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Sample records for leg deep venous

  1. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Adderley, Una

    2016-01-15

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.

  2. 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.

  3. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea

    2011-12-21

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide

  4. [Effect of meteorological variations on the emergence of deep venous thrombosis of the leg].

    Science.gov (United States)

    Esquenet, P; Boudet, J; Sevestre-Pietri, M A; Ganry, O; Pietri, J

    1997-10-01

    Recent articles have established a significant relationship between metereology variables and the development of vascular disease. We performed a retrospective study to determine relationships between the development of deep vein thrombosis in the lower limb and certain meteorology variables. We identified 345 cases of phlebitis in 1995. We studied the distribution of the number of venous thrombosis per day, per month and per season. We compared certain meteorological data (atmospheric pressure, temperature, mean hygrometery) for days with and days without venous thrombosis and the atmospheric variations during the 48 hours prior to venous thrombosis. There was a significant relationship (p < 0.004) between the mean number of cases of phlebitis recorded per day and season with winter predominating. On days when phlebitis occurred, the atmospheric pressure was significantly lower (p < 0.05). The number of thrombotic events was significantly different on days when the variation was greater than 10 hectopascals than on days when the variation was less than 10 hectopascals (p < 0.05). In our study, deep vein thrombosis of the lower limb was significantly associated with certain meteorology variables. Prospective multicentric studies are needed to confirm these relationships.

  5. Endovenous management of venous leg ulcers.

    Science.gov (United States)

    Raju, Seshadri; Kirk, Orla K; Jones, Tamekia L

    2013-04-01

    Compression is the current "standard" in the treatment of venous leg ulcers, and corrective surgery is ancillary. The emergence of safe and effective minimally invasive corrective techniques prompts a reappraisal of this paradigm. Among 192 consecutive limbs with venous leg ulcers, 189 were treated by (1) endovenous laser ablation (n = 30), (2) iliac vein stent placement (n = 89), or (3) both (n = 69). Residual deep reflux was not treated. No specialized wound care was used, and 38% of patients did not use stockings. Outcome measures were time to heal the ulcer and cumulative long-term healing. Sixty percent of the limbs were post-thrombotic. The median reflux segment score was 3 (range, 0-7). Thirty-seven percent had deep axial reflux. Median intravascular ultrasound-detected stenosis was 70% (range, 0%-100%) in stented patients. Sensitivity of venography to iliac vein obstruction was 52%. Postprocedural mortality was 0%, and 2% had deep venous thrombosis (ulcers approximately ≤1 inch in diameter had healed. Larger ulcers were slower in healing (P pressure). However, long-term ulcer healing was inferior in limbs with reflux segment score of ≥3 (P ulcers in this consecutive series achieved long-term healing with the described minimally invasive algorithm. Uncorrected residual reflux was not an impediment to ulcer healing. Ulcers sized ≤1 inch required no specialized or prolonged wound care. Compression was not necessary to achieve or maintain healing after interventional correction. Copyright © 2013 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment......%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line...

  8. History of venous leg ulcers.

    Science.gov (United States)

    Gianfaldoni, S; Wollina, U; Lotti, J; Gianfaldoni, R; Lotti, T; Fioranelli, M; Roccia, M G

    To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

  9. Venous leg ulcer in the context of chronic venous disease.

    Science.gov (United States)

    Lozano Sánchez, F S; Marinel lo Roura, J; Carrasco Carrasco, E; González-Porras, J R; Escudero Rodríguez, J R; Sánchez Nevarez, I; Díaz Sánchez, S

    2014-05-01

    Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5-C6 and C1 (control) group. Data from a national, multicentre, observational and cross-sectional study (n = 1598) were used to compare three groups of CVD: C1 (n = 243), C5 (n = 136) and C6 (n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers (P ulcers than in those with C1 (P ulcers (C6) had lower QoL scores, but the differences were not statistically significant. Patients with venous leg ulcers (C5-C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.

  10. The recalcitrant venous leg ulcer - A never ending story?

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan); M.B. Maessen-Visch (Birgitte); S.I. Langendoen; K.P. de Roos; H.A.M. Neumann (Martino)

    2013-01-01

    textabstractIntroduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is

  11. Compression Stockings for Treating Venous Leg Ulcers

    Directory of Open Access Journals (Sweden)

    J. P. Benigni

    2013-01-01

    Full Text Available Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle. Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit. In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings.

  12. Venous thrombosis during pregnancy: leg and trimester of presentation

    NARCIS (Netherlands)

    Ginsberg, J. S.; Brill-Edwards, P.; Burrows, R. F.; Bona, R.; Prandoni, P.; Büller, H. R.; Lensing, A.

