko; Sugimoto, Tatsuho [Tonami General Hospital, Toyama (Japan); Asakura, Hidesaku; Kinuya, Seigo; Michigishi, Takatoshi; Tonami, Norihisa

2001-12-01

Antiphospholipid antibodies (AA) are immunoglobulins that cross-react with phospholipid on cell membrane, and are therefore associated with a hypercoagulable state manifested by arterial/venous thromboses. We aimed to determine the prevalence of deep venous thrombosis in the lower limbs and the pelvic region (DVT) and pulmonary embolism (PE) in patients with positive AA. Sixty-six patients (48 female, 18 male) with positive lupus anticoagulant (LA) and/or positive anticardiolipin antibody (aCL) underwent radionuclide (RN) venography with 370 MBq of {sup 99m}Tc-MAA. Pulmonary perfusion scintigraphy was performed in 58 patients. Fifteen patients had positive LA and positive aCL (LA+/aCL+), 33 patients had positive LA only (LA+/aCL-) and 18 patients had positive aCL only (LA-/aCL+). Forty-three patients were diagnosed with primary antiphospholipid syndrome (APS) and 19 were diagnosed with APS associated with SLE. DVT was detected in 21 of 66 patients (32%). Patients with LA+/aCL+ showed higher prevalence of DVT (53%) as compared to LA+/aCL- (27%) and LA-/aCL+ (22%). PE was found in 13 of 58 patients (22%). The prevalence of PE was higher in patients with positive aCL (33% in LA+/aCL+; 36% in LA-/aCL+) than in patients with negative aCL (10%). Because of the high prevalence of DVT and PE in patients with AA, RN scintigraphy must be recommended in screening for these clinical troubles. These results indicate that the prevalence of DVT and PE may vary in subgroups of AA. (author)

Primary anti-phospholipid antibody syndrome causing recurrent venous thrombosis and thrombocytopenia in a patient with Addison's disease.

Science.gov (United States)

Elebrashy, Ibrahim; Yousief, Elham; Saif, Aasem

2014-12-01

We report a case of Addison's disease presenting with recurrent deep venous thrombosis and thrombocytopenia and proved to have primary anti-phospholipid antibody syndrome. The case report highlights the shared autoimmune nature of both diseases.

Peripherally inserted central catheters and upper extremity deep vein thrombosis

International Nuclear Information System (INIS)

Ong, B.; Gibbs, H.; Catchpole, I.; Hetherington, R.; Harper, J.

2006-01-01

The purpose of the study was to determine the incidence and risk factors for venous thrombosis in patients with a peripherally inserted central catheter (PICC). A retrospective study of all upper extremity venous duplex scans was carried out in the Vascular Medicine department from year 2000 to 2002 inclusive. A chart review of positive scans was undertaken to identify possible thrombotic risk factors. Of 317 upper extremity venous duplex scans carried out, 115, or 32%, were positive for upper extremity deep vein thrombosis. Three main risk factors were identified - presence of a central line, malignancy and administration of chemotherapy. PICC were the most common central line present. Symptomatic thrombosis occurred in 7% of PICC inserted for chemotherapy compared with 1% of PICC inserted for other reasons. Ten per cent of the patients receiving chemotherapy through a PICC developed a thrombosis. The post-thrombotic syndrome was infrequent following upper extremity deep vein thrombosis. Patients receiving chemotherapy through a PICC are at increased risk of thrombosis. There may be a role for prophylactic low-dose anticoagulation in these high-risk patients

Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis

NARCIS (Netherlands)

Heijboer, H.; Jongbloets, L. M.; Büller, H. R.; Lensing, A. W.; ten Cate, J. W.

1992-01-01

In the diagnostic management of patients with clinically suspected recurrent deep-vein thrombosis (DVT), there are potential limitations to all available diagnostic techniques. Since venous abnormalities may persist for some time after an acute thrombosis, the usefulness of compression

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy.

Science.gov (United States)

Gedikoglu, Murat; Oguzkurt, Levent

2017-01-01

We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.

Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.

Science.gov (United States)

Chopra, Vineet; Anand, Sarah; Hickner, Andy; Buist, Michael; Rogers, Mary Am; Saint, Sanjay; Flanders, Scott A

2013-07-27

Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71). PICCs are

A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils

International Nuclear Information System (INIS)

Sonnenschein, Martin J.; Anderson, Suzanne E.; Lourens, Steven; Triller, Juergen

2004-01-01

Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13-14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included

Primary chronic venous insufficiency of the lower extremities: preoperative color duplex Doppler ultrasound study

International Nuclear Information System (INIS)

Selfa, S.; Diago, T.; Ricart, M.; Chulia, R.; Martin, F.

2000-01-01

To asses the role of color duplex Doppler ultrasound (CDU) in the preoperative study of patients with varicose veins in lower extremities. We employed CDU to examine varicose veins in 342 lower limbs, assessing reflux in saphenous veins (SV), deep venous system (DVS) and perforating veins (PV). We analyzed the relationship between the anatomical extent of the reflux and the clinical findings. Insufficiency of the superficial venous system alone was uncommon, occurring in only 10.8% of the limbs examined. Reflux was observed in SV and PV in 48.2% of the legs. It was detected in all three systems in 29.2% of cases. The presence of reflux in more than one system and more than one value was associated with increased clinical severity. The site of venous reflux in lower extremities with varicose veins varies. Greater clinical severity is observed in the presence of more marked reflux in the DVS and PV. CDU provides anatomic and functional data on the three venous systems of the lower limbs, allowing an individualized therapeutic surgery. Preoperative localization of incompetent PV by means of CDU facilities their ligation. CDU is the technique of choice for the preoperative examination of the venous systems of patients with varicose veins. (Author)

Doppler ultrasound venous mapping of the lower limbs

Directory of Open Access Journals (Sweden)

Galeandro AI

2012-02-01

Full Text Available Aldo Innocente Galeandro1, Giovanni Quistelli2, Pietro Scicchitano2, Michele Gesualdo2, Annapaola Zito2, Paola Caputo2, Rosa Carbonara2, Giuseppe Galgano3, Francesco Ciciarello4, Sandro Mandolesi4, Claude Franceschi5, Marco Matteo Ciccone21Centro Diagnostica Globale and ASL-TA, Taranto, Italy; 2Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO, University of Bari, Bari, Italy; 3Cardiovascular Diseases Section, Ente Ecclesiastico Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Bari, Italy; 4Cardiology Department, Policlinico Umberto I, Sapienza University of Rome, Italy; 5Vascular Laboratories of Hospitals Saint Joseph and Pitié-Salpétrière, Paris, FranceBackground: The study aim was to test the accuracy (intra and interobserver variability, sensitivity, and specificity of a simplified noninvasive ultrasound methodology for mapping superficial and deep veins of the lower limbs.Methods: 62 consecutive patients, aged 62 ± 11 years, were enrolled. All underwent US-examinations, performed by two different investigators, of both legs, four anatomical parts, and 17 veins, to assess the interobserver variability of evaluation of superficial and deep veins of the lower limbs.Results: Overall the agreement between the second versus the first operator was very high in detecting reflux (sensitivity 97.9, specificity 99.7, accuracy 99.5; P = 0.80 at McNemar test. The higher CEAP classification stages were significantly associated with reflux (odds ratio: 1.778, 95% confidence interval: 1.552–2.038; P < 0.001 as well as with thrombosis (odds ratio: 2.765, 95% confidence interval: 1.741–4.389; P < 0.001. Thus, our findings show a strict association between the symptoms of venous disorders and ultrasound evaluation results for thrombosis or reflux.Conclusion: This study demonstrated that our venous mapping protocol is a reliable method showing a very low interobserver variability, which makes it

Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi.

Science.gov (United States)

Santin, Brian J; Lohr, Joanne M; Panke, Thomas W; Neville, Patrick M; Felinski, Melissa M; Kuhn, Brian A; Recht, Matthew H; Muck, Patrick E

2015-04-01

Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation. At 1 week after the procedure, each femoral vein was imaged by color Duplex ultrasound and sent for histologic interpretation for differentiation between EHIT and DVT. Five blinded vascular surgery faculty, two vascular surgery fellows, and three vascular surgery residents reviewed the ultrasound images. Thrombi associated with radiofrequency ablation demonstrated a greater degree of hypercellular response, fibroblastic reaction, and edema (3.42 vs 2.92; 3.75 vs 2.42; 2.83 vs 1.33). Specimens harvested from the iatrogenic-induced DVT swine demonstrated a more prolific response to trichrome staining (3.42 vs 2.67). Evidence of revascularization was found in all of the EHIT specimens but in 33% of DVT specimens. On the basis of histologic findings, the pathologist predicted correct modality 92% of the time. Subgroup analysis comparing paired specimens from each swine failed to demonstrate any marked pathologic differences. Recorded ultrasound images from EHIT and DVT samples were reviewed by fellows, residents, and vascular surgery staff to determine whether clot was stationary or free-floating (n = 111; 93%), evidence of retracted or adherent vein (n = 105; 88%), and absence of color flow (n = 102; 85%). The degree of occlusion (partial vs total) and degree of distention of a visualized vein were least likely to be agreed on by reviewers (n = 95; 79% each, respectively). In subgroup (DVT vs EHIT) analyses, the

Positive imaging of venous thrombi and thromboemboli with Ga-67 DFO-DAS-fibrinogen

Energy Technology Data Exchange (ETDEWEB)

Yamamoto, Kazutaka; Senda, Michio; Fujita, Toru; Yonekura, Yoshiharu; Kumada, Kaoru; Yokoyama, Akira; Torizuka, Kanji

1988-05-01

A newly developed thrombus imaging agent, /sup 67/Ga-DFO-DAS-fibrinogen (/sup 67/Ga-fibrinogen), was used for 22 studies in 20 cases of suspected deep venous thrombosis. Increased accumulation of /sup 67/Ga-fibrinogen in venous thrombi was depicted at 48 h after injection in 10 of the 15 cases (10 of 17 studies) who showed abnormal findings in radionuclide venography. A hot spot in the lung emboli was visualized in two cases. Seven of the eight cases having anticoagulant therapy showed increased /sup 67/Ga-fibrinogen uptake, while follow-up /sup 67/Ga-fibrinogen scintigraphy after the administration of heparin and urokinase did not reveal an abnormal hot spot in one case. /sup 67/Ga-fibrinogen can be made available simply by adding /sup 67/Ga solution to a vial containing fibrinogen-DAS-DFO conjugate. In conclusion, /sup 67/Ga-fibrinogen is considered to be a promising agent for detecting active venous thrombi and to assess the effect of anticoagulant therapy.

Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Directory of Open Access Journals (Sweden)

Adhikari, Srikar

2015-03-01

Full Text Available Introduction: Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT. A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US examinations performed on emergency department (ED patients. Methods: We performed a retrospective six-year review of an academic ED’s records of adult patients who underwent a comprehensive lower extremity duplex venous US examination for the evaluation of DVT. The entire US report was thoroughly reviewed for non-thrombotic findings. Results: We detected non-thrombotic findings in 263 (11%, 95% CI [9.5-11.9%] patients. Among the non-thrombotic findings, venous valvular incompetence (81, 30% was the most frequent, followed by cyst/mass (41, 15%, lymphadenopathy (33, 12%, phlebitis (12, 4.5%, hematoma (8, 3%, cellulitis (1, 0.3% and other (6, 2.2%. Conclusion: In our study, we detected a variety of non-thrombotic abnormalities on comprehensive lower extremity venous duplex US examinations performed on ED patients. Some of these abnormalities could be clinically significant and potentially be detected with point-of-care lower extremity US examinations if the symptomatic region is evaluated. In addition to assessment of the proximal veins for DVT, we recommend sonographic evaluation of the symptomatic area in the lower extremity when performing point-of-care ultrasound examinations to identify non-thrombotic abnormalities that may require immediate intervention or close follow up. [West J Emerg Med. 2015;16(2:250–254.

The combined vaginal contraceptive ring, nuvaring, and cerebral venous sinus thrombosis: a case report and review of the literature.

Science.gov (United States)

Kolacki, Christian; Rocco, Vito

2012-04-01

Combined oral contraceptives are known to confer a risk of venous thromboembolism, including cerebral venous sinus thrombosis (CVST), to otherwise healthy women. NuvaRing (Organon USA, Inc., Roseland, NJ) is a contraceptive vaginal ring that delivers 120 μg of etonogestrel and 15 μg of ethinyl estradiol per day. Its use has been associated with rare venous thromboembolic events, but few cases of CVST associated with NuvaRing have been reported. To describe a case that illustrates the increased risk of CVST associated with use of NuvaRing. We describe the case of a NuvaRing user who presented to our emergency department with a headache, who was diagnosed with CVST. Evidence suggests that NuvaRing has at least as much prothrombotic potential as combined oral contraceptives. Thus, emergency physicians should suspect serious venous thromboembolic events, including CVST, deep venous thrombosis, and pulmonary embolism, in NuvaRing users in the proper clinical setting. Copyright © 2012 Elsevier Inc. All rights reserved.

Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with nonparalyzed patients immobilized due to spinal fractures

International Nuclear Information System (INIS)

Myllynen, P.; Kammonen, M.; Rokkanen, P.; Boestman, O.L.; Lalla, M.; Laasonen, E.

1985-01-01

The occurrence of deep venous thrombosis (DVT) was studied in the series of 23 consecutive patients with acute spinal cord injury and 14 immobilized patients with spinal fractures without paralysis. The incidence of DVT in paralyzed patients was 100% as detected by the 125 I-labeled fibrinogen test and confirmed by contrast venography, and 64% as detected by repeated clinical examinations and confirmed by contrast venography. The respective incidence of DVT in nonparalyzed patients with spinal fractures was 0%. The diagnosis of DVT was reached earlier with the radiofibrinogen test than with the clinical followup (5 days vs. 25 days). Two of the 23 paralyzed patients (9%) developed nonfatal clinical pulmonary embolism (PE). There were no differences in the values of routine coagulation tests. The result justifies prophylactic anticoagulant therapy in all cases of spinal cord injury during the acute post-traumatic phase

Three Incomplete Caries Removal Techniques Compared Over Two Years in Primary Molars with Asymptomatic Deep Caries or Reversible Pulpitis.

Science.gov (United States)

Chompu-inwai, Papimon; Boonsongsawat, Kamolthip; Sastraruji, Thanapat; Sophasri, Tidarat; Mankaen, Siripun; Nondon, Sutasinee; Tunlek, Sumattaya; Katwong, Supitchaya

2015-01-01

To directly compare the survival rates of three incomplete caries removal techniques that differed in the amount of caries removal and the base material used. Ninety-six primary molars with asymptomatic deep caries or reversible pulpitis were randomly assigned to three groups: (1) indirect pulp treatment (IPT); (2) minimal caries removal with both resin-modified glass ionomer base material and luting cement (MCRB/L); and (3) minimal caries removal with only resin-modified glass ionomer luting cement (MCRL). The treatments were followed clinically and radiographically for two years. The two-year survival probabilities in the IPT, MCRB/L, and MCRL groups were 0.90 (95 percent confidence interval [CI] equals 0.73 to 0.97), 0.93 (95 percent CI equals 0.76 to 0.98), and 0.77 (95 percent CI equals 0.58 to 0.89), respectively. There was no significant difference in the two-year survival probabilities of the three studied groups (generalized Wilcoxon P=.07). Following two years, neither the amount of caries removal nor the base material affected the success of incomplete caries removal treatment. However, minimal caries removal with MCRB/L presented the highest survival rate among the tested groups and resulted in no incidence of pulp exposure.