    1992-01-01

    In order to determine the relative frequencies of left and right leg venous thrombosis during pregnancy and the frequencies of venous thrombosis during the three trimesters, a cohort study of 60 consecutive patients with a first episode of venous thrombosis during pregnancy was performed.

  13. [Prophylaxis of Recurrent Venous Leg Ulcer].

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    Kroeger, K; Storck, M; Kujath, P; Rabe, E; Dissemond, J

    2017-06-01

    Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU. Georg Thieme Verlag KG Stuttgart · New York.

  14. Nurses' knowledge about venous leg ulcer care: a literature review.

    Science.gov (United States)

    Ylönen, M; Stolt, M; Leino-Kilpi, H; Suhonen, R

    2014-06-01

    There is an increasing prevalence of venous leg ulcers coinciding with increasing older people populations. They are therefore important health problems, which restrict daily activities and incur high costs. Efficient and comprehensive nursing care for people with venous leg ulcers requires knowledge of causes, presentations and characteristics, the effects that venous leg ulcers have on individuals and nursing care with evidence-based treatment. To identify the gaps between nurses' demonstrated knowledge of venous leg ulcers and the related nursing care treatment with evidence-based nursing care. A computerized search using MEDLINE, CINAHL the COCHRANE LIBRARY was conducted. The initial search yielded 174 citations from which 16 relevant articles were included in this review. Four themes in venous leg ulcer nursing care emerged demonstrating nurses' knowledge gaps: assessment, physiology and the healing process, nursing care and dressings, and compression treatment. This review suggests that there is a lack of knowledge related to venous leg ulcer physiology, the healing process and how this influences care and treatment. Nurses may not be using the evidence base sufficiently well to support ulcer healing and patient well-being. There is a need for a positive work culture development and ongoing educational programmes aimed at improving nurses' knowledge of venous leg ulcer treatment and care, which address the themes within the results of this review. © 2014 International Council of Nurses.

  15. Squamous cell carcinoma developed on chronic venous leg ulcer.

    Science.gov (United States)

    Sîrbi, Adelina Gabriela; Florea, Marius; Pătraşcu, Virgil; Rotaru, Maria; Mogoş, Dan Gabriel; Georgescu, Claudia Valentina; Mărgăritescu, Nicolae Dragoş

    2015-01-01

    Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34βE12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.

  16. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

    Meyer-Olesen, Christine L; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs ...BACKGROUND: The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease...... in the general population. METHODS: We included 54628 participants from the Copenhagen City Heart Study (1981-83) and the Copenhagen General Population Study (2004-12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome...

  17. Evidence for varicose vein surgery in venous leg ulceration.

    Science.gov (United States)

    Kheirelseid, Elrasheid A H; Bashar, Khalid; Aherne, Thomas; Babiker, Thamir; Naughton, Peter; Moneley, Daragh; Walsh, Stewart R; Leahy, Austin L

    2016-08-01

    Venous leg ulcers affect 1-3% of adults with a significant economic impact, utilizing 1% of annual healthcare budgets in some western European countries. To determine the effects of intervention for incompetent superficial veins on ulcer healing and recurrence in patients with active or healed venous ulcers. In October 2014, we searched Medline, CINAHL, EMBASE, Scopus, the Cochrane library and Web of Science without date or language restriction for relevant randomized or observational studies. Bibliographies of included studies were also searched for additional studies. Observational studies or randomized controlled trials comparing intervention for varicose veins with compression therapy alone for venous leg ulcers were eligible. In addition, studies compared open to endovenous therapy for varicose veins in patients with leg ulcers and those compared treating saphenous and perforating veins to treating saphenous veins only were also included. Studies had to report at least one ulcer-related outcome (healing rate, recurrence or time to healing). Details of potentially eligible studies were extracted and summarized using a data extraction table. Data extraction and quality assessment were performed independently by two review authors, and any disagreements resolved by consensus or by arbitration of a third author. Intervention for superficial venous reflux improved ulcer healing (risk ratio = 1.11 [1.00, 1.22], 95% CI, p = 0.04) and reduced recurrence (risk ratio = 0.48 [0.32, 0.67], 95% CI, p venous leg ulcer is at beast weak. A well-structured RCT is required to investigate the role of endovenous ablation of incompetent superficial veins in improving venous leg ulcer outcomes. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  18. E-survey on venous leg ulcer among Dutch dermatologists

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan); K.P. de Roos; R.J.M. Vogels (R. J M); H.A.M. Neumann (Martino)

    2013-01-01

    textabstractAim: To get insight into the frequency of venous leg ulceration in the Dutch dermatologic practice, and into how this profession treats this disease. Design: Material and Methods: An e-survey was conducted. To all Dutch dermatologists and residents dermatology an email was sent with an

  19. Doppler diagnosis of deep venous thrombosis

    International Nuclear Information System (INIS)

    Nix, L.

    1984-01-01

    The venous Doppler examination has been shown to be a sensitive test for the diagnosis of deep venous thrombosis. An experienced technologist can perform the examination in about ten minutes at the bedside or in the laboratory. Because the venous Doppler examination is subjective, it requires considerable experience of the examiner to achieve maximal accuracy. Nevertheless, with sufficient practice the technologist may employ this instrument with skill and versatility to detect both obstruction and valvular incompetence in the superficial, communicating, and deep veins of the lower and upper extremities

  20. Trombose venosa profunda como complicação da escleroterapia química no tratamento de telangiectasias dos membros inferiores Deep venous thrombosis as complication of chemical sclerotherapy in the treatment of leg telangiectasias

    Directory of Open Access Journals (Sweden)

    Adilson Ferraz Paschôa

    2005-01-01

    Full Text Available Os autores relatam dois casos de escleroterapia de telangiectasias, as quais complicaram com trombose venosa profunda. O primeiro caso foi confirmado por flebografia, e o segundo, por duplex scan. Um paciente, 8 anos após, apresentou uma tromboflebite espontânea de veia safena parva, que resultou em pesquisa de trombofilia positiva para o Fator V Leiden. A outra paciente teve pesquisa de trombofilia negativa. Os relatos de tromboembolismo relacionado à escleroterapia são escassos na literatura. O objetivo do trabalho é alertar para essa possibilidade, valorizando as queixas de dor e edema após a escleroterapia. Havendo suspeita clínica, o duplex scan deve ser realizado.The authors report two cases of sclerotherapy for telangiectasias, which complicated with deep venous thrombosis. The first case was confirmed by phlebography and the second one by duplex scan. One patient, 8 years later, had a spontaneous lesser saphenous vein thrombophlebitis, which resulted in positive thrombophilia investigation for factor V Leiden. The other patient had negative investigation for thrombophilia. There are very few reports on thromboembolism after sclerotherapy in the literature. This study aims to warn against this possibility, valuing the complaints of pain and swollen leg after the sclerotherapy. In case of clinical suspicion, a duplex scan should be performed.

  1. Which dressings reduce inflammation and improve venous leg ulcer healing.

    Science.gov (United States)

    Raffetto, Joseph D

    2014-05-01

    Chronic venous leg ulcers (VLU) affect around 1% of the adult population in the Western world. The impact of VLU is both social and economic, with significant expenditures on active venous ulcers to provide medical treatment and eventual healing. At the core of VLU is venous hypertension which affects the venous macrocirculation. The changes incurred in venous hemodynamics leads to microcirculatory changes affecting the postcapillary venule and surrounding tissues. Inflammation by leukocytes affecting the venous endothelium, promotes a complex cascade and activation of adhesion molecules expression, chemokines and cytokines released, altered growth factor responses, and activation of protease (e.g. tPA) and proteinase (e.g. MMPs) activity that causes dysregulation and compromise of tissue integrity with eventual dermal damage and ulcer development. A critical component to treating VLU is correcting the abnormal venous hemodynamics and compression therapy. Unfortunately, VLU recurrence ranges between 30-70%, and other modalities in therapy along with compression are required. The goal for adjuvant products is to restore the balance from an inflammatory chronic wound to that of a reparative wound that will promote provisional matrix and epithelialization. There are many products on the market that can be used as adjuvant to compression therapy, but it must be recognized that there is a paucity of clinical trials that have evaluated the clinical effectiveness of specific products with clearly defined end points, and most importantly a healed VLU with a low recurrence rate. This review will discuss the fundamentals of VLU inflammation, and evaluate the available literature that may have benefit in reducing inflammation and lead to effective VLU healing. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease.