[Symmetrical phlebothrombosis of lower extremities resulting from congenital malformation of vena cava inferior].

Science.gov (United States)

Halcín, A; Kovácová, E; Mikla, F; Reptová, A; Bedeová, J

2009-12-01

Agenesis/atresia ofvena cava inferior is a rare congenital anomaly, caused by an aberrance of embryonal venous system development. This is in most cases asymptomatic, because of well developed collateral venous circulation. However, in some cases, it can be manifested with occurence of deep thrombosis in area of pelvis and lower limbs. In this case report, we repon a 21 year old male with painful swelling of both lower limbs. Ultrasonographic examination revealed a bilateral thrombosis in deep venous system of lower limbs and pelvis. Subsequent CT angiography showed atresia ofinfrarenal segment ofvena cava inferior. According to the CT image thrombotic proces affected also collateral venous system, that joined mostly to vena azygos and hemiazygos. Examination of coagulation system didn't reveal a procuring cause ofthrombotic occurrence. We realized a systemic trombolysis with streptokinase during 5 days. Starting from the fifth day we administered a low molecular weight heparin in anticoagulant dose. This treatment showed a good clinical effect. Pacient was discharged with a long-term oral warfarin therapy in combination with acetylsalicylic acid. In next four months of taking recommended therapy no relapse of thrombotic process nor evolvement of bleeding complication was observed.

Prothrombin and risk of venous thromboembolism, ischemic heart disease and ischemic cerebrovascular disease in the general population

DEFF Research Database (Denmark)

Weischer, Maren; Juul, Klaus; Zacho, Jeppe

2010-01-01

OBJECTIVE: We tested the hypotheses that Prothrombin G20210A heterozygosity associate with increased risk of venous thromboembolism (VTE), ischemic heart disease (IHD), and ischemic cerebrovascular disease (ICVD) in the general population and re-tested risk of IHD and ICVD in two case......-control studies. METHODS: 9231 individuals from the Danish general population were followed for VTE (VTE=DVT+PE), deep venous thrombosis (DVT), pulmonary embolism (PE), IHD, myocardial infarction (MI), ICVD, and ischemic stroke (IS) for a median of 24 years. Case-control studies included 2461 IHD cases and 867...

[Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"].

Science.gov (United States)

Sanson, H; Gautier, V; Stansal, A; Sfeir, D; Franceschi, C; Priollet, P

2016-12-01

Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging. A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode. The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined. Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations. Copyright © 2016. Published by Elsevier Masson SAS.

Percutaneous placed bioprosthetic venous valve in the treatment of deep vein reflux: animal experiments and clinical trials

International Nuclear Information System (INIS)

Lu Wei; Li Yanhao; Dusan Pavcnik

2008-01-01

Objective: To evaluate the efficiency of percutaneously placed bioprosthetic bicuspid venous valve (BVV) in the treatment of deep vein insufficiency in animal experiments and clinical trials. Methods: BVV was made of two pieces of lyophilized porcine small intestinal submucosa(SIS) which were attached to a stent frame. Three kinds of BVVs (BVV1, BVV2, BVV3) was developed using different kinds of stent frames and different methods of attachment. BVV1, BVV2 and BVV3 were percutaneously placed into ovine's jugular veins acrossed the nature valves. Ascending and descending angiography were performed before and after' BVVs placement. The patency of veins and the function of valves was evaluated during 5 weeks to 6 months follow-up. In clinical trial, BVV1 and BVV3 were percutaneously placed into 3 and 15 patients with chronic venous insufficiency (CVI) respectively. The patency of veins and the function of valves was also evaluated during 1 to 3 years' follow-up. Results: In animal experiment, BVV1, BVV2, and BVV3 were placed to 24, 26 and 12 ovine's jugular veins respectively. During 5 weeks to 6 months follow- up period, 22 (88.0%), 24(92.3%) and 12 of the BVVs exhibited good function. Endothelium of both surfaces of SIS leaflets was complete in approximately 3 months. SIS was gradually reabsorbed and replaced by the host's own cells. Three BVV1 were placed into 3 patients with CVI. At the third years follow-up, symptoms relieved in 2 cases and no change of clinical symptoms was found in 1 patient. BVV3 were percutaneously placed into 15 patients with advanced symptomatic CVI. At one month and 3 months' follow- up after BVV3 placement, all BVV3 functioned well. However, BVV3 were flexible and functioned well in only 4 cases at 1 year' s follow-up. Intravascular ultrasound revealed thickened rigid cusps with valve leakage of different levels and no symptom resolved in 11 cases. Conclusions: Percutaneous implantation of bioprosthetic BVV is a promising method in the

Extensive cerebral venous thrombosis in a renal allograft recipient

International Nuclear Information System (INIS)

Nayak, Shobhana G.; Satish, R.; Gokulnath

2008-01-01

An increased risk of venous thromboembolism has been demonstrated following renal transplantation. Commonly reported sites have been deep vein thrombosis, pulmonary thromboembolism and vascular thrombosis involving the graft. Cerebral venous thrombosis (CVT) has not been reported in literature so far. A 36-year-old male patient, transplanted in January 2005 with normal graft functions, was admitted with history of headache, blurring of vision and vomiting. Examination revealed papilledema and no neurological deficits. Baseline investigations and analysis of cerebrospinal liquid were normal. Cerebral magnetic resonance venogram revealed extensive CVT involving superior sagittal sinus, bilateral transverse sinuses and the right sigmoid sinus. He was investigated for a thrombophilic disorder; serum homocysteine, protein C and S levels, antiphospholipid antibody and antithrombin-III levels were done despite which no conclusive diagnosis could be arrived at. To our knowledge, this is the first report of extensive CVT described in a transplant recipient. Ne definite prothrombotic or predisposing factors could be identified in our patient and the cause of CVT remains unclear. (author)

Venous Ulcers

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Caprini, J.A.; Partsch, H.; Simman, R.

2013-01-01

Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

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Cakir, Volkan, E-mail: drvolkancakir@gmail.com [Katip Celebi University, Ataturk Training and Research Hospital, Department of Radiology, Division of İnterventional Radiology (Turkey); Gulcu, Aytac, E-mail: aytac.gulcu@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Akay, Emrah, E-mail: emrahakay@hotmail.com [Sakarya University Hospital, Department of Radiology (Turkey); Capar, Ahmet E., E-mail: ahmetergina@gmail.com [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Gencpinar, Tugra, E-mail: tugra01@hotmail.com [Dokuz Eylul University Hospital, Department of Cardiovascular Surgery (Turkey); Kucuk, Banu, E-mail: banu.kucuk@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Karabay, Ozalp, E-mail: ozalp.karabay@deu.edu.tr [Dokuz Eylul University Hospital, Department of Cardiovascular Surgery (Turkey); Goktay, A. Yigit, E-mail: yigit.goktay@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey)

2014-08-15

PurposeThe purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis.MethodsIn this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.ResultsDeep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms.ConclusionsFor treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical

[Proportion and prevention of venous thromboembolism among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Beijing].

Science.gov (United States)

Liang, Li-rong; Zhang, Zhu; Wang, Hong; Xu, Zhen-yang; Qian, Xiao-sen; Zhang, Zuo-qing; Chen, Jin; Zhang, Feng-zhen; Yang, Yuan-hua

2013-08-13

To explore the proportion and prevention status of venous thromboembolism (VTE) among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing. Based on a multi-center retrospective study, a total of 636 hospitalized AECOPD patients from 17 class 2/3 hospitals in Beijing were examined from September 1, 2011 to March 31, 2012. They fulfilled one of the following criteria: respiratory failure type II, on invasive or non-invasive mechanical ventilation, hospitalization for pulmonary infection, bedridden duration ≥ 3 days and congestive heart failure. All investigators received standardized training and used a standardized questionnaire to collect data on VTE risk factors, the diagnosis of VTE and the utilization of VTE prophylaxis. According to Caprini score, they were categorized into 3 groups of lower risk (Caprini score ≤ 3), moderate risk (Caprini score 4-6) and high risk ( ≥ 7) to compare the intergroup differences in the VTE proportion and the utilization of VTE prophylaxis. A total of 636 patients were assessed. There were 416 males and 220 females with a mean (SD) age of 74.9 ± 9.3 years. Among them, 133 patients received lower extremity venous ultrasonic examination and 92 were diagnosed with deep venous thrombosis (DVT) including 2 patients with pulmonary thromboembolism (PTE). Thus the overall incidence of VTE was 14.5% (92/636) and increased with age (Ptrend = 0.044). The proportion of VTE in asymptomatic patients was higher in those symptomatic ones (21.1% vs 8.0%, P = 0.000). And it was the highest in high risk group, followed by lower risk and moderate risk groups at 17.9% (14/78), 16.0% (26/163) and 13.2% (52/395) respectively, There was no statistical significance (P = 0.450 for group difference, Ptrend = 0.946). Among 544 patients without VTE, only 19.1% (104/544) employed the pharmacologic and/or mechanical methods for preventing VTE. The prevention proportion gradually increased with rising

Malaria PCR Detection in Cambodian Low-Transmission Settings: Dried Blood Spots versus Venous Blood Samples

Science.gov (United States)

Canier, Lydie; Khim, Nimol; Kim, Saorin; Eam, Rotha; Khean, Chanra; Loch, Kaknika; Ken, Malen; Pannus, Pieter; Bosman, Philippe; Stassijns, Jorgen; Nackers, Fabienne; Alipon, SweetC; Char, Meng Chuor; Chea, Nguon; Etienne, William; De Smet, Martin; Kindermans, Jean-Marie; Ménard, Didier

2015-01-01

In the context of malaria elimination, novel strategies for detecting very low malaria parasite densities in asymptomatic individuals are needed. One of the major limitations of the malaria parasite detection methods is the volume of blood samples being analyzed. The objective of the study was to compare the diagnostic accuracy of a malaria polymerase chain reaction assay, from dried blood spots (DBS, 5 μL) and different volumes of venous blood (50 μL, 200 μL, and 1 mL). The limit of detection of the polymerase chain reaction assay, using calibrated Plasmodium falciparum blood dilutions, showed that venous blood samples (50 μL, 200 μL, 1 mL) combined with Qiagen extraction methods gave a similar threshold of 100 parasites/mL, ∼100-fold lower than 5 μL DBS/Instagene method. On a set of 521 field samples, collected in two different transmission areas in northern Cambodia, no significant difference in the proportion of parasite carriers, regardless of the methods used was found. The 5 μL DBS method missed 27% of the samples detected by the 1 mL venous blood method, but most of the missed parasites carriers were infected by Plasmodium vivax (84%). The remaining missed P. falciparum parasite carriers (N = 3) were only detected in high-transmission areas. PMID:25561570

Common iliac vein thrombosis as a result of proximal venous stenosis following renal transplantation: A case report

Directory of Open Access Journals (Sweden)

Atish Chopra

2016-12-01

Full Text Available Proximal iliac vein stenosis resulting in iliac vein thrombus and venous outflow obstruction in renal transplant patients is an exceedingly rare occurrence. We present a case of a 63-year-old male who underwent deceased donor renal transplantation and presented 12 days later with ipsilateral lower extremity swelling and plateauing serum creatinine. Further work-up demonstrated proximal iliac vein deep venous thrombosis and anticoagulation was initiated. However, propagation of the thrombus developed despite receiving therapeutic anticoagulation. Subsequent venography demonstrated proximal iliac venous stenosis and the patient underwent successful catheter-directed alteplase thrombolysis, inferior vena cava filter placement and iliac vein stenting with salvage of the renal allograft. A diagnostic strategy and management algorithm for iliac vein stenosis and thrombosis in a renal transplant recipient is proposed.

Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs).

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Kanin, Maralee; Young, Guy

2013-11-01

The recent proliferation of deep vein thrombosis in children has been attributed to the increased use of central venous catheters, specifically tunneled lines and peripherally inserted central catheters. A formal comparison of the incidence rate for deep vein thrombosis between tunneled lines and peripherally inserted central catheters has not been undertaken. Children inclusion. Data were extracted from the hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision coding. Patients were excluded if they received more than one central line. Data collected included type of central line, deep vein thrombosis event, and underlying medical illnesses classified according to chronic complex conditions. Over the seven year study period there was an overall rate of 73 deep vein thromboses per 10,000 hospital discharges. Of the 6915 eligible subjects, 181 had a deep vein thrombosis for an overall incidence rate of 2.6%. There were 152 thrombi (2.6%) in subjects with peripherally inserted central catheters and 29 thrombi (3.1%) in subjects with tunneled lines [OR=.83 (0.55, 1.29), p=0.38]. Despite the relative ease and simplicity of use of peripherally inserted central catheters leading to a substantial rise in their use, this study demonstrates that such lines pose a substantial risk for venous thrombosis and no difference in incidence was detected between such lines and tunneled lines. © 2013.

Brain venous pathologies: MRI findings

International Nuclear Information System (INIS)

Salvatico, Rosana; Gonzalez, Alejandro; Yanez, Paulina; Romero, Carlos; Trejo, Mariano; Lambre, Hector

2006-01-01

Purpose: To describe MRI findings of the different brain venous pathologies. Material and Methods: Between January 2002 and March 2004, 18 patients were studied 10 males and 8 females between 6 and 63 years old; with different brain venous pathologies. In all cases brain MRI were performed including morphological sequences with and without gadolinium injection and angiographic venous sequences. Results: 10 venous occlusions were found, 6 venous angiomas, and 2 presented varices secondary to arteriovenous dural fistula. Conclusion: Brain venous pathologies can appear in many different clinical contexts, with different prognosis and treatment. In all the cases brain MRI was the best imaging study to disclose typical morphologic abnormalities. (author) [es

Cerebral venous angiomas

International Nuclear Information System (INIS)

Agnoli, A.L.; Hildebrandt, G.

1985-01-01

Clinical symptoms and radiological signs in 15 patients with cerebral venous malformations are presented and the diagnostic problems discussed. The circulation time in combination with cerebral malformations and angiomas of the scalp are described. CT findings in cases of venous malformations of the brain stem are evaluated. Spot-like enhancement, as well as sharply demarcated round shaped enhancement are characteristic for venous angiomas. Cavernous angiomas usually present as homogenous or inhomogenous round shaped enhanced areas. (Author)

Primary thromboprophylaxis for cancer patients with central venous catheters--a reappraisal of the evidence.

LENUS (Irish Health Repository)

Cunningham, M S

2006-01-30

Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis.

Manual Aspiration Thrombectomy with Stent Placement: Rapid and Effective Treatment for Phlegmasia Cerulea Dolens with Impending Venous Gangrene

International Nuclear Information System (INIS)

Oguzkurt, Levent; Tercan, Fahri; Ozkan, Ugur

2008-01-01

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene

Venous ulcers -- self-care

Science.gov (United States)

... surgery to improve blood flow through your veins. Prevention If you are at risk for venous ulcers, take the steps listed above under Wound Care. ... weight if you are overweight. Manage your blood pressure and cholesterol levels. ... Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis ...

Quantity of residual thrombus after successful catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with recurrence.