    Science.gov (United States)

    Danielsson, Gudmundur; Eklof, Bo; Grandinetti, Andrew; Lurie, Fedor; Kistner, Robert L

    2003-12-01

    We undertook this cross-sectional study to investigate the distribution of venous reflux and effect of axial reflux in superficial and deep veins and to determine the clinical value of quantifying peak reverse flow velocity and reflux time in limbs with chronic venous disease. Four hundred one legs (127 with skin changes, 274 without skin changes) in 272 patients were examined with duplex ultrasound scanning, and peak reverse flow velocity and reflux time were measured. Both parameters were graded on a scale of 0 to 4. The sum of reverse flow scores was calculated from seven venous segments, three in superficial veins (great saphenous vein at saphenofemoral junction, great saphenous vein below knee, small saphenous vein) and four in deep veins (common femoral vein, femoral vein, deep femoral vein, popliteal vein). Axial reflux was defined as reflux in the great saphenous vein above and below the knee or in the femoral vein to the popliteal vein below the knee. Reflux parameters and presence or absence of axial reflux in superficial or deep veins were correlated with prevalence of skin changes or ulcer (CEAP class 4-6). The most common anatomic presentation was incompetence in all three systems (superficial, deep, perforator; 46%) or in superficial or perforator veins (28%). Isolated reflux in one system only was rare (15%; superficial, 28 legs; deep, 14 legs; perforator, 18 legs). Deep venous incompetence was present in 244 legs (61%). If common femoral vein reflux was excluded, prevalence of deep venous incompetence was 52%. The cause, according to findings at duplex ultrasound scanning, was primary in 302 legs (75%) and secondary in 99 legs (25%). Presence of axial deep venous reflux increased significantly with prevalence of skin changes or ulcer (C4-C6; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.56-4.67). Of 110 extremities with incompetent popliteal vein, 81 legs had even femoral vein reflux, with significantly more skin changes or ulcer, compared

  3. Delivery of Compression Therapy for Venous Leg Ulcers

    DEFF Research Database (Denmark)

    Zarchi, Kian; Jemec, Gregor B E

    2014-01-01

    IMPORTANCE: Despite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited. OBJECTIVE: To assess whether home care nurses achieve......; and a multilayer, 2-component bandage, as well as, association between achievement of optimal pressure and years in the profession, attendance at wound care educational programs, previous work experience, and confidence in bandaging ability. RESULTS: A substantial variation in the exerted pressure was found...

  4. A new option for endovascular treatment of leg ulcers caused by venous insufficiency with fluoroscopically guided sclerotherapy

    Science.gov (United States)

    Garcarek, Jerzy; Falkowski, Aleksander; Rybak, Zbigniew; Jargiello, Tomasz; Łokaj, Marek; Czapla, Norbert

    2015-01-01

    Introduction Ulcers of lower legs are the most bothersome complication of chronic venous insufficiency (CVI). Aim To assess the effectiveness of endovascular fluoroscopically guided sclerotherapy for the treatment of venous ulcers. Material and methods Thirty-eight limbs in 35 patients with crural venous ulcers were treated with guided sclerotherapy under the control of fluoroscopy. Patients with non-healing ulcers in the course of chronic venous insufficiency, with and without features of past deep vein thrombosis, were qualified for the study. Doppler ultrasound and dynamic venography with mapping of venous flow were performed. Ambulatory venous pressure measurements, leg circumference and varicography were performed just before and following the procedure. Results In 84% of cases, ulcers were treated successfully and healed. Patients with post-thrombotic syndrome (n = 17) healed in 13 (76.5%) cases, whereas patients without post-thrombotic syndrome (n = 21) healed in 19 (90.5%) cases. The mean time of healing of an ulcer for all patients was 83 days (in the first group it was 121 days and in the second group 67 days). Recurrence of an ulcer was observed in 10 limbs: 6 cases in the first group and 4 cases in the second group. Occurrence of deep vein thrombosis associated with the procedure was not observed. Temporary complications were reported but none giving a serious clinical outcome. Conclusions Endovascular fluoroscopically guided sclerotherapy can be an alternative method of treatment of venous ulcers, especially in situations when surgical procedures or other options of treatment are impossible. PMID:26649090

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Mesenchymal stem cell in venous leg ulcer: An intoxicating therapy.

    Science.gov (United States)

    Athanerey, Anjali; Patra, Pradeep Kumar; Kumar, Awanish

    2017-08-01

    Venous leg ulcers (VLU) are a prevalent and reoccurring type of complicated wound, turning as a considerable public healthcare issue, with critical social and economic concern. There are both medical and surgical therapies to treat venous leg ulcers; however, a cure does not yet exist. Mesenchymal stem cells (MSC) are capable and proved of accelerating wound healing in vivo and their study with human chronic wounds is currently awaited. MSCs are a promising source of adult progenitor cells for cellular therapy and have been demonstrated to differentiate into various mesenchymal cell lineages. They have a crucial and integral role in native wound healing by regulating immune response and inflammation. Improved understanding of the cellular and molecular mechanisms at work in delayed wound healing compels to the development of cellular therapy in VLU. This review focuses on the current treatment option of VLU and further emphasizing the role of MSCs in accelerating the healing process. With further understanding of the mechanism of action of these cells in wound improvement and, the involvement of cytokines can also be revealed that could be used for the therapeutic purpose for VLU healing. Clinical uses of MSCs have been started already, and induced MSCs are surely a promising tool or compelling therapy for VLU. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  7. Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation.

    Science.gov (United States)

    Marston, William A; Crowner, Jason; Kouri, Ana; Kalbaugh, Corey A

    2017-07-01

    The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial previously reported that patients with venous leg ulcers treated with saphenous stripping experienced a significantly reduced incidence of ulcer recurrence compared with patients treated with compression therapy. Most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class 5 (C5) and class 6 (C6) patients. We retrospectively reviewed all CEAP C5 or C6 patients treated with EVTA to define the incidence of ulcer healing and recurrence. Patients with active ulcers were managed weekly in a comprehensive wound center until healed. After healing, patients were treated with compression stockings and returned at 6-month intervals for follow-up. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with ulcer recurrence. EVTA of the great saphenous vein (n = 146), small saphenous vein (n = 20), or both (n = 7) was performed on 173 limbs with active (n = 72) or healed (n = 101) ulcers. Deep venous insufficiency was present in 54 cases (31.2%). Concomitant phlebectomy was performed in 59 limbs (34%). Median follow-up time was 25.2 months after EVTA. Venous ulcers healed after EVTA in 57% of cases at 3 months, 74% at 6 months, and 78% at 12 months. Ulcers recurred in 9% of patients at 1 year after EVTA, 20% at 2 years, and 29% at 3 years of follow-up. Ulcers recurred significantly more often in patients with deep venous insufficiency and in patients who did not undergo phlebectomy of associated varicose veins at the time of EVTA. Ulcers recurred in a minority of CEAP clinical C5 and C6 patients after EVTA of the saphenous veins. Ulcer recurrence was less frequent in patients without

  8. Chronic venous leg ulcers – role of topical zinc

    Directory of Open Access Journals (Sweden)

    Maher SF

    2015-06-01

    Full Text Available Sara F Maher Physical Therapy Program, Department of Healthcare Sciences, Wayne State University, Detroit, MI, USA Abstract: Topical zinc has been used in the treatment of wounds for over 3,000 years, and is reported to have antiseptic, astringent, anti-inflammatory, antimicrobial, and wound healing properties. Fourteen studies were identified and reviewed, to assess the efficacy of this treatment modality as either a bandage or skin protectant in the treatment of venous ulcers. The authors of three studies reported improved healing time or success rate in wounds treated with zinc-based products. However, the authors of one study attributed the faster healing rate mainly to the extra compression (that improved venous blood return, delivered by the non-elastic paste bandage, and not by the zinc oxide alone. The quality of evidence is fair, as 50% of the studies were conducted prior to 2000 and 50% of the studies utilized fewer than 45 patients randomized to two or more groups. Other treatments have been reported to be more cost-effective than zinc, including hydrocolloids, four-layer compression systems, and CircAid Thera-boots. Finally, zinc was reported to be less comfortable, less easy to use, and caused increased pain, in comparison to other products on the market. This literature review, therefore, demonstrated that current evidence is insufficient to determine the effectiveness of zinc-based products in the treatment of venous wounds. Future research is needed focusing on larger, high-quality trials with an emphasis on quality of life issues and cost-effectiveness of treatment. Keywords: chronic wounds, leg ulcers, venous insufficiency, topical zinc

  9. [Treatment of patients with venous leg ulcers: what if compression therapy alone is no longer beneficial?

    NARCIS (Netherlands)

    Montfrans, C. van; Boer, E.M. de; Jansma, E.P.; Gibbs, S.; Mekkes, J.R.; Vleuten, C.J.M. van der; Maessen-Visch, M.B.

    2013-01-01

    - Non-healing venous leg ulcers are a cumbersome problem for the patient and the physician.- Adequate compression therapy that reduces venous pressure is the cornerstone of treatment.- For each patient treatment of superficial venous insufficiency should be considered.- Adjuvant surgical, physical

  10. Diurnal variations in lower leg subcutaneous blood flow rate in patients with chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Sindrup, J H; Kastrup, J; Kristensen, J K

    1991-01-01

    The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12-20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium...... telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30-40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After...... approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P less than 0.01). The blood flow then returned...