Science.gov (United States)

Aziz, F; Comerota, A J

2012-08-01

Iliofemoral deep venous thrombosis (IFDVT) is an independent risk factor for recurrent DVT. It has been observed that recurrent DVT correlates with residual thrombus. This study evaluates whether risk of recurrence is related to the amount of residual thrombus following catheter-directed thrombolysis (CDT) for IFDVT. Patients who underwent CDT for IFDVT had their degree of lysis quantified by a reader blind to the patients' long-term clinical outcome. Patients were classified into two groups, ≥50% and thrombus. Recurrence was defined as a symptomatic presentation with image verification of new or additional thrombus. A total of 75 patients underwent CDT for IFDVT. Median follow-up was 35.9 months. Sixty-eight patients (91%) had no evidence of recurrence and seven (9%) developed recurrence. Of the patients who had ≥50% (mean 80%) residual thrombus, 50% (4/8) experienced recurrence, but in those with thrombus, only 5% (3/67) had recurrent DVT (P = 0.0014). The burden of residual thrombus at completion of CDT correlates with the risk of DVT recurrence. Patients having CDT for IFDVT had a lower risk of recurrence than expected. Successful clearing of acute clot in IFDVT patients significantly reduces the recurrence risk compared to patients with a large residual thrombus burden. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Models of the venous system

DEFF Research Database (Denmark)

Mehlsen, J

2000-01-01

Cardiac output is largely controlled by venous return, the driving force of which is the energy remaining at the postcapillary venous site. This force is influenced by forces acting close to the right atrium, and internally or externally upon the veins along their course. Analogue models of the v......Cardiac output is largely controlled by venous return, the driving force of which is the energy remaining at the postcapillary venous site. This force is influenced by forces acting close to the right atrium, and internally or externally upon the veins along their course. Analogue models...... of the venous system require at least three elements: a resistor, a capacitor and an inductor, with the latter being of more importance in the venous than in the arterial system. Non-linearities must be considered in pressure/flow relations in the small venules, during venous collapse, or low flow conditions...

Venous, Arterialized-Venous, or Capillary Glucose Reference Measurements for the Accuracy Assessment of a Continuous Glucose Monitoring System.

Science.gov (United States)

Kropff, Jort; van Steen, Sigrid C; deGraaff, Peter; Chan, Man W; van Amstel, Rombout B E; DeVries, J Hans

2017-11-01

Different reference methods are used for the accuracy assessment of continuous glucose monitoring (CGM) systems. The effect of using venous, arterialized-venous, or capillary reference measurements on CGM accuracy is unclear. We evaluated 21 individuals with type 1 diabetes using a capillary calibrated CGM system. Venous or arterialized-venous reference glucose samples were taken every 15 min at two separate visits and assessed per YSI 2300 STAT Plus. Arterialization was achieved by heated-hand technique. Capillary samples were collected hourly during the venous reference visit. The investigation sequence (venous or arterialized-venous) was randomized. Effectiveness of arterialization was measured by comparing free venous oxygen pressure (PO2) of both visit days. Primary endpoint was the median absolute relative difference (ARD). Median ARD using arterialized-venous reference samples was not different from venous samples (point estimated difference 0.52%, P = 0.181). When comparing the three reference methods, median ARD was also not different over the full glycemic range (venous 9.0% [n = 681], arterialized-venous 8.3% [n = 684], and capillary 8.1% [n = 205], P = 0.216), nor over the separate glucose ranges. Arterialization was successful (PO2 venous 5.4 kPa vs. arterialized-venous 8.9 kPa, P reference measurements did not significantly impact CGM accuracy. Venous reference seems preferable due to its ease of operation.

Deep-Diving California Sea Lions: Are They Pushing Their Physiological Limit

Science.gov (United States)

2015-09-30

highly variable. Venous oxygen content can actually increase during short duration dives. This suggests very little muscle blood flow and evven the use...the sea lion, the emperor penguin (Aptenodytes forsteri), another animal that dives on inspiration with a large respiratory O2 store, also can...in deep-diving emperor penguins (Wright et al. 2014), and in deep-diving bottlenose dolphins (Tursiops truncatus), which also dive on inspiration

A systematic review of the efficacy and limitations of venous intervention in stasis ulceration.

Science.gov (United States)

Montminy, Myriam L; Jayaraj, Arjun; Raju, Seshadri

2018-05-01

Surgical techniques to address various components of chronic venous disease are rapidly evolving. Their efficacy and generally good results in treating superficial venous reflux (SVR) have been documented and compared in patients presenting with pain and swelling. A growing amount of literature is now available suggesting their efficacy in patients with venous leg ulcer (VLU). This review attempts to summarize the efficacy and limitations of commonly used venous interventions in the treatment of SVR and incompetent perforator veins (IPVs) in patients with VLU. A systematic review of the published literature was performed. Two different searches were conducted in MEDLINE, Embase, and EBSCOhost to identify studies that examined the efficacy of SVR ablation and IPV ablation on healing rate and recurrence rate of VLU. In the whole review, 1940 articles were screened. Of those, 45 were included in the SVR ablation review and 4 in the IPV ablation review. Data were too heterogeneous to perform an adequate meta-analysis. The quality of evidence assessed by the Grading of Recommendations Assessment, Development, and Evaluation for the two outcomes varied from very low to moderate. Ulcer healing rate and recurrence rate were between 70% and 100% and 0% and 49% in the SVR ablation review and between 59% and 93% and 4% and 33% in the IPV ablation review, respectively. To explain those variable results, limitations such as inadequate diagnostic techniques, saphenous size, concomitant calf pump dysfunction, and associated deep venous reflux are discussed. Currently available minimally invasive techniques correct most venous pathologic processes in chronic venous disease with a good sustainable healing rate. There are still specific diagnostic and efficacy limitations that mandate proper match of individual patients with the planned approach. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Relationship between neighborhood socioeconomic status and venous thromboembolism: results from a population-based study.

Science.gov (United States)

Kort, D; van Rein, N; van der Meer, F J M; Vermaas, H W; Wiersma, N; Cannegieter, S C; Lijfering, W M

2017-12-01

Essentials Literature on socioeconomic status (SES) and incidence of venous thromboembolism (VTE) is scarce. We assessed neighborhood SES with VTE risk in a population of over 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. These findings are helpful to inform policy and resource allocation in health systems. Background The association between socioeconomic status and arterial cardiovascular disease is well established. However, despite its high burden of disability-adjusted life years, little research has been carried out to determine whether socioeconomic status is associated with venous thromboembolism. Objective To determine if neighborhood socioeconomic status is associated with venous thromboembolism in a population-based study from the Netherlands. Methods We identified all patients aged 15 years and older with a first event of venous thromboembolism from inhabitants who lived in the urban districts of The Hague, Leiden and Utrecht in the Netherlands in 2008-2012. Neighborhood socioeconomic status was based on the status score, which combines educational level, income and unemployment on a four-digit postal code level. Incidence rate ratios of venous thromboembolism were calculated for different levels of neighborhood socioeconomic status, with adjustments for age and sex. Results A total of 7373 patients with a first venous thromboembolism (median age 61 years; 50% deep vein thrombosis) were identified among more than 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. In the two highest status score groups (i.e. the 95-99th and > 99th percentile), the adjusted incidence rate ratios were 0.91 (95% confidence interval [CI], 0.84-1.00) and 0.80 (95% CI, 0.69-0.93), respectively, compared with the reference status score group (i.e. 30-70th percentile). Conclusions High neighborhood socioeconomic status is associated with a lower risk of first venous thromboembolism. © 2017

Bacterial signatures in thrombus aspirates of patients with lower limb arterial and venous thrombosis.

Science.gov (United States)

Vakhitov, Damir; Tuomisto, Sari; Martiskainen, Mika; Korhonen, Janne; Pessi, Tanja; Salenius, Juha-Pekka; Suominen, Velipekka; Lehtimäki, Terho; Karhunen, Pekka J; Oksala, Niku

2018-06-01

Increasing data supports the role of bacterial inflammation in adverse events of cardiovascular and cerebrovascular diseases. In our previous research, DNA of bacterial species found in coronary artery thrombus aspirates and ruptured cerebral aneurysms were mostly of endodontic and periodontal origin, where Streptococcus mitis group DNA was the most common. We hypothesized that the genomes of S mitis group could be identified in thrombus aspirates of patients with lower limb arterial and deep venous thrombosis. Thrombus aspirates and control blood samples taken from 42 patients with acute or acute-on-chronic lower limb ischemia (Rutherford I-IIb) owing to arterial or graft thrombosis (n = 31) or lower limb deep venous thrombosis (n = 11) were examined using a quantitative real-time polymerase chain reaction to detect all possible bacterial DNA and DNA of S mitis group in particular. The samples were considered positive, if the amount of bacterial DNA in the thrombus aspirates was 2-fold or greater in comparison with control blood samples. In the positive samples the mean difference for the total bacterial DNA was 12.1-fold (median, 7.1), whereas the differences for S mitis group DNA were a mean of 29.1 and a median of 5.2-fold. Of the arterial thrombus aspirates, 57.9% were positive for bacterial DNA, whereas bacterial genomes were found in 75% of bypass graft thrombosis with 77.8% of the prosthetic grafts being positive. Of the deep vein thrombus aspirates, 45.5% contained bacterial genomes. Most (80%) of bacterial DNA-positive cases contained DNA from the S mitis group. Previous arterial interventions were significantly associated with the occurrence of S mitis group DNA (P = .049, Fisher's exact test). This is the first study to report the presence of bacterial DNA, predominantly of S mitis group origin, in the thrombus aspirates of surgical patients with lower limb arterial and deep venous thrombosis, suggesting their possible role in the pathogenesis of

Elevated plasma factor VIII enhances venous thrombus formation in rabbits: contribution of factor XI, von Willebrand factor and tissue factor.

Science.gov (United States)

Sugita, Chihiro; Yamashita, Atsushi; Matsuura, Yunosuke; Iwakiri, Takashi; Okuyama, Nozomi; Matsuda, Shuntaro; Matsumoto, Tomoko; Inoue, Osamu; Harada, Aya; Kitazawa, Takehisa; Hattori, Kunihiro; Shima, Midori; Asada, Yujiro

2013-07-01

Elevated plasma levels of factor VIII (FVIII) are associated with increased risk of deep venous thrombosis. The aim of this study is to elucidate how elevated FVIII levels affect venous thrombus formation and propagation in vivo. We examined rabbit plasma FVIII activity, plasma thrombin generation, whole blood coagulation, platelet aggregation and venous wall thrombogenicity before and one hour after an intravenous infusion of recombinant human FVIII (rFVIII). Venous thrombus induced by the endothelial denudation of rabbit jugular veins was histologically assessed. Thrombus propagation was evaluated as indocyanine green fluorescence intensity. Argatroban, a thrombin inhibitor, and neutralised antibodies for tissue factor (TF), factor XI (FXI), and von Willebrand factor (VWF) were infused before or after thrombus induction to investigate their effects on venous thrombus formation or propagation. Recombinant FVIII (100 IU/kg) increased rabbit plasma FVIII activity two-fold and significantly enhanced whole blood coagulation and total plasma thrombin generation, but did not affect initial thrombin generation time, platelet aggregation and venous wall thrombogenicity. The rFVIII infusion also increased the size of venous thrombus 1 hour after thrombus induction. Argatroban and the antibodies for TF, FXI or VWF inhibited such enhanced thrombus formation and all except TF suppressed thrombus propagation. In conclusion, elevated plasma FVIII levels enhance venous thrombus formation and propagation. Excess thrombin generation by FXI and VWF-mediated FVIII recruitment appear to contribute to the growth of FVIII-driven venous thrombus.

Prophylaxis of Venous Thrombosis.

Science.gov (United States)

Goldhaber, Samuel Z.

2001-06-01

Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive

The collateral venous system in late pregnancy: A systematic review of the literature.

Science.gov (United States)

Humphries, Aimee; Stone, Peter; Mirjalili, S Ali

2017-11-01

Recent literature has reported an association between maternal supine sleep position and stillbirth during late pregnancy. In this position the gravid uterus almost completely obstructs the inferior vena cava. A small number of women experience supine hypotension, thought to be due in part to inadequate collateral venous circulation. The aim of this paper is to review the literature describing the anatomy of the collateral venous system and in particular the azygos system, the abdominal portion of which has not been well studied. A systematic review was conducted using the electronic databases: Medline, Embase, Scopus, and Google Scholar. Relevant anatomical and radiological literature concerning the azygos system in particular was reviewed. The search was limited to adult human studies only. The collateral venous system can be divided into superficial, intermediate and deep systems. The azygos system in particular provides immediate collateral venous circulation in the event of acute inferior vena caval obstruction. The abdominal portion of this pathway, including the ascending lumbar vein, has not been well studied and there are certain variations that can render it ineffective. In conclusion, the collateral venous system provides an alternative route for blood to flow back to the systemic circulation when acute occlusion of the inferior vena cava occurs in the supine position during late pregnancy. However, certain anatomical variations can render this pathway ineffective, and this could have implications for the development of supine hypotension and stillbirth in late pregnancy. Clin. Anat. 30:1087-1095, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Embolization of a deep orbital varix through endovascular route

Directory of Open Access Journals (Sweden)

R Ravi Kumar

2015-01-01

Full Text Available We report a case of the primary deep orbital venous varix treated by endovascular coil embolization procedure by transfemoral catheterization. This method of treatment has the advantage of image-guided localization of the pathology, real-time management and confirmation of the success of the procedure in the sitting.

Deep Vein Thrombosis: Risk Factors and Prevention in Surgical ...

African Journals Online (AJOL)

BACKGROUND: Deep vein thrombosis (DVT) is a cause of preventable morbidity and mortality in hospitalized surgical patients. The occurrence of the disease is related to presence of risk factors, which are related primarily to trauma, venous stasis and hyper-coagulability. DVT seems not to be taken seriously by many ...

[Asymptomatic bacteriuria in pregnancy].

Science.gov (United States)

Caputo, S; Ciardo, A

2001-01-01

Pregnancy is a predisposing factor for urinary tract infection and pregnant women suffering from this pathology are exposed to dangerous risks which may condition maternal wellbeing and fetal prognosis. Asymptomatic bacteriuria is the common bacterial infection requiring medical treatment in pregnancy. Diagnosis and treatment of asymptomatic bacteriuria is important as approximately 20-40% of these women, if untreated during pregnancy, will develop a symptomatic urinary tract infection.

The value of MR angiography in the diagnosis of deep vein thrombosis of the lower limbs: comparative study with DSA

International Nuclear Information System (INIS)

Feng Min; Wang Shuzhi; Gu Jianping; Sun Jun; Mao Cunnan; Lu Lingquan; Yin Xindao

2007-01-01

Objective: To assess the clinical values of MR angiography (MRA) in the detection of deep vein thrombosis of the lower limbs. Methods: Two-dimensional time of flight (2D TOF) MRA was performed in thirty patients who were suspected of having deep vein thrombosis in the lower limbs. The findings of MRA were compared to that of digital subtraction angiography (DSA). Results: twenty-five cases showed deep vein thrombosis in the lower limbs, the MRA findings included venous filling defect (14 cases), occlusions and interruptions of veins (8 cases), venous recanalizations (3 cases), collateral veins (25 cases). Taking the results of DSA as a golden standard, MRA detected all of the affected cases with only one case as the false positive. Conclusion: 2D TOF MRA is a method of choice in the diagnosis of deep vein thrombosis of the lower limbs. (authors)

Warfarin for venous thromboembolism prophylaxis after elective hip or knee arthroplasty: exploring the evidence, guidelines, and challenges remaining.

Science.gov (United States)

Dager, William E

2012-01-01

Guidelines for the prevention of venous thromboembolism (VTE) after elective total hip or knee arthroplasty (THA/TKA) have been developed separately by the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). Differences exist in approaches to preventing postoperative VTE through prophylaxis. To compare trials using vitamin K antagonists (VKAs) and differences in guidelines to determine the benefits and drawbacks of warfarin for VTE prophylaxis following THA/TKA. Guidelines from the AAOS published in 2009 and revised in 2011 and from the ACCP published in 2008 were compared for recommendations on the use of VKAs. A MEDLINE search from 1960 to November 2009 was conducted to identify pertinent articles on the use of warfarin or VKAs for VTE prophylaxis following THA/TKA. Search terms included warfarin, vitamin K antagonist, total hip or total knee replacement, and total hip or total knee arthroplasty. Only clinical trials in which warfarin was the primary agent for prophylaxis compared to other anticoagulants were included. Data on differences between guideline recommendations for the use of VKAs and the importance of a deep vein thrombosis or asymptomatic events were extracted. Thirteen comparative trials using VKAs for VTE prophylaxis and international normalized ratio (INR) targets were assessed. Overall, the incidence of bleeding tended to be lower with the use of VKAs, but thrombosis when including asymptomatic events was numerically higher when comparing INR targets. However, INR targets varied, with no comparative trials assessing the AAOS 2009 recommended INR target of 1.5-2.0. The AAOS guidelines initially recommended a longer duration of therapy and expressed stronger support for the use of aspirin for prophylaxis; however, in 2011, its guidelines were revised, with no specific recommendations as to agent, dose, or INR target goal. Warfarin is an effective agent to prevent VTE after elective THA/TKA. The most

Semuloparin for prevention of venous thromboembolism after major orthopedic surgery

DEFF Research Database (Denmark)

Lassen, M R; Fisher, W; Mouret, P

2012-01-01

BACKGROUND: Semuloparin is a novel ultra-low-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. OBJECTIVES: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic...... was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM...

Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty: A network meta-analysis.

Science.gov (United States)

Gao, Ji-Hai; Chu, Xiu-Cheng; Wang, Lin-Liang; Ning, Bo; Zhao, Chuan-Xin

2017-10-01

After arthroplasty treatment, some complications commonly occur, such as early revision, infection/dislocation, and venous thromboembolism (VTE). This study aims to use a network meta-analysis to compare effects of 9 anticoagulant drugs (edoxaban, dabigatan, apixaban, rivaroxaban, warfarin, heparin, bemiparin, ximelagatran, and enoxaparin) in preventing postoperative complications in arthroplasty patients. After retrieving PubMed, Embase, and Cochrane Library database from the inception to November 2016, randomized controlled trials were enrolled. The integration of direct and indirect evidences was performed to calculate odd ratios and the surface under the cumulative ranking curves. Nineteen eligible randomized controlled trials were included. The network meta-analysis results showed that compared with warfarin, edoxaban, apixaban, and rivaroxaban had a lower incidence rate in asymptomatic deep venous thrombosis, which indicated that edoxaban, apixaban, and rivaroxaban had better effects on prevention. Similarly, in comparison to enoxaparin, edoxaban and rivaroxaban had better effect; rivaroxaban was better than ximelagatran in preventive effects. Compared with apixaban, edoxaban, dabigatan, rivaroxaban, and enoxaparin had a higher incidence rate in clinically relevant non-major bleeding, which showed that preventive effects were relatively poor. In addition, the results of the surface under the cumulative ranking curves showed that rivaroxaban and bemiparin worked best on symptomatic deep venous thrombosis and pulmonary embolism. In terms of bleeding, apixaban and warfarin had better preventive effects. Our findings suggested that rivaroxaban may work better in terms of symptomatic deep venous thrombosis and pulmonary embolism, whereas apixaban had better preventive effects in bleeding.

A case of mixed type laryngocele presented with deep neck infection and review of the literature

Directory of Open Access Journals (Sweden)

Salih Bakır

2012-09-01

Full Text Available Laryngocele is an abnormal dilatation of the laryngeal ventricular saccule that may extend into the subcutaneous tissues of the neck through the thyrohyoid membrane or confined to the endolarynx. The etiology is still unclear. Many laryngoceles are asymptomatic. An asymptomatic laryngocele appears and produces symptoms only as it enlarges or when it becomes infected. In this report, we present a 40-year-old female patient, which had an asymptomatic neck swelling for 20 years, referred for deep neck infection, dysphonia and dyspnea. J Clin Exp Invest 2012; 3 (3: 415-419Key words: Larynx, laryngocele, laryngopyocele, neck mass

Should asymptomatic bacteriuria be screened in pregnancy?

Science.gov (United States)

Uncu, Y; Uncu, G; Esmer, A; Bilgel, N

2002-01-01

The incidence of asymptomatic bacteriuria is reported as 2-14% during pregnancy. Fetal and maternal complications like acute pyelonephritis, hypertension, anemia, preterm labor, low-birth-weight infants and intrauterine growth retardation can be expected. The purpose of this study was to determine the incidence of asymptomatic bacteriuria during pregnancy and its relation to pregnancy complications. The study involved 270 pregnant women up to 32 gestational weeks during a 9-month period. At the initial visit, they were screened with urine culture in order to detect asymptomatic bacteriuria. A control group was formed in a retrospective manner from the first day of the study with 186 pregnant women who delivered in our clinic and who were not screened for asymptomatic bacteriuria. The incidence of asymptomatic bacteriuria was 9.31%. Escherichia coli accounted for 79%, which was the most frequent of the isolates. We observed recurrence and had to apply treatment again to 21.7% of the women. The sensitivity, specificity, positive predictive and negative predictive values of leucocyturia as a screening test for asymptomatic bacteriuria were 91.3%, 83.6%, 45.6% and 98.5%, respectively. We diagnosed preterm labor in six of 23 (26%) with asymptomatic bacteriuria and 16 in 163 (9.3%) women in the urine culture negative group. The ratio acute pyelonephritis in the group which was routinely screened and treated for asymtomatic bacteriuria was 0.5% while the prevalence was 2.1% in the nonscreened group. Considering the relatively high incidence of asymptomatic bacteriuria during pregnancy and the relevant complications, we propose to screen and treat asymptomatic bacteriuria routinely in all pregnant women.

Cerebral venous sinus thrombosis on MRI: A case series analysis

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Sanjay M Khaladkar

2014-01-01

Full Text Available Background: Cerebral venous sinus thrombosis (CVST is a rare form of stroke seen in young and middle aged group, especially in women due to thrombus of dural venous sinuses and can cause acute neurological deterioration with increased morbidity and mortality if not diagnosed in early stage. Neurological deficit occurs due to focal or diffuse cerebral edema and venous non-hemorrhagic or hemorrhagic infarct. Aim and Objectives: To assess/evaluate the role of Magnetic Resonance Imaging (MRI and Magnetic Resonance Venography (MRV as an imaging modality for early diagnosis of CVST and to study patterns of venous thrombosis, in detecting changes in brain parenchyma and residual effects of CVST using MRI. Materials and Methods: Retrospective descriptive analysis of 40 patients of CVST diagnosed on MRI brain and MRV was done. Results: 29/40 (72.5% were males and 11/40 (27.5% were females. Most of the patients were in the age group of 21-40 years (23/40-57.5%. Most of the patients 16/40 (40% presented within 7 days. No definite cause of CVST was found in 24 (60% patients in spite of detailed history. In 36/40 (90% of cases major sinuses were involved, deep venous system were involved in 7/40 (17.5% cases, superficial cortical vein was involved in 1/40 (2.5% cases. Analysis of stage of thrombus (acute, subacute, chronic was done based on its appearance on T1 and T2WI. 31/40 (77.5% patients showed complete absence of flow on MRV, while 9/40 (22.5% cases showed partial flow on MR venogram. Brain parenchyma was normal in 20/40 (50% patients while 6/40 (15% cases had non-hemorrhagic infarct and 14/40 (35% patients presented with hemorrhagic infarct. Conclusion: Our study concluded that MRI brain with MRV is sensitive in diagnosing both direct signs (evidence of thrombus inside the affected veins and indirect signs (parenchymal changes of CVST and their follow up.

The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

International Nuclear Information System (INIS)

Wohlgemuth, Walter A.; Müller-Wille, René; Teusch, Veronika I.; Dudeck, Oliver; Cahill, Anne M.; Alomari, Ahmad I.; Uller, Wibke

2015-01-01

PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate

The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

Energy Technology Data Exchange (ETDEWEB)

Wohlgemuth, Walter A., E-mail: walter.wohlgemuth@ukr.de; Müller-Wille, René, E-mail: Rene.Mueller-Wille@ukr.de; Teusch, Veronika I., E-mail: Veronika.Teusch@gmx.de [University Medical Center Regensburg, Department of Radiology (Germany); Dudeck, Oliver, E-mail: Oliver.Dudeck@med.ovgu.de [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Cahill, Anne M., E-mail: Cahill@email.chop.edu [Perelman School of Medicine of the University of Pennsylvania, Division of Interventional Radiology, Department of Radiology, Children’s Hospital of Philadelphia (United States); Alomari, Ahmad I., E-mail: Ahmad.Alomari@childrens.harvard.edu [Boston Children’s Hospital and Harvard Medical School, Division of Vascular and Interventional Radiology (United States); Uller, Wibke, E-mail: Wibke.Uller@ukr.de [University Medical Center Regensburg, Department of Radiology (Germany)

2015-06-15

PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate.

Venous Thoracic Outlet Compression and the Paget-Schroetter Syndrome: A Review and Recommendations for Management

International Nuclear Information System (INIS)

Thompson, J. F.; Winterborn, R. J.; Bays, S.; White, H.; Kinsella, D. C.; Watkinson, A. F.

2011-01-01

Paget Schroetter syndrome, or effort thrombosis of the axillosubclavian venous system, is distinct from other forms of upper limb deep vein thrombosis. It occurs in younger patients and often is secondary to competitive sport, music, or strenuous occupation. If untreated, there is a higher incidence of disabling venous hypertension than was previously appreciated. Anticoagulation alone or in combination with thrombolysis leads to a high rate of rethrombosis. We have established a multidisciplinary protocol over 15 years, based on careful patient selection and a combination of lysis, decompressive surgery, and postoperative percutaneous venoplasty. During the past 10 years, a total of 232 decompression procedures have been performed. This article reviews the literature and presents the Exeter Protocol along with practical recommendations for management.

Cerebral Venous Thrombosis and Pulmonary Embolism with Prothrombin G20210A Gene Mutation

OpenAIRE

Dagli, Canan Eren; Koksal, Nurhan; Guler, Selma; Gelen, Mehmet Emin; Atilla, Nurhan; Tuncel, Deniz

2010-01-01

A 25-year-old man presented with symptoms of syncope, cough, headache and hemoptysis. Cranial MR and venography showed thrombus formation in the right transverse sinus and superior sagittal sinus. Computed tomographic pulmonary angiography (CTPA) showed an embolic thrombus in the right pulmonary truncus and lung abscess. The patient was young, and there were no signs of lower extremity deep venous thrombosis or other major risk factors for pulmonary embolism (PE) including cardiac anomaly. Th...

Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

NARCIS (Netherlands)

van Beest, Paul A.; van der Schors, Alice; Liefers, Henriëtte; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michaël A.; Spronk, Peter E.

2012-01-01

Objective: The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design: Prospective observational controlled study. Setting: Nonacademic university-affiliated

Upper Extremity Deep Vein Thromboses: The Bowler and the Barista

Directory of Open Access Journals (Sweden)

Seth Stake

2016-01-01

Full Text Available Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses.

Upper Extremity Deep Vein Thromboses: The Bowler and the Barista.

Science.gov (United States)

Stake, Seth; du Breuil, Anne L; Close, Jeremy

2016-01-01

Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses.

Relationship between deep venous thrombosis and inflammatory cytokines in postoperative patients with malignant abdominal tumors

Energy Technology Data Exchange (ETDEWEB)

Du, T.; Tan, Z. [National Wuhan University, Zhongnan Hospital, School of Medicine, Department of General Surgery, Wuhan, Hubei Province (China)

2014-08-22

Deep venous thrombosis (DVT) is a common surgical complication in cancer patients and evidence that inflammation plays a role in the occurrence of DVT is increasing. We studied a population of cancer patients with abdominal malignancies with the aim of investigating whether the levels of circulating inflammatory cytokines were associated with postoperative DVT, and to determine the levels in DVT diagnoses. The serum levels of C-reactive protein (CRP), interleukins (IL)-6 and IL-10, nuclear transcription factor-κB (NF-κB) and E-selectin (E-Sel) were determined in 120 individuals, who were divided into 3 groups: healthy controls, patients with and patients without DVT after surgery for an abdominal malignancy. Data were analyzed by ANOVA, Dunnet's T3 test, chi-square test, and univariate and multivariate logistic regression as needed. The CRP, IL-6, NF-κB, and E-Sel levels in patients with DVT were significantly higher than those in the other groups (P<0.05). The IL-10 level was higher in patients with DVT than in controls but lower than in patients without DVT. Univariate analysis revealed that CRP, IL-6, NF-κB, and E-Sel were statistically associated with the risk of DVT (OR=1.98, P=0.002; OR=1.17, P=0.000; OR=1.03, P=0.042; and OR=1.38, P=0.003; respectively), whereas IL-10 had a protective effect (OR=0.94, P=0.011). Multivariate analysis showed that E-Sel was an independent risk factor (OR=1.41, P=0.000). Thus, this study indicated that an increased serum level of E-Sel was associated with increased DVT risk in postoperative patients with abdominal malignancy, indicating that E-Sel may be a useful predictor of diagnosis of DVT.

Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis.

Science.gov (United States)

Tan, Melanie; Mol, Gerben C; van Rooden, Cornelis J; Klok, Frederikus A; Westerbeek, Robin E; Iglesias Del Sol, Antonio; van de Ree, Marcel A; de Roos, Albert; Huisman, Menno V

2014-07-24

Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficult with compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ = 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins. © 2014 by The American Society of Hematology.

Venous malformations: MR imaging features that predict skin burns after percutaneous alcohol embolization procedures

International Nuclear Information System (INIS)

Fayad, Laura M.; Hazirolan, Tuncay; Carrino, John A.; Bluemke, David A.; Mitchell, Sally

2008-01-01

To examine the value of magnetic resonance (MR) imaging for predicting the occurrence of skin burns in patients with venous malformations who undergo percutaneous alcohol embolization was the objective of the study. Pre-procedural MR imaging at 1.5 T from 40 patients with venous malformations who had undergone percutaneous alcohol embolization was retrospectively reviewed by two observers for these features: anatomic location, definition (well-defined or ill-defined), and the presence of skin, subcutaneous tissue, muscle, tendon, bone, joint, and deep venous system involvement. One observer recorded the length of skin involvement and volume of the malformation. Univariate and multivariate analysis tests were used to determine whether an association between the occurrence of skin burns and MR imaging features existed. The anatomic locations of the venous malformations were the lower extremity (20 out of 40), upper extremity (11 out of 40), trunk (four out of 40), head/neck (three out of 40) and pelvis (two out of 40). Of the 40 subjects, 15% (six out of 40) experienced skin burns. There was a significant association between the absence of muscle involvement (p=0.0198) as well as the length of skin involvement (p=0.027), with the occurrence of skin burns. Malformation size and all other features were not significantly associated with skin burns. Skin burns in patients with venous malformations treated with alcohol embolization are associated with the length of skin involvement and with the absence of deeper tissue involvement, as depicted on MR imaging. (orig.)

Ulcer due to chronic venous disease: a sociodemographic study in northeastern Brazil.