  11. EVALUATION OF HEALING EFFECTS OF NEW HERBAL FORMULATION ON VENOUS LEG ULCER: PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Ivana Binić

    2011-06-01

    Full Text Available Venous leg ulcers represent a significant public health problem that will increase as the population ages. A wide variety of agents are available for the treatment of venous leg ulcers, including ointments and dressings. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as an antimicrobial, antifungal, astringent and etc.The aim of the study was to establish the healing effects of herbal therapy on non-infected venous leg ulcers. The major components of the DermaplantG were extract of Allii bulbus, Hyperici herba and extract of Calendulae flos. In the study were included 18 patients with venous leg ulcers treated by DermaplantG herbal therapy. Our investigation focused on the five controls (baseline, 1st , 3rd, 5th 7th weeks of the parameters changes important for ulcer healing: wound surface area and reduction of venous leg ulcer score (fibrin deposits, exudation and eczema. Within-treatment analysis showed that, following DermaplantG herbal treatment, there was a significant decrease in surface leg ulcer and venous leg ulcer score after 7th treatment week (P < 0.05. The results of this pilot study demonstrate healing and antimicrobiologic efects of herbal therapy on non-infected venous leg ulcer.

  12. Ultrasound in the diagnosis of deep venous thrombosis

    International Nuclear Information System (INIS)

    Braband, K.; Sortland, O.

    1989-01-01

    In a prospective study ultrasonography (US) was compared with venography for diagnosis of deep venous thrombosis of the leg. Using venography, thrombosis was demonstrated in 25 patients. Based on two criteria, non-compressible vein and intraluminal echoes, US showed thrombosis in 23 patients, i.e. the sensitivity was 92%. Isolated calf vein thrombosis was demonstrated in 2 out 4 patients. In 18% of the patients with negative venography, other pathological conditions were demonstrated by US, (i.e. Baker's cysts, calf vein hematomas and superficial calf vein thrombosis) which could explain the clinical condition. Venography is a somewhat costly procedure. The cost of film and non-ionic contrast medium is approximately NOK 400, while the cost of film for an US examination is about NOK 10

  13. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization.

    Science.gov (United States)

    Testroote, Mark; Stigter, Willem A H; Janssen, Loes; Janzing, Heinrich M J

    2014-04-25

    Immobilization of the lower leg is associated with venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is an anticoagulant treatment which might be used in adult patients with lower-leg immobilization to prevent deep venous thrombosis (DVT) and its complications. This is an update of the review first published in 2008. To assess the effectiveness of low molecular weight heparin for the prevention of venous thromboembolism in patients with lower-leg immobilization in an ambulant setting. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched June 2013) and CENTRAL (2013, Issue 5). Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that described thromboprophylaxis by means of LMWH compared with no prophylaxis or placebo in adult patients with lower-leg immobilization. Immobilization was by means of a plaster cast or brace. Two authors independently assessed trial quality and extracted data. The review authors contacted the trial authors for additional information if required. Statistical analysis was carried out using Review Manager (RevMan 5). We included six RCTs fulfilling the above criteria with a total of 1490 patients. We found an incidence of VTE ranging from 4.3% to 40% in patients who had a leg injury that had been immobilized in a plaster cast or a brace for at least one week and who received no prophylaxis, or placebo. This number was significantly lower in patients who received daily subcutaneous injections of LMWH during immobilization (event rates ranging from 0% to 37%; odds ratio (OR) 0.49; fixed 95% confidence interval (CI) 0.34 to 0.72; with minimal evidence of heterogeneity with an I(2) of 20%, P = 0. 29). Comparable results were seen in the following subcategories: operated patients, conservatively treated patients, patients with fractures, patients with soft-tissue injuries, patients with proximal thrombosis, patients with

  14. The relationship between lower limb symptoms and superficial and deep venous reflux on duplex ultrasonography: The Edinburgh Vein Study.

    Science.gov (United States)

    Bradbury, A; Evans, C J; Allan, P; Lee, A J; Ruckley, C V; Fowkes, F G

    2000-11-01

    Previous work from this group has demonstrated the relationships between lower limb symptoms and the presence and severity of trunk varicose veins as seen on clinical examination to be generally weak, symptom specific, and gender dependent. This study was undertaken to investigate the relationships in the general population between lower limb symptoms and the presence of superficial or deep venous reflux. A cross-sectional study was made of an age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 selected from 12 general practices in Edinburgh, Scotland. Subjects completed a self-administered questionnaire regarding symptoms (heaviness/tension, a feeling of swelling, aching, restless legs, cramps, itching, tingling) and underwent duplex ultrasound examination of the superficial and deep venous systems of both legs. Reflux of 0.5 seconds or greater was considered pathologic. Deep venous reflux was defined as reflux in at least the popliteal vein. There was a significant positive relationship between isolated superficial reflux and the presence of heaviness/tension (P superficial reflux in men was not significantly positively associated with any symptom. Isolated deep venous reflux was not significantly related to any symptom in either leg in either sex. Combined reflux was related to a feeling of swelling (P =.018, right leg; P =.0022, left leg), cramps (P =.0049, left leg) and itching (P =.0043, left leg) in men, and aching (P =.03, right leg) and cramps (P =.026, left leg) in women. In the general population, only certain lower limb symptoms were related to the presence of reflux on duplex ultrasound scanning. The strongest relationships were observed in the left legs of men with combined superficial and deep reflux.

  15. Recalcitrant Venous Leg Ulcers May Heal by Outpatient Treatment of Venous Disease Even in the Presence of Concomitant Arterial Occlusive Disease.

    Science.gov (United States)

    Mosti, G; Cavezzi, A; Massimetti, G; Partsch, H

    2016-09-01

    Peripheral arterial occlusive disease (PAOD) is reported in about 15-20% of patients with venous leg ulcers (VLU). In such cases arterial recanalization is often recommended, and compression therapy is considered a contraindication when the ankle brachial pressure index (ABPI) is venous recalcitrant leg ulcer" [pvRLU]) and with associated PAOD ("mixed arterial and venous recalcitrant leg ulcer" [mavRLU]), by treating only the venous disease. The records of 180 outpatients with recalcitrant ulcers treated between January 2011 and July 2014 were reviewed retrospectively. In total, 109 were affected by pvRLU and 71 by mavRLU, with moderate PAOD defined by an ABPI between 0.5 and 0.8. In addition to the same local wound dressing, the patients received ultrasound guided foam sclerotherapy of the refluxing superficial veins and a modified inelastic compression with a pressure ≤ 40 mmHg. No patient was referred for arterial revascularization. The patients were followed until ulcer healing. Patients with pvRLU and mavRLU showed comparable demographic characteristics. Twenty-five patients were lost to follow up and the outcomes were analyzed in 93 patients with pVLU (85.4%) and in 62 patients with mavRLU (87.4%). The maximum time to complete healing was 48 weeks in the pvRLU group and 52 weeks in the mavRLU group (p = .009), The median healing time was 23 (pvRLU) versus 25.5 weeks (mavRLU) (p = .030). Deep venous incompetence (p ulcer surface area (p ulcer duration (p ulcers by treating venous incompetence by foam sclerotherapy and modified compression is successful, even if underlying moderate PAOD is not actively treated. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Baseline factors affecting closure of venous leg ulcers.

    Science.gov (United States)

    Marston, William A; Ennis, William J; Lantis, John C; Kirsner, Robert S; Galiano, Robert D; Vanscheidt, Wolfgang; Eming, Sabine A; Malka, Marcin; Cargill, D Innes; Dickerson, Jaime E; Slade, Herbert B

    2017-11-01

    The objective of this study was to characterize factors associated with closure of venous leg ulcers (VLUs) in a pooled analysis of subjects from three randomized clinical trials. Closure of VLUs after treatment with HP802-247, an allogeneic living cell therapy consisting of growth-arrested human keratinocytes and fibroblasts, vs standard therapy with compression bandaging was evaluated in three phase 3 clinical trials of similar design. Two trials enrolled subjects with VLUs ranging from 2 cm 2 to 12 cm 2 in area with 12-week treatment periods; the third trial enrolled subjects with VLUs between >12 cm 2 and ≤36 cm 2 with a 16-week treatment period. The first trial went to completion but failed to demonstrate a benefit to therapy with HP802-247 compared with placebo, and because of this, the remaining trials were terminated before completion. On the basis of no differences in outcomes between groups, subjects from both HP802-247 and control groups were pooled across all three studies. Cox proportional hazards regression analysis was employed to evaluate factors associated with VLU closure. This analysis included data from 716 subjects with VLU. Factors evaluated for association with healing included age, gender, race, diabetes, glycated hemoglobin level, body mass index, treatment (HP802-247 vs compression alone), and ulcer characteristics including location and area and duration at baseline. In an initial model including all of these putative factors, the following were significant at the P < .10 level: diagnosis of diabetes mellitus, gender, wound location (ankle or leg), baseline wound area, and wound duration at baseline. In a final model including only these factors, all but diabetes mellitus were significant at the P < .05 level. Effect sizes were as follows (hazard ratio [95% confidence interval]): female gender (1.384 [1.134-1.690]), wound location on the leg (1.490 [1.187-1.871]), smaller wound area at baseline (0.907 [0.887-0.927]), and shorter

  17. Sustaining Behavior Changes Following a Venous Leg Ulcer Client Education Program.

    Science.gov (United States)

    Miller, Charne; Kapp, Suzanne; Donohue, Lisa

    2014-09-04

    Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the "Leg Ulcer Prevention Program" (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n = 49) examination of behavior maintenance across an average 8 to 9 months period. Physical activity levels increased over time. Leg elevation, calf muscle exercises, and soap substitute use were seen to fluctuate over the follow up time points. The use of a moisturizer showed gradual decline over time. The provision of a client-focused venous leg ulcer program was associated with behavior changes that had varied sustainability across the evaluation period.