Science.gov (United States)

de Souza, Edson Marques; Yoshida, Winston Bonetti; de Melo, Valdinaldo Aragão; Aragão, José Aderval; de Oliveira, Luiz Augusto Bitencurt

2013-07-01

Venous ulcers account for 70% of chronic leg ulcers and affect about 2-7% of the population, causing much socioeconomic impact and reducing patients' quality of life. In this study we aimed to describe the clinical features of venous ulcers and sociodemographic characteristics of patients with ulcers due to chronic venous disease (CVD). This cross-sectional, observational study was conducted at the Vascular Surgery Service, Universidade Federal de Sergipe, in northeastern Brazil. The study included a consecutive series of 154 patients with active venous ulcers (CEAP C6) in the lower limb due to CVD. Sociodemographic characteristics (age, gender, race, monthly income, education, occupation, and caregiver) and clinical data (affected limb, ulcer site, etiopathogenesis, recurrence, and time elapsed since the first episode of ulcer) were collected. A possible correlation of time elapsed since the first episode of ulcer and number of recurrences with primary or secondary etiology was analyzed by Mann-Whitney U-test. Of the 154 patients analyzed, 79% were female, 94% were ethnically black or brown, 90% had a monthly income less than or equal to minimum wage, 47% were illiterate, 35% had not completed elementary school, 50% had informal jobs, 19.5% were retired, and 18.2% received sick pay from the social security system. The mean age was 53.7 years. Both limbs were affected similarly, and venous ulcers were located predominantly on the medial aspect of the leg (84%). The median time elapsed since the first episode of ulcer was 36 months, being significantly higher in patients with venous ulcers of secondary etiology (P < 0.0003). The prevalence of recurrence was also significantly higher in patients with venous ulcers of secondary etiology (P < 0.001). According to CEAP classification, 65% of ulcers were primary (Ep), 94.1% demonstrated reflux involving the superficial system (As), 92% had incompetent perforators (Ap), 35% demonstrated reflux involving the deep system

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

International Nuclear Information System (INIS)

Sharifi, Mohsen; Bay, Curt; Skrocki, Laura; Lawson, David; Mazdeh, Shahnaz

2012-01-01

Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of ≥7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

Energy Technology Data Exchange (ETDEWEB)

Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com [Arizona Cardiovascular Consultants (United States); Bay, Curt [A.T. Still University, Arizona School of Health Sciences (United States); Skrocki, Laura; Lawson, David; Mazdeh, Shahnaz [Arizona Cardiovascular Consultants (United States)

2012-12-15

Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of {>=}7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.

Does the real-time ultrasound guidance provide safer venipuncture in implantable venous port implantation?

Science.gov (United States)

Yıldırım, İlknur; Tütüncü, Ayşe Çiğdem; Bademler, Süleyman; Özgür, İlker; Demiray, Mukaddes; Karanlık, Hasan

2018-03-01

To examine whether the real-time ultrasound-guided venipuncture for implantable venous port placement is safer than the traditional venipuncture. The study analyzed the results of 2153 venous ports placed consecutively from January 2009 to January 2016. A total of 922 patients in group 1 and 1231 patients in group 2 were admitted with venous port placed using the traditional landmark subclavian approach and real-time ultrasound-guided axillary approach, respectively. Sociodemographic characteristics of patients, early (pneumothorax, pinch-off syndrome, arterial puncture, hematoma, and malposition arrhythmia) and late (deep vein thrombosis, obstruction, infection, erosion-dehiscence, and rotation of the port chamber) complications and the association of these complications with the implantation method were evaluated. There were no significant differences in the sociodemographic characteristics of the patients between the two groups. The overall and early complications in group 2 were significantly lower than those in group 1. Pinch-off syndrome only developed in group 1. Seven patients and two patients had pneumothorax in groups 1 and 2, respectively. Puncture number was significantly associated with the development of the overall complications. The ultrasound-guided axillary approach may be preferred as a method to reduce the risk of both early and late complications. Large, randomized, controlled prospective trials will be helpful in determining a safer implantable venous port implantation technique.

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria.

Science.gov (United States)

Nicolle, Lindsay E

2016-04-19

Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.

The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria

Directory of Open Access Journals (Sweden)

Lindsay E. Nicolle

2016-04-01

Full Text Available Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions.

Science.gov (United States)

Margolis, Jay M; Deitelzweig, Steven; Kline, Jeffrey; Tran, Oth; Smith, David M; Bookhart, Brahim; Crivera, Concetta; Schein, Jeff

2016-10-06

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin. Hospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013. Patients treated with warfarin were matched 1:1 to patients treated with rivaroxaban using exact and propensity score matching. Hospital LOS, time from first dose to discharge, and hospitalization costs were reported descriptively and with generalized linear models (GLMs). The final study cohorts each included 1223 patients (751 with pulmonary embolism and 472 with deep vein thrombosis). Cohorts were well matched for demographic and clinical characteristics. Mean (±SD) LOS was 3.7±3.1 days for patients taking rivaroxaban and 5.2±3.7 days for patients taking warfarin, confirmed by GLM-adjusted results (rivaroxaban 3.7 days, warfarin 5.3 days, P<0.001). Patients with provoked venous thromboembolism admissions showed longer LOSs (rivaroxaban 5.1±4.5 days, warfarin 6.5±5.6 days, P<0.001) than those with unprovoked venous thromboembolism (rivaroxaban 3.3±2.4 days, warfarin 4.8±2.8 days, P<0.001). Days from first dose to discharge were 2.4±1.7 for patients treated with rivaroxaban and 3.9±3.7 for patients treated with warfarin when initiated with parenteral anticoagulants (P<0.001), and 2.7±1.7 and 3.7±2.1, respectively, when initiated without parenteral anticoagulants (P<0.001). Patients initiated on rivaroxaban incurred significantly lower mean total hospitalization costs ($8688±$9927 versus $9823±$9319, P=0.004), confirmed by modeling (rivaroxaban $8387 [95

Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

NARCIS (Netherlands)

van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

2012-01-01

Objective:  The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design:  Prospective observational controlled study. Setting:  Nonacademic university-affiliated

Awareness of venous thromboembolism in mental health services for older people.

Science.gov (United States)

van Zyl, M; Wieczorek, G; Reilly, J

2014-05-01

Venous thromboembolism (VTE) is an important safety issue in the inpatient mental health care of older people. In a survey of specialist mental health staff, knowledge of deep vein thrombosis was good. More variable awareness of the presentation and risk factors for pulmonary embolism indicates the need for training integrated into regular physical health care updates. Currently, failure to adequately screen and prevent venous thromboembolism (VTE) is estimated to cause between 25,000 and 32,000 potentially avoidable deaths annually in the United Kingdom. The authors aimed to assess the awareness of VTE in clinical staff working in Mental Health Services for Older People, Tees, Esk and Wear Valleys National Health Service Foundation Trust. A questionnaire was devised to assess knowledge of VTE symptoms, risk factors, prevention, and treatment in clinical staff working in Mental Health Service for Older Peoples' inpatient units. Forty-nine nurses, 12 consultant psychiatrists, and 11 clinical pharmacists responded. A significant proportion of staff had previous involvement in VTE treatment. Staff had significantly more limited knowledge of pulmonary embolism compared to deep vein thrombosis with areas for improvement in presentation, risk factors, and prevention. The study confirms a need for improved awareness among all clinical staff including nurses, pharmacists, and doctors, which can be met by including VTE awareness in First Response training, and encouraging use of the Department of Health VTE e-learning tool. © 2013 John Wiley & Sons Ltd.

Outcomes and predictors of failure of thrombolysis for iliofemoral deep venous thrombosis.

Science.gov (United States)

Avgerinos, Efthymios D; Hager, Eric S; Naddaf, Abdallah; Dillavou, Ellen; Singh, Michael; Chaer, Rabih A

2015-01-01

Catheter-directed thrombolysis (CDT) with adjunctive mechanical techniques, when successful, is reported to alleviate symptoms of acute iliofemoral deep venous thrombosis (IFDVT) and to lower the occurrence of the post-thrombotic syndrome (PTS). This study aimed to determine longer term outcomes of catheter-based interventions for IFDVT and to identify predictors of immediate and mid-long-term failures that would guide optimal patient selection. Consecutive patients who underwent CDT or pharmacomechanical thrombolysis for IFDVT between May 2007 and March 2013 were identified from a prospectively maintained database. Assessment of predictors of immediate periprocedural failure was based on the degree of clot lysis (≤ 50% vs >50%) and 30-day recurrence of DVT. Long-term anatomic and clinical failures and outcomes were assessed by ultrasound imaging of the lysed segments and Villalta score (≥ 5 vs <5). Survival analysis was used to assess primary patency and PTS morbidity. Multivariate binary logistic and Cox regression models were used to determine predictors of anatomic and clinical failures. During the study period, 93 patients (118 limbs; mean age, 49.4 ± 16.2 years; 47 women) with symptoms averaging 11.1 ± 9.6 days in duration were treated with various combinations of CDT or pharmacomechanical thrombolysis; in 52 (56%), at least one iliocaval stent was deployed. Immediate treatment failure was seen in 11 patients (12%) predicted by the preoperative indication "phlegmasia" (odds ratio, 3.12; P = .042) and recent surgery (odds ratio, 19.6; P = .018). At a mean ultrasonographic follow-up of 16 ± 14 months (range, 1-65 months), six more patients sustained a rethrombosis, accounting for an overall 3-year primary patency of 72.1%. In the long-term model, loss of primary patency was associated with recent surgery (hazard ratio [HR], 4.04; P = .023), malignant disease (HR, 6.75; P = .016), and incomplete thrombolysis (≤ 50%) (HR, 5.83; P < .001). By

Ocularhaemodynamics parameters of asymptomatic HAART ...

African Journals Online (AJOL)

Results: Vmax of blood flow in central retinal artery (CRA) of asymptomatic HAART - experienced HIV infected children was 12.2cm/s while that of seronegative children was 13.4 cm/s. The PI and RI of blood flow in CRA of asymptomatic HAARTexperienced HIV-infected children were 0.8 and 0.5 respectively while those of ...

Human cerebral venous outflow pathway depends on posture and central venous pressure

DEFF Research Database (Denmark)

Gisolf, J; van Lieshout, J J; van Heusden, K

2004-01-01

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture...... and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway...

Deep venous thrombosis due to massive compression by uterine myoma

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Aleksandra Brucka

2010-10-01

Full Text Available A 42-year-old woman, gravida 3, para 3 was admitted to hospital because of painful oedema of her right lower extremity. Initial physical examination revealed a gross, firm tumour filling the entire peritoneal cavity. Doppler ultrasound scan revealed a thrombus in the right common iliac vein, extending to the right femur and popliteal veins, and partially into the calf deep vein. Computed tomography confirmed the existence of an abdominal tumour probably deriving from the genital organs and the presence of a thrombus in the said veins.The patient underwent hysterectomy where a myomatous uterine was removed. She was put on subcutaneous enoxaparine and compressive therapy of the lower extremities. Such symptoms as pain and oedema receded. Control Doppler scan showed fibrinolysis, partial organization of the thrombus and final vein recanalisation. After exclusion of other risk factors of deep vein thrombosis apart from stasis, we conclude that the described pathology was the effect of compression of regional pelvic structures by a uterine myoma.

Asymptomatic Bacteriuria and Bacterial Interference.

Science.gov (United States)

Nicolle, Lindsay E

2015-10-01

Asymptomatic bacteriuria is very common. In healthy women, asymptomatic bacteriuria increases with age, from women age 80 years, but is uncommon in men until after age 50 years. Individuals with underlying genitourinary abnormalities, including indwelling devices, may also have a high frequency of asymptomatic bacteriuria, irrespective of age or gender. The prevalence is very high in residents of long-term-care facilities, from 25% to 50% of women and 15% to 40% of men. Escherichia coli is the most frequent organism isolated, but a wide variety of other organisms may occur. Bacteriuria may be transient or persist for a prolonged period. Pregnant women with asymptomatic bacteriuria identified in early pregnancy and who are untreated have a risk of pyelonephritis later in pregnancy of 20% to 30%. Bacteremia is frequent in bacteriuric subjects following mucosal trauma with bleeding, with 5% to 10% of patients developing severe sepsis or septic shock. These two groups with clear evidence of negative outcomes should be screened for bacteriuria and appropriately treated. Asymptomatic bacteriuria in other populations is benign and screening and treatment are not indicated. Antimicrobial treatment has no benefits but is associated with negative outcomes including reinfection with antimicrobial resistant organisms and a short-term increased frequency of symptomatic infection post-treatment. The observation of increased symptomatic infection post-treatment, however, has led to active investigation of bacterial interference as a strategy to prevent symptomatic episodes in selected high risk patients.

Colorectal cancer with venous tumor thrombosis

OpenAIRE

Kensuke Otani; Soichiro Ishihara; Keisuke Hata; Koji Murono; Kazuhito Sasaki; Koji Yasuda; Takeshi Nishikawa; Toshiaki Tanaka; Tomomichi Kiyomatsu; Kazushige Kawai; Hiroaki Nozawa; Hironori Yamaguchi; Toshiaki Watanabe

2018-01-01

Summary: Colorectal cancer is seldom accompanied by venous tumor thrombosis, and little is known about the features of venous tumor thrombosis in colorectal cancer. However, some reports show that colorectal cancer patients can develop venous tumor thrombosis and warn clinicians not to overlook this complication. In this report, we perform a review of 43 previously reported cases and investigate the characteristics of colorectal cancer accompanied by venous tumor thrombosis. The histological ...

Diagnosis and endovascular treatment of multiple cerebral venous and venous sinuses thrombosis

International Nuclear Information System (INIS)

Li Baomin; Zhang Ji; Yin Ling; Huang Xusheng; Jiang Jinli; Liu Jun; Lang Senyang; Zhou Dingbiao; Zhu Ke

2000-01-01

Objective: Eighty-five cases with multiple cerebral venous and venous sinuses thrombosis including the diagnosis and endovascular therapy were reported. Methods: The long T2 and short T1 signals in the related regions of multiple venous sinuses on MRI and prolonged blood circulation time of the brain with tortuous dilatation of vein in angiography were the important characteristics for the diagnosis. Of the 85 cases, the treatment procedures were consisted of injecting urokinase intermittently via common carotid artery and intra-sinus contact thrombolysis as well as warfarin intake orally. Results: Intracranial pressure of 80 cases reduced down between 230 and 300 mm H 2 O, and clinical deficits were markedly improved within 10 days. Re-angiography of 18 cases revealed recanalization partly in 5 cases and circulation time appeared near normal i 8 cases during one week after therapy. Conclusions: Combined intraarterial thrombolysis consecutively with general anticoagulation for the treatment of multiple thrombosis in cerebral venous sinuses may be one of the effective means

Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers.

Science.gov (United States)

Ehrmann, Christine; Maier, Matthias; Mengiardi, Bernard; Pfirrmann, Christian W A; Sutter, Reto

2014-09-01

To determine the spectrum of magnetic resonance (MR) imaging findings at the calcaneal attachment of the plantar fascia in asymptomatic volunteers. The study was approved by the institutional review board, and informed consent was obtained from all subjects. MR imaging was performed in 77 asymptomatic volunteers (mean age, 48.0 years; age range, 23-83 years) with use of a 1.5-T system. There were 40 women (mean age, 49.0 years; age range, 24-83 years) and 37 men (mean age, 48.0 years; age range, 23-83 years). Signal intensity characteristics and thickness of the medial, central, and lateral fascicles of the plantar fascia were assessed independently by two radiologists. The presence of soft-tissue edema, bone marrow edema, and bone spur formation at the attachment of the plantar fascia was noted. Datasets were analyzed with inferential statistic procedures. The mean thickness of the plantar fascia was 0.6 mm (medial fascicle), 4.0 mm (central fascicle), and 2.3 mm (lateral fascicle). Increased signal intensity in the plantar fascia was seen with the T1-weighted sequence in 16 of the 77 volunteers (21%), the T2-weighted sequence in six (7.8%), and the short inversion time inversion-recovery sequence in six (7.8%). Soft-tissue edema was seen deep to the plantar fascia in five of the 77 volunteers (6.5%) and superficial to the plantar fascia in 16 (21%). A calcaneal spur was detected in 15 of the 77 volunteers (19%). Calcaneal bone marrow edema was present in four volunteers (5.2%). T1-weighted signal intensity changes in the plantar fascia, soft-tissue edema superficial to the plantar fascia, and calcaneal spurs are common findings in asymptomatic volunteers and should be used with caution in the diagnosis of plantar fasciitis. Increased signal intensity within the plantar fascia with fluid-sensitive sequences is uncommon in asymptomatic volunteers.

Imaging Characteristics of Venous Parenchymal Abnormalities.

Science.gov (United States)

Arnoux, Audrey; Triquenot-Bagan, Aude; Andriuta, Daniela; Wallon, David; Guegan-Massardier, Evelyne; Leclercq, Claire; Martinaud, Olivier; Castier-Amouyel, Mélody; Godefroy, Olivier; Bugnicourt, Jean-Marc

2017-12-01

There are few published data on the patterns of parenchymal imaging abnormalities in a context of cerebral venous thrombosis (CVT). The objectives of the present study were to describe the patterns of parenchymal lesions associated with CVT and to determine the lesion sites. We included 44 consecutively hospitalized patients with CVT and parenchymal lesions on magnetic resonance imaging. The diagnosis of CVT had been confirmed by magnetic resonance imaging/magnetic resonance venography. Magnetic resonance imaging patterns for CVT were retrospectively analyzed with regard to the lesion's type, shape, and site. The most frequent stroke subtype was hemorrhagic ischemia (in 56.8% of cases), followed by intracerebral hematoma (in 22.72% of cases) and nonhemorrhagic ischemia (in 20.45% of cases). Although there were no significant differences between these 3 groups with regard to the clinical and radiological characteristics, we observed a nonsignificant trend ( P =0.08) toward a shorter time interval between hospital admission and magnetic resonance imaging for nonhemorrhagic stroke. The CVT parenchymal abnormalities were centered on 6 main foci and were related to the site of venous occlusion: (1) the inferior parietal lobule (n=20; 44.5%), associated mainly with occlusion of the transverse sinus (n=10) or pure cortical veins (n=10); (2) the inferior and posterior temporal regions (n=10; 22.75%), associated mainly with occlusion of the transverse sinus (n=9); (3) the parasagittal frontal region (n=6; 13.6%), associated mainly with occlusion of the superior sagittal sinus (n=4) or the transverse sinus (n=4); (4) the thalamus (n=5; 11.3%) associated with occlusion of the straight sinus (n=5); (5) the cerebellar hemisphere (n=2; 4.5%), associated in both cases with occlusion of the transverse sinus; and (6) the deep hemispheric regions (n=3; 6.8%), associated with occlusion of the superior sagittal sinus in all cases. Parenchymal lesions caused by CVT display specific

Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia

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Kim Houlind

2013-12-01

Full Text Available Background: Patients with critical lower limb ischemia without patent pedal arteries cannot be treated by the conventional arterial reconstruction. Venous arterialization has been suggested to improve limb salvage in this subgroup of patients but has not gained wide acceptance. We report our early experience after implementing deep and superficial venous arterialization of the lower limb. Materials and methods: Ten patients with critical ischemia and without crural or pedal arteries available for conventional bypass surgery or angioplasty were treated with distal venous arterialization. Inflow was from the most distal unobstructed segment. Run-off was the dorsal pedal venous arch (n=5, the dorsal pedal venous arch and a concomitant vein of the posterior tibial artery (n=3, or the dorsal pedal venous arch and a concomitant vein of the common plantar artery (n=2 depending on the location of the ischemic lesion. Venous valves were destroyed using antegrade valvulotomes, guide wires, knob needles, or retrograde valvulotomes via an extra incision. Results: Seven of the operated limbs were amputated after 23 (1–256 days (median [range]. The main reasons for amputation were lack of healing of either the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing but without pain 309 days after surgery. Conclusion: Venous arterialization may be used as a treatment of otherwise unsalveable limbs. The success rate is, however, limited. Technical optimization of the technique is warranted.

Significance of venous anastomosis in fingertip replantation.

Science.gov (United States)

Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Abe, Yukio; Dhawan, Vikas

2003-03-01

Adequate venous outflow is the most important factor for successful fingertip replantation. The authors have attempted venous anastomosis in all cases of fingertip replantation to overcome postoperative congestion. In this article, the significance of venous repair for fingertip replantation is described from the authors' results of 64 complete fingertip amputations in 55 consecutive patients, which were replanted from January of 1996 to June of 2001. The overall survival rate was 86 percent. Of the 44 replantations in zone I, 37 survived, and the success rate was 84 percent. Of the 20 replantations in zone II, 18 survived, and the success rate was 90 percent. Venous anastomosis was attempted in all cases, but it was possible in 39 zone I and in all zone II replantations. For arterial repair, vein grafts were necessary in 17 of the 44 zone I and in one of the 20 zone II replantations; for venous repair, they were necessary in six zone I replantations and one zone II replantation. Postoperative vascular complications occurred in 15 replantations. There were five cases of arterial thrombosis and 10 cases of venous congestion. Venous congestion occurred in nine zone I and one zone II replantations. In five of these 10 replantations, venous anastomosis was not possible. In another five replantations, venous outflow was established at the time of surgery, but occlusion occurred subsequently. Except for the five failures resulting from arterial thrombosis, successful venous repair was possible in 49 of 59 replantations (83 percent). Despite the demand for skillful microsurgical technique and longer operation time, the authors' results using venous anastomosis in successful fingertip replantations are encouraging. By performing venous anastomosis, external bleeding can be avoided and a higher survival rate can be achieved. Venous anastomosis for fingertip replantation is a reliable and worthwhile procedure.

Malformação de veia cava inferior e trombose venosa profunda: fator de risco de trombose venosa em jovens Inferior vena cava malformation and deep venous thrombosis: a risk factor of venous thrombosis in the young

Directory of Open Access Journals (Sweden)

Renan Roque Onzi

2007-06-01

Full Text Available A ausência da veia cava inferior, alteração no processo de formação embriológica que ocorre entre a sexta e a oitava semanas de gestação, é uma rara anomalia congênita. Porém, recentemente foi confirmada como sendo um fator de risco importante para o desenvolvimento de trombose venosa profunda, especialmente em jovens. Apresentamos um caso de trombose em veias cava inferior, ilíacas, femorais e poplíteas num jovem de 16 anos com agenesia de um segmento de veia cava infra-renal e veia renal esquerda retroaórtica.Absence of inferior vena cava, caused by aberrant development within the sixth to eighth weeks of gestation, is a rare congenital anomaly. However, it has been recently confirmed as a major risk factor for the development of deep venous thrombosis, especially in young patients. We report a case of inferior vena cava, iliac, femoral and popliteal vein thrombosis in a 16-year-old patient with inferior vena cava agenesis and retroaortic left renal vein.

A Case Study of Deep Vein Thrombosis of the Right Internal Jugular Vein in a Healthy 21-Year-Old Male

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Javier Corral

2016-01-01

Full Text Available We are reporting a case of a healthy 21-year-old male, with no significant past medical history, who was found to have an incidental nonocclusive deep vein thrombosis in the right internal jugular vein detected on a head MRI previously ordered for work-up of headaches. A follow-up upper extremity venous Doppler ultrasound confirmed the presence of a partially occlusive deep vein thrombosis in the right jugular vein. The case presented is unique for the reason that the patient is young and has no prior risk factor, personal or familial, for venous thrombosis except for associated polycythemia on clinical presentation.

ASYMPTOMATIC BACTERIURIA AND PYURIA IN PREGNANCY

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M Rahimkhani

2008-11-01

Full Text Available "nPregnant women are at increased risk for urinary tract infection (UTI but in many cases infection is asymptomatic. This study was performed to determine the incidence of asymptomatic bacteriuria and pyuria in pregnant women. A total of 86 pregnant women during first trimester and 56 nonpregnant women were evaluated. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine samples were collected for both groups. Urine samples were examined microscopically and were cultured. Bacteriological examination revealed asymptomatic bacteriuria in 25 (29.1% and 3 (5.4% of the study group and controls, respectively (P < 0.05. Microscopic analysis of urine revealed pyuria in 18 (20.9% and 3 (5.4% of the study group and controls, respectively (P < 0.05. In study group, Escherichia coli were found in 20%, Staphylococcus epidermidis in 36%, Staphylococcus haemolyticus in 12%, streptococcus group D in 12%, Staphylococcus saprophyticus in 12% and Proteus mirabilis in 8%. In control group, E. coli were found in 33.3% and S. epidermidis in 66.7%. Our results show that the incidence of asymptomatic bacteriuria is significantly higher in pregnant women than nonpregnant women. The main finding in the present study was that 29.1% of the pregnant women who were in first trimester had asymptomatic bacteriuria which is much higher than figures reported from other countries. The use of microscopic urinanalysis was not an effective method of detecting asymptomatic bacteriuria and urine culture is necessary for screening these pregnant women.

Venous abnormalities demonstrated by computed tomography

Energy Technology Data Exchange (ETDEWEB)

Ishikawa, T; Tsukune, Y; Ashida, H; Tokuda, M; Oyama, Y [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

1980-05-01

CT is capable of demonstrating various venous changes. However, little have been described on this subject in the literature. Examples of various venous abnormalities such as obstructed jugular vein, superior and inferior vena cava (IVC), tumor invasion of IVC and renal vein and venous changes in portal hypertension were presented. It was stressed that noninvasive CT is a good tool in diagnosis of some of venous changes and may be able to eliminate angiography in such cases.

Preoperative Hospitalization Is Independently Associated With Increased Risk for Venous Thromboembolism in Patients Undergoing Colorectal Surgery: A National Surgical Quality Improvement Program Database Study.

Science.gov (United States)

Greaves, Spencer W; Holubar, Stefan D

2015-08-01

An important factor in the pathophysiology of venous thromboembolism is blood stasis, thus, preoperative hospitalization length of stay may be contributory to risk. We assessed preoperative hospital length of stay as a risk factor for venous thromboembolism. We performed a retrospective review of patients who underwent colorectal operations using univariate and multivariable propensity score analyses. This study was conducted at a tertiary referral hospital. Data on patients was obtained from the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 Participant Use Data Files. Short-term (30-day) postoperative venous thromboembolism was measured. Our analysis included 242,670 patients undergoing colorectal surgery (mean age, 60 years; 52.9% women); of these, 72,219 (29.9%) were hospitalized preoperatively. The overall rate of venous thromboembolism was 2.07% (1.4% deep vein thrombosis, 0.5% pulmonary embolism, and 0.2% both). On multivariable analysis, the most predictive independent risk factors for venous thromboembolism were return to the operating room (OR, 1.62 (95% CI, 1.44-1.81); p relationship between preoperative lengths of stay and risk of postoperative venous thromboembolism (p risk factor for venous thromboembolism and its associated increase in mortality after colorectal surgery, whereas laparoscopy is a strong protective variable. Further research into preoperative screening for highest-risk patients is indicated.

Comparing and contrasting current guidelines for venous thromboembolism prophylaxis after total hip and total knee arthroplasty.

Science.gov (United States)

Lachiewicz, Paul F

2011-01-01

Orthopaedic surgeons may be impacted by three different clinical venous thromboembolism guidelines: the American College of Chest Physicians guidelines, the Surgical Care Improvement Project guidelines, and, most recently, the American Academy of Orthopaedic Surgeons (AAOS) guideline. The American College of Chest Physicians guidelines use deep venous thrombosis detected by venography or ultrasonography as their primary outcome measure. High-grade recommendations are based on prospective randomized studies only, usually comparing one pharmacologic agent to another. The Surgical Care Improvement Project guidelines are essentially based on the 2004 American College of Chest Physicians guidelines and seek to determine if surgeons prescribe venous thromboembolism prophylaxis within 24 hours of admission. Compliance with these guidelines may affect the quality rating of a particular hospital. The AAOS guideline was designed with the clinical outcome measures of symptomatic pulmonary embolism, fatal pulmonary embolism, major bleeding, and all-cause mortality. This guideline recommends that surgeons preoperatively evaluate the patient's risks (standard or elevated) for pulmonary embolism and serious bleeding and individualize pharmacologic prophylaxis based on a risk-benefit ratio. The three guidelines all have advantages and disadvantages.

Portomesenteric venous thrombosis: A rare but probably under-reported complication of laparoscopic surgery: A case series

Directory of Open Access Journals (Sweden)

Yan Mei Goh

2017-01-01

Full Text Available Portomesenteric venous thrombosis (PMVT is a rare but well-reported complication following laparoscopic surgery. We present three cases of PMVT following laparoscopic surgery. Our first case is a 71-year-old morbidly obese woman admitted for elective laparoscopic giant hiatus hernia (LGHH repair. Post-operatively, she developed multi-organ dysfunction and computed tomography scan revealed portal venous gas and extensive small bowel infarct. The second patient is a 51-year-old man with known previous deep venous thrombosis who also had elective LGHH repair. He presented 8 weeks post-operatively with severe abdominal pain and required major bowel resection. Our third case is an 86-year-old woman who developed worsening abdominal tenderness 3 days after laparoscopic right hemicolectomy for adenocarcinoma and was diagnosed with an incidental finding of thrombus in the portal vein. She did not require further surgical intervention. The current guidelines for thromboprophylaxis follow-up in this patient group may not be adequate for the patients at risk. Hence, we propose prolonged period of thromboprophylaxis in the patients undergoing major laparoscopic surgery.

An analysis of leukapheresis and central venous catheter use in the randomized, placebo controlled, phase 3 IMPACT trial of Sipuleucel-T for metastatic castrate resistant prostate cancer.

Science.gov (United States)

Flanigan, Robert C; Polcari, Anthony J; Shore, Neil D; Price, Thomas H; Sims, Robert B; Maher, Johnathan C; Whitmore, James B; Corman, John M

2013-02-01

Sipuleucel-T is an autologous cellular immunotherapy. We review the safety of the leukapheresis procedure required for sipuleucel-T preparation and complications related to venous catheter use in the randomized, placebo controlled phase 3 IMPACT (IMmunotherapy for ProstAte Cancer Trial) study (NCT 00065442). A total of 512 patients with asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer were enrolled in the study. All patients were scheduled to undergo 3 standard 1.5 to 2.0 blood volume leukapheresis procedures at 2-week intervals. Leukapheresis related adverse events and those related to venous catheter use were reviewed. Immune cell counts were examined throughout the treatment course. Of 512 enrolled patients 506 underwent 1 or more leukapheresis procedures and were included in this analysis. Adverse events were comparable between the sipuleucel-T and control arms. Leukapheresis related adverse events were primarily associated with transient hypocalcemia (39.3%). Most leukapheresis related adverse events (97%) were of mild/moderate intensity. Median white blood cell count and absolute monocyte and lymphocyte counts were stable and within normal ranges throughout the treatment course. Of all patients 23.3% had a central venous catheter placed primarily for leukapheresis. Patients with vs without a central venous catheter had a higher risk of infection potentially related to catheter use (11.9% vs 1.3%, p nervous system (5.9% vs 2.1%, p = 0.06). Adverse events related to leukapheresis are manageable and quickly reversible. The majority of patients can undergo leukapheresis without a central venous catheter. Central venous catheters are associated with an increased risk of infections and venous vascular events. Peripheral intravenous access should be used when feasible. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Altered Venous Function during Long-Duration Spaceflights

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Jacques-Olivier Fortrat

2017-09-01

Full Text Available Aims: Venous adaptation to microgravity, associated with cardiovascular deconditioning, may contribute to orthostatic intolerance following spaceflight. The aim of this study was to analyze the main parameters of venous hemodynamics with long-duration spaceflight.Methods: Venous plethysmography was performed on 24 cosmonauts before, during, and after spaceflights aboard the International Space Station. Venous plethysmography assessed venous filling and emptying functions as well as microvascular filtration, in response to different levels of venous occlusion pressure. Calf volume was assessed using calf circumference measurements.Results: Calf volume decreased during spaceflight from 2.3 ± 0.3 to 1.7 ± 0.2 L (p < 0.001, and recovered after it (2.3 ± 0.3 L. Venous compliance, determined as the relationship between occlusion pressure and the change in venous volume, increased during spaceflight from 0.090 ± 0.005 to 0.120 ± 0.007 (p < 0.01 and recovered 8 days after landing (0.071 ± 0.005, arbitrary units. The index of venous emptying rate decreased during spaceflight from −0.004 ± 0.022 to −0.212 ± 0.033 (p < 0.001, arbitrary units. The index of vascular microfiltration increased during spaceflight from 6.1 ± 1.8 to 10.6 ± 7.9 (p < 0.05, arbitrary units.Conclusion: This study demonstrated that overall venous function is changed during spaceflight. In future, venous function should be considered when developing countermeasures to prevent cardiovascular deconditioning and orthostatic intolerance with long-duration spaceflight.

Fragment E1 labeled with I-123 in the detection of venous thrombosis

International Nuclear Information System (INIS)

Knight, L.C.; Maurer, A.H.; Robbins, P.S.; Malmud, L.S.; Budzynski, A.Z.

1985-01-01

Fragment E1, which has been shown to have specific binding affinity for thrombi in an animal model, was investigated in humans for its safety and ability to bind to venous thrombi. Human Fragment E1 was labeled with I-123 and administered intravenously to patients with proved or suspected deep vein thrombosis. The vascular distribution of radioactivity was documented by obtaining gamma camera images of the patients' legs for 30 minutes following administration of I-123-Fragment E1. All patients (n = 5) with documented venous thrombi had rapid localization of labeled Fragment E1 in the area of thrombus. Patients without evidence of thrombi (n = 5) showed no focal localization, although two of these patients showed diffuse uptake along the length of the veins, due to superficial phlebitis. Analysis of blood samples in four patients indicated that disappearance of Fragment E1 from the circulation was more rapid in individuals with thrombosis (t 1/2 = 20 min) than in individuals without thrombosis (t 1/2 = 90 min), and a radiolabeled species of high molecular weight was found in patients with thrombosis but was absent from patients without thrombosis. These early results suggest that radiolabeled Fragment E1 is a safe and potentially valuable agent for the rapid detection of venous thrombosis

Venous chest anatomy: clinical implications

International Nuclear Information System (INIS)

Chasen, M.H.; Charnsangavej, C.

1998-01-01

This article provides a practical approach to the clinical implications and importance of understanding the collateral venous anatomy of the thorax. Routine radiography, conventional venography, computed tomography (CT), and magnetic resonance (MR) imaging studies provide correlative anatomic models for the demonstration of how interconnecting collateral vascular networks within the thorax maintain venous stability at all times. Five major systems comprise the collateral venous network of the thorax ( Fig. 1 ). These include the paravertebral, azygos-hemiazygos, internal mammary, lateral thoracic, and anterior jugular venous systems (AJVS). The five systems are presented in the following sequence: (a) a brief introduction to the importance of catheter position and malposition in understanding access to the thoracic venous system, (b) the anatomy of the azygos-hemiazygos systems and their relationship with the paravertebral plexus, (c) the importance of the AJVS, (d) 'loop' concepts interconnecting the internal mammary and azygos-hemiazygos systems by means of the lateral thoracic and intercostal veins, and (e) the interconnecting venous networks on the thoracic side of the thoracoabdominal junction. Certain aspects of the venous anatomy of the thorax will not be discussed in this chapter and include (a) the intra-abdominal anastomoses between the superior and inferior vena cavae (IVC) via the internal mammary, lateral thoracic, and azygos-hemiazygos systems (beyond the scope of this article), (b) potential collateral vessels involving vertebral, parascapular, thyroidal, thymic, and other smaller veins that might anastomose with the major systems, and (c) anatomic variants and pitfalls that may mimic pathologic conditions (space limitations). (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

Sonographic detection of portal venous gas

International Nuclear Information System (INIS)

Lee, Wang Yul; Lee, S. K.; Cho, O. K.

1989-01-01

Portal venous gas suggests underlying bowel disease such as strangulating intestinal obstruction and its demonstration carries with it an important implications with respect to patient management. Radiography has been the gold standard for the detection of portal venous gas. We have experienced two cases of portal venous gas diagnosed by ultrasound. Sonographic findings were floating echoes in the main portal vein and highly echogenic linear or patchy echoes within the hepatic parenchyma. Simple abdominal films of those cases failed to demonstrate gas in the portal venous system

Intra-Arterial Thrombolysis for Deep Vein Thrombosis of the Lower Extremity: Case Report

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Kim, Moo Sang; Roh, Byung Suk [Dept. of Radiology, Wonkwang University School of Medicine, Iksan (Korea, Republic of)

2011-09-15

If the appropriate catheterization of the affected vein was not possible because of a narrowed or thrombus-filled venous lumen, successful treatment gets into trouble during catheter directed regional thrombolysis for treatment of deep vein thrombosis. In this situation, intra-arterial thrombolysis can be considered as an alternative treatment, but to the best of our knowledge, only two reports have been described. We present here cases of successful intra-arterial thrombolysis in patients with deep vein thrombosis.

Multicenter assessment of venous reflux by duplex ultrasound.

Science.gov (United States)

Lurie, Fedor; Comerota, Anthony; Eklof, Bo; Kistner, Robert L; Labropoulos, Nicos; Lohr, Joann; Marston, William; Meissner, Mark; Moneta, Gregory; Neglén, Peter; Neuhardt, Diana; Padberg, Frank; Welsh, Harold J

2012-02-01

This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression-decompression). The study enrolled 17 healthy volunteers and 57 patients with primary chronic venous disease. Repeatability of reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable (P ultrasound detection of venous reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic reflux can significantly improve the reliability of reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Endogenous sex hormones and risk of venous thromboembolism in women and men

DEFF Research Database (Denmark)

Holmegard, Haya N; Nordestgaard, B G; Schnohr, P

2014-01-01

Heart Study, who had estradiol and testosterone concentrations measured. Of these, 636 developed VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) during a follow-up of 21 years (range, 0.02-32 years). Associations between endogenous estradiol and testosterone concentrations and risk...... of VTE were estimated by Cox proportional hazards regression with time-dependent covariates and corrected for regression dilution bias. RESULTS: Multifactorially adjusted hazard ratios of VTE for individuals with estradiol levels >75th vs. ≤25th percentile were 0.84 (95%CI, 0.25-2.85), 1.05 (0...

Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

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Pekindil, Goekhan [Department of Radiology, Trakya University School of Medicine, 22030 Edirne (Turkey); Varol, Fuesun G. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Ali Yuece, M. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Yardim, Turgut [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey)

1999-03-01

Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period.

Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

International Nuclear Information System (INIS)

Pekindil, Goekhan; Varol, Fuesun G.; Ali Yuece, M.; Yardim, Turgut

1999-01-01

Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period

Asymptomatic cerebral hemorrhage detected by MRI

International Nuclear Information System (INIS)

Nakajima, Yumi; Ohsuga, Hitoshi; Yamamoto, Masahiro; Shinohara, Yukito

1991-01-01

Detection of previous cerebral infarction on CT films of patients with no history of stroke is a common occurrence. The incidence of silent cerebral infarction was reported to be about 10 to 11 percent, but very few reports concerning asymptomatic cerebral hemorrhage available. However, recent clinical application of MRI has resulted in the detection of old asymptomatic hemorrhage in patients with no history known stroke-like episodes. The purpose of this study was to elucidate the incidence, the cause and the character of the asymptomatic cerebral hemorrhage among patients who had undergone MRI examinations. From September 1987 through June 1990, 2757 patients have undergone 3474 MR scans of the brain with 1.0 Tesla Siemens Magneton unit in our hospital. Seventeen patients showed no clinical signs or symptoms suggesting a stroke episode corresponding to the detected hemorrhagic lesion. The 17 patients corresponded to 0.6% of the patients who underwent MRI, 1.5% of the patients with cerebrovascular disease and 9.5% of the patients with intracerebral hemorrhage(ICH), which was rather higher than expected. Among the 17 patients, 12 were diagnosed as primary ICH and 5 as secondary ICH. Most of the primary asymptomatic hemorrhage were hypertensive ones and slit-like curvilinear lesions between the putamen and claustrum or external capsule. The secondary asymptomatic hemorrhage were due to AVM and angiomas in the frontal cortex, thalamus and pons. (author)

Asymptomatic cerebral hemorrhage detected by MRI

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Nakajima, Yumi; Ohsuga, Hitoshi; Yamamoto, Masahiro; Shinohara, Yukito [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine

1991-03-01

Detection of previous cerebral infarction on CT films of patients with no history of stroke is a common occurrence. The incidence of silent cerebral infarction was reported to be about 10 to 11 percent, but very few reports concerning asymptomatic cerebral hemorrhage available. However, recent clinical application of MRI has resulted in the detection of old asymptomatic hemorrhage in patients with no history known stroke-like episodes. The purpose of this study was to elucidate the incidence, the cause and the character of the asymptomatic cerebral hemorrhage among patients who had undergone MRI examinations. From September 1987 through June 1990, 2757 patients have undergone 3474 MR scans of the brain with 1.0 Tesla Siemens Magneton unit in our hospital. Seventeen patients showed no clinical signs or symptoms suggesting a stroke episode corresponding to the detected hemorrhagic lesion. The 17 patients corresponded to 0.6% of the patients who underwent MRI, 1.5% of the patients with cerebrovascular disease and 9.5% of the patients with intracerebral hemorrhage(ICH), which was rather higher than expected. Among the 17 patients, 12 were diagnosed as primary ICH and 5 as secondary ICH. Most of the primary asymptomatic hemorrhage were hypertensive ones and slit-like curvilinear lesions between the putamen and claustrum or external capsule. The secondary asymptomatic hemorrhage were due to AVM and angiomas in the frontal cortex, thalamus and pons. (author).

Evaluation of diagnostic reliability of radionuclide phlebography using 99mTc-MAA to detect deep venous thrombosis; Its role in establishing indications for inferior vena cava filter implantation

International Nuclear Information System (INIS)

Markovic, S.; Odavic, M.; Spaic, R.; Rostovac, M.; Ajdinovic, B.; Matunovic, A.; Raicevic, B.; Prvulov, S.; Kamenica, S.

1991-01-01

Radionuclide phlebography (RNP) of the lower extremities and pelvis was performed using 99m Tc-MAA in 40 patients with pulmonary thromboembolism. Deep venous thrombosis (DVT) was found in all patients, more frequently in the right calf and in the left iliac veins in 20 patients (55%). RNP and contrast phlebography (CP) were performed in 18 patients and confirmed the presence of DVT in all cases. The greatest specificity of RNP was obtained in the left (92.4%) and in the right pelvis (80%). In 12 of 18 patients in whom a cava filter was implanted, specificity of RNP was 100% for the left thigh and 91.7% for other localizations. In establishing indications for cava filter implantation, RNP should be performed prior to CP and bilaterally, but in case of non-indicated CE, RNP findings should be sufficient. (orig.) [de

Unilateral papilledema in cerebral venous sinus thrombosis

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Girish Baburao Kulkarni

2017-01-01

Full Text Available In the majority of patients with raised intracranial pressure, the papilledema is bilateral. Unilateral papilledema is rare in conditions causing intracranial hypertension, and it has been described in Foster–Kennedy syndrome and in some cases of idiopathic intracranial hypertension. It has never been reported in cerebral venous thrombosis. We report a young lady presenting with features of subacute onset of headache with seizures, on evaluation she had superior sagittal and bilateral lateral sinus thrombosis. The risk factors found on evaluation were Vitamin B12 deficiency and hyperhomocysteinemia. On optic fundus examination, she had swollen optic disc on the right side with normal fundus on the left side, confirmed with the orbital ultrasound B-scan and optic coherence tomography. Her magnetic resonance imaging showed features of raised intracranial pressure with thrombosis of the superior sagittal and bilateral lateral sinus thrombosis. She was treated with anticoagulation (heparin followed by oral anticoagulants, antiedema measures, and vitamin supplementation for hyperhomocysteinemia. She improved over time and was asymptomatic during follow-up. We discuss the possible mechanisms described in the literature for unilateral papilledema. This report highlights the need for carefully performing bilateral fundus examination so as not to miss the vision or life-threatening causes of a headache.

[Risk factors for the development of venous insufficiency of the lower limbs during pregnancy--part 1].

Science.gov (United States)

Ropacka-Lesiak, Mariola; Kasperczak, Jarosław; Breborowicz, Grzegorz H

2012-12-01

, adhesion molecules, and reduce platelet response, i.e. the aggregation and adhesion in the presence of monocytes. Estradiol increases the production, activity and bioavailability of nitric oxide, a molecule with a strong vasodilating effect. Additionally adverse affects may appear due to short intervals between pregnancies, genetics, presence of venous thrombosis or venous insufficiency in the superficial and deep system in anamnesis. Caesarean section is also a risk factor for venous thrombosis. Family factors are associated with inheritance of the formation of varicose changes and venous insufficiency in both ways, dominant and recessive, and also sex-related. Among other factors affecting the development of venous insufficiency during pregnancy the following can be distinguished: type of work (standing, sitting, in forced positions and vibration), interval between pregnancies (determining the possibility of regeneration of physiological regeneration of the system). In case of women who were pregnant more than once, the risk of developing varicose veins and other venous insufficiency is doubled.

Venous filling time using air-plethysmography correlates highly with great saphenous vein reflux time using duplex.

Science.gov (United States)

Lattimer, C R; Azzam, M; Kalodiki, E; Geroulakos, G

2014-03-01

Venous filling time (VFT90) is the time taken to reach 90% of the venous volume in the calf. It is recorded by air-plethysmography (APG(®)) and is assumed to measure global venous reflux duration. However, this has never been confirmed by duplex. The aim of the study was to compare VFT on APG to venous reflux time/duration (RT) measured simultaneously with duplex on the same patients. Twenty-six consecutive patients, M:F = 16:10, age (25-78), C1 = 1, C2 = 4, C3 = 8, C4a = 6, C4b = 4, C5 = 2, C6 = 1, underwent simultaneous APG with duplex. The venous filling index (VFI, mL/second), VFT90 (seconds), great saphenous vein (GSV) RT on duplex, averaged thigh GSV diameter and thigh length (length) between the APG sensor air-cuff and duplex transducer were recorded. The VFT100 was calculated by VFT90/0.9. The additional time taken to fill the thigh was achieved using the VFI, length and deep vein diameter (d), to determine the corrected reflux duration: CRD = VFT100 + (length × πd(2)/4 (1/VFI)). Twenty-five patients are presented. One patient with very mild reflux (VFT90 = 55.9 seconds) had an indeterminate endpoint on duplex and was excluded. The median (range) VFI and GSV diameter was 4.9(1.3-15.5) mL/second and 7(4-17) mm, respectively. The VFT90 and VFT100 both correlated with RT on duplex (Spearman, P duplex RT at 24 (16.9) versus 28 (20) seconds respectively, P duplex by performing simultaneous measurements. There was an excellent correlation between the VFT90 versus duplex RT, thereby comparing reverse flow in a single superficial vein against the legs overall venous haemodynamic status. These tests can both be used in the quantification of reflux.

Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography

International Nuclear Information System (INIS)

Miller, Elka; Daneman, Alan; Doria, Andrea S.; Blaser, Susan; Traubici, Jeffrey; Jarrin, Jose; Shroff, Manohar; Moineddin, Rahim; Moore, Aideen

2012-01-01

Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease. To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV). Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2-7.6 h) of the MRI study using a standard protocol. Fifty consecutive neonates participated in the study (30 males [60%]; 25-41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82-100%), for MRV reading, 99% (range, 96-100%) and for intermodality, 100% (range, 96-100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94-98%) and transverse sinuses (82-86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques. Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease. (orig.)

Asymptomatic Bacteriuria Frequency in Pregnancy

OpenAIRE

Sarı O et al.

2011-01-01

Most of the complications caused by asymptomatic bacteriuria (ABU) in pregnancy can be avoided by early treatment. In our study, we aimed to determine the urinary infection prevalence and the pathogen agent identification in the pregnant women observing in our clinic. 240 asymptomatic pregnant women having no antibiotic treatment history during last 1 week and were enrolled to the study. Urine specimens were collected from 12th and 16th week pregnant women, and were examined by light microsco...

YouTube as a potential source of information on deep venous thrombosis.

Science.gov (United States)

Bademci, Mehmet Ş; Yazman, Serkan; Güneş, Tevfik; Ocakoglu, Gokhan; Tayfur, Kaptanderya; Gokalp, Orhan

2017-09-01

Background No work has been reported on the use of video websites to learn about deep vein thrombosis and the value of education using them. We examined the characteristics and scientific accuracy of videos related to deep vein thrombosis on YouTube. Methods YouTube was surveyed using no filter and the key words 'deep vein thrombosis' and 'leg vein clot' in June 2016. The videos evaluated were divided into three groups in terms of their scientific content, accuracy, and currency: useful, partly useful, and useless. Results Of the 1200 videos watched, 715 (59.58%) were excluded with the exclusion criteria. Although most of the videos uploaded (22.9%, n = 111) were created by physicians, the number of views for website-based videos was significantly higher (p = 0.002). When the uploaded videos were assessed in terms of their usefulness, videos from physicians and hospitals were statistically more useful than other videos (p < 0.001). Conclusions For videos created by medical professionals to be of higher quality, we believe they should be more up-to-date and comprehensive, and contain animations about treatment modalities and early diagnosis in particular.

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines.

Science.gov (United States)

Nicolle, Lindsay E

2006-08-01

Asymptomatic bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.

Current concepts in repair of extremity venous injury.

Science.gov (United States)

Williams, Timothy K; Clouse, W Darrin

2016-04-01

Extremity venous injury management remains controversial. The purpose of this communication is to offer perspective as well as experiential and technical insight into extremity venous injury repair. Available literature is reviewed and discussed. Historical context is provided. Indication, the decision process for repair, including technical conduct, is delineated. In particular, the authors' experiences in both civilian and wartime injury are used for perspective. Extremity venous injury repair was championed within data from the Vietnam Vascular Registry. However, patterns of extremity venous injury differ between combat and civilian settings. Since Vietnam, civilian descriptive series opine the benefits and potential complications associated with both venous injury repair and ligation. These surround extremity edema, chronic venous insufficiency, thromboembolism, and limb loss. Whereas no clear superiority in either approach has been identified to date, there appears to be no increased risk of pulmonary embolism or chronic venous changes with repair. Newer data from the wars in Iraq and Afghanistan and meta-analysis have reinforced this and also have suggested limb salvage benefit for extremity venous repair in combined arterial and venous injuries in modern settings. The patient's physiologic state and associated injury drive five triage categories suggesting vein injury management. Vein repair thrombosis occurs in a significant proportion, yet many recanalize and possibly have a positive impact on limb venous return. Further, early decompression favors reduced blood loss, acute edema, and inflammation, supporting collateral development. Large soft tissue injury minimizing collateral capacity increases the importance of repair. Constructs of repair are varied with modest differences in patency. Venous shunting is feasible, but specific roles remain nebulous. An aggressive posture toward extremity venous injury repair seems justified today because of the likely

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

Science.gov (United States)

Boyle, Soames; White, Richard H.; Brunson, Ann

2013-01-01

Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

Venous coupler use for free-flap breast reconstructions: specific analyses of TMG and DIEP flaps.

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Bodin, Frédéric; Brunetti, Stefania; Dissaux, Caroline; Erik, A Sauleau; Facca, Sybille; Bruant-Rodier, Catherine; Liverneaux, Philippe

2015-05-01

The purpose of this report was to present the results of comparisons of anastomotic data and flap complications in the use of venous coupler in breast reconstruction with the transverse musculocutaneous gracilis (TMG) flap and the deep inferior epigastric perforator (DIEP) flap. Over a three-year period, 95 patients suffering from breast cancer were treated with mastectomy and breast reconstruction using free flaps. We performed 121 mechanical venous anastomoses for 105 flap procedures (80 DIEP and 25 TMG). The coupler size, anastomotic duration, number of anastomoses and postoperative complications were assessed for the entire series. The coupling device was perfectly suitable for all end-to-end anastomoses between the vein(s) of the flap and the internal mammary vein(s). No venous thrombosis occurred. The mean anastomotic time did not significantly differ between the DIEP (330 seconds) and TMG flap procedures (352 seconds) (P = 0.069). Additionally, there were no differences in coupling time observed following a comparison of seven coupler sizes (P = 0.066). The mean coupler size used during the TMG flap procedure was smaller than that used with the DIEP (2.4 mm versus 2.8 mm) (P TMG flap (28%) than with the DIEP flap (11%). The coupler size used was smaller for the TMG procedure and when double venous anastomosis was performed. Additionally, anastomotic time was not affected by the flap type or coupler size used or by anastomosis number. © 2014 Wiley Periodicals, Inc.

Cerebral venous thrombosis

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Soralova, T.; Sevcikova, H.; Petersky, D.

2014-01-01

We decided to process this theme due to its nonspecific clinical features as they often cause diagnostic problems not only to clinicians but also to diagnostic. It is important to think of this disease mainly in young women who administer hormonal contraception. Imaging methods play the crucial role in diagnostic of cerebral venous sinus thrombosis. The gold standard is a native CT of brain which shows the venous sinus thrombosis as a hyperdense lesion in the locus of the sinus (dense triangle sign), CT venography shows the sinus thrombosis as a defect in a contrast filling of the venous sinus (empty delta sign). Other investigative methods are magnetic resonance imaging or MRA. In short we also mention quite a rare but more serious thrombosis of profound cerebral veins v. cerebri magna-Galeni, vv. cerebri internae). The importance of early diagnostic and non specificity of symptoms is presented in 3 clinical cases that are the part of this work. (author)

Venous ligation: a novel strategy for glans enhancement in penile prosthesis implantation.

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Hsu, Geng-Long; Hill, James W; Hsieh, Cheng-Hsing; Liu, Shih-Ping; Hsu, Chih-Yuan

2014-01-01

Although penile implantation remains a final solution for patients with refractory impotence, undesirable postoperative effects, including penile size reduction and cold sensation of the glans penis, remain problematic. We report results of a surgical method designed to avoid these problems. From 2003 to 2013, 35 consecutive patients received a malleable penile implant. Of these, 15 men (the enhancing group) were also treated with venous ligation of the retrocoronal venous plexus, deep dorsal vein, and cavernosal veins. The remaining 20 men formed the control group, treated with only a penile implant. Follow-up ranged from 1.1 to 10.0 years, with an average of 6.7 ± 1.5 years. Although preoperative glanular dimension did not differ significantly between the two groups, significant respective difference at one day and one year postoperatively was found in the glanular circumference (128.8 ± 6.8 mm versus 115.3 ± 7.2 mm and 130.6 ± 7.2 mm versus 100.5 ± 7.3 mm; both Penhance the glans penis dimension in implant patients.

The Anatomical Correlation between the Internal Venous Vertebral System and the Cranial Venae Cavae in Rabbit.

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Mazensky, David; Petrovova, Eva; Danko, Jan

2013-01-01

The aim of this study was to describe the possible variations in the connection between the internal venous vertebral system and the cranial vena cava in rabbit using corrosion technique. The study was carried out on 40 adult New Zealand white rabbits. The venous system was injected by using Batson's corrosion casting kit number 17. We found the connection between the internal venous vertebral system and the cranial vena cava by means of the vertebral veins and the right azygos vein. The vertebral vein was present as independent tributary in 36 cases (90%). In the rest of the cases, it was found as being double, being triple, or forming a common trunk with other veins. The azygos vein was present as independent tributary of the cranial vena cava in 39 cases (97.5%). We found also a common trunk formed by the junction of the deep cervical vein, the right vertebral vein, and the azygos vein in one case (2.5%). The azygos vein received 6, 7, 8, or 9 pairs of dorsal intercostal veins. Documenting the anatomical variations in the rabbit will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

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Kreidy R

2011-09-01

Full Text Available Raghid Kreidy1, Elias Stephan2, Pascale Salameh3, Mirna Waked4 1Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 2Department of Geriatrics, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 3Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 4Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon Aim: The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%. Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied. Methods: Between July 2007 and January 2010, 95 consecutive Lebanese geriatric ($60 years of age inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years. Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis. Results: Out of 95 patients, 33 patients (34.7% were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal using complete venous ultrasound. Nine of these 33 patients (27.2% had a history of venous thromboembolism and eleven (33.3% presented with edema of lower

Human cerebral venous outflow pathway depends on posture and central venous pressure

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Gisolf, J; van Lieshout, J J; van Heusden, K; Pott, F; Stok, W J; Karemaker, J M

2004-01-01

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R2 = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins. PMID:15284348

Penile venous surgery for treating erectile dysfunction: Past, present, and future perspectives with regard to new insights in venous anatomy

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Cheng-Hsing Hsieh

2016-06-01

Full Text Available In the physiologic model of normal erectile function, a healthy veno-occlusive mechanism is essential to initiate and maintain a rigid erection. The surgical treatment of patients with venous leakage, which is synonymous with corporoveno-occlusive dysfunction (CVOD, was based on the decreased venous outflow during the erection process. The initial reports of short-term results were promising, but the long-term benefits of penile venous ligation surgery were limited. Most clinical guideline panels concluded that surgeries performed in an attempt to limit the venous outflow of the penis were not recommended. Consequently, this surgery was nearly abandoned in most medical societies worldwide. These unfavorable postoperative outcomes seemed attributable to the indispensable usage of electrocautery and insufficient venous management, based on conventional penile venous anatomy. Advances in better understanding of human penile venous anatomy has enabled the development of refined penile venous stripping surgery. The thorough stripping surgery is an even more radical procedure, which is an even more radical procedure, and seems to be a viable option for the treatment of CVOD, however, there is still a need for further study with well-defined diagnostic criteria, and standardized patient and partner outcome assessment.

Cerebral venous outflow and cerebrospinal fluid dynamics

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Clive B. Beggs

2014-12-01

Full Text Available In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins.

A case of huge colon carcinoma and right renal angiomyolipoma accompanied by proximal deep venous thrombosis, pulmonary embolism and tumor thrombus in the renal vein.

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Ban, Daisuke; Yamamoto, Seiichiro; Kuno, Hirofumi; Fujimoto, Hiroyuki; Fujita, Shin; Akasu, Takayuki; Moriya, Yoshihiro

2008-10-01

A preoperative inferior vena cava (IVC) filter is reported to be effective in surgical cases with proximal deep venous thrombosis (DVT) or in which pulmonary embolism (PE) has already developed, and considered to be at high risk of developing secondary fatal PE during or after surgery. However, guidelines for using an IVC filter have yet to be established. The patient in the present report had two huge tumors, ascending colon cancer and renal angiomyolipoma, which occupied the entire right half of the abdomen, coexisting PE, DVT and tumor thrombus in the right renal vein. Secondary PE is fatal in the perioperative period, therefore, the vena cava filters were preoperatively inserted into the supra- and the infrarenal IVC. We successfully removed the tumors without complications. The patient is alive without tumor recurrence and PE or recurrent DVT 1 year and 6 months after surgery. The coexistence of two huge abdominal tumors as potential causes of PE and DVT is extremely rare, and we could have safely undergone the operation, using two vena cava filters in the supra- and infrarenal IVC.

Asymptomatic plasmodial infection in Colombian pregnant women.

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Carmona-Fonseca, Jaime; Agudelo, Olga M; Arango, Eliana M

2017-08-01

Information about asymptomatic plasmodial infection is scarce in the world, and the current antimalarial program goals (control, elimination, and eradication) demand this evidence to be well documented in different populations and malaria transmission settings. This study aimed to measure the prevalence of API in Colombian pregnant women at delivery. A retrospective prevalence survey was used. Women were recruited at hospital obstetric facility in each of the municipalities of Turbo, Necoclí in Antioquia department, and Puerto Libertador in Córdoba department. Malaria infection was tested by thick blood smear (TBS) and real-time quantitative PCR (qPCR). Ninety-six pregnant women at delivery were studied: 95% were asymptomatic (91/96), 45% had asymptomatic plasmodial infection (API) by qPCR (41/91), and only 8% (7/91) had API by microscopy. The prevalence of submicroscopic infections (TBS negative and qPCR positive) was very high, 37% (34/91) in asymptomatic women and 41% (39/96) in total women studied (91 asymptomatic and 5 symptomatic). The prevalence of API in Colombian pregnant women is much higher than which is expected for a country that does not have the level of malaria transmission as Sub-Saharan African countries. Copyright © 2017 Elsevier B.V. All rights reserved.

The role of apixaban for venous and arterial thromboembolic disease.

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Prom, Rathasen; Spinler, Sarah A

2011-10-01

To provide a comprehensive review of the pharmacology, pharmacokinetics, pharmacodynamics, clinical trial data, adverse effects, and drug interactions of apixaban. An English-language literature search was performed with MEDLINE/PubMed from January 2007 to August 2011 using the search terms apixaban, factor Xa inhibitors, FXa inhibitors, BMS-562247-01, venous thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, acute coronary syndrome, ACS, atrial fibrillation, atrial arrhythmias, total hip replacement or arthroplasty, total knee replacement or arthroplasty, and orthopedic surgery to identify relevant articles. The references of the retrieved articles, professional society meeting abstracts, and the Web site www.clinicaltrials.gov were reviewed to identify other pertinent articles. Pertinent original studies involving apixaban's pharmacology, pharmacokinetics, drug interactions, and clinical efficacy and safety data were included. Results of 2 large Phase 3 trials suggest that apixaban is superior for stroke and systemic embolism prevention compared to both aspirin and warfarin in patients with atrial fibrillation (AF); rates of major bleeding and intracranial hemorrhage were similar to those of aspirin but significantly reduced compared to warfarin. Completed trials in orthopedic surgery found apixaban to be superior to enoxaparin in total hip replacement (THR) surgery but inferior in total knee replacement (TKR) surgery, with similar rates of major bleeding. A Phase 3 trial of apixaban in acute coronary syndrome was stopped early because of excess bleeding. Future Phase 3 trials will help to determine apixaban's role for treatment of deep vein thrombosis and pulmonary embolism. Currently, apixaban is approved only in Europe for prophylaxis of venous thromboembolism in adults who have undergone elective THR or TKR. A Phase 3 trial in patients with AF revealed apixaban to be superior to warfarin for stroke and systemic embolism