  18. Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Weller, Carolina D; Barker, Anna; Darby, Ian; Haines, Terrence; Underwood, Martin; Ward, Stephanie; Aldons, Pat; Dapiran, Elizabeth; Madan, Jason J; Loveland, Paula; Sinha, Sankar; Vicaretti, Mauro; Wolfe, Rory; Woodward, Michael; McNeil, John

    2016-04-11

    Venous leg ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of ulcers remain unhealed after 2 years, and ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing. This randomised, double-blinded, multicentre, placebo-controlled, clinical trial will recruit participants with venous leg ulcers from community settings and hospital outpatient wound clinics across Australia. Two hundred sixty-eight participants with venous leg ulcers will be randomised to receive either aspirin or placebo, in addition to compression therapy, for 24 weeks. The primary outcome is time to healing within 12 weeks. Secondary outcomes are ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks. The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous leg ulcers. Study completion is anticipated to occur in December 2018. Australian New Zealand Clinical Trials Registry, ACTRN12614000293662.

  19. Sonography and risk factors for lower limb deep venous thrombosis ...

    African Journals Online (AJOL)

    Background: Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have ...

  20. ANTIMICROBIOLOGICAL EFFECTS OF NEW NATURAL ANTISEPTIC FORMULATION ON NON-INFECTED VENOUS LEG ULCER: PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Ivana Binić

    2011-09-01

    Full Text Available Venous leg ulcers represent a significant public health problem that will increase as the population ages. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as antimicrobial, antifungal, astringent etc. The aim of the study was to establish the in-vivo antimicrobial effects of herbal hydrogel formulation DermaplantG. The major components of the DermaplantG were the extracts of Allii bulbus, Hyperici herba and extract of Calendulae flos. A total of 12 patients with non-infected venous leg ulcers were treated twice daily, for 5 weeks, with new hydrogel formulation. All ulcers showed clinical signs of contamination or colonization without signs of systemic infection. Premoistening the swab with sterile saline was considered when the surface of the wound was dry. The tip of the swab was rolled on its side in a zigzag pattern for at least one full rotation. Standard methods for isolation and identification of aerobic and anaerobic bacteria were used. On baseline assessment, a large number of different types of bacteria were detected in all venous leg ulcers. S. aureus and P. aeruginosa were isolated from almost all controls.On baseline, mixed bacterial flora (50% was isolated in six venous leg ulcers (five ulcers with S. aureus-P. aeruginosa and one ulcer with E.coli-Enterobacter spp-P.aeruginosa. At the end of the treatment in DermaplantG group in 8 venous ulcers were detected S. aureus (66.66% and P. aeruginosa (16.66%, and one venous leg ulcers was detected as sterile (8.33%. The number of different types of isolated bacterial species decreased significantly (P<0.05 after the use of DermaplantG herbal preparations. Therapy in DermaplantG group was administered without any side effects.The preliminary results of this pilot study demonstrate potential antimicrobial effects of herbal therapy on non-infected venous leg ulcers.

  1. Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology

    Energy Technology Data Exchange (ETDEWEB)

    Parellada, Antoni J.; Reiter, Sean B.; Glickman, Peter L.; Kloss, Linda A. [Frankford Hospitals, DII - Diagnostic Imaging, Inc., Department of Radiology, Philadelphia, PA (United States); Morrison, William B. [Thomas Jefferson University, Philadelphia, PA (United States); Carrino, John A. [Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Patel, Pinecca [Frankford Hospitals, Jefferson Health System, Philadelphia, PA (United States)

    2006-09-15

    The purpose of this study was to highlight the critical role that MRI may play in diagnosing unsuspected lower extremity deep venous thrombosis and to stress the importance of scrutinizing MRI studies of the lower extremity showing apparently non-specific muscle edema for any evidence of intramuscular venous thrombosis. The imaging studies of four patients in whom deep venous thrombosis was unsuspected on clinical grounds, and first diagnosed on the basis of MRI findings, were reviewed by two musculoskeletal radiologists in consensus. In all four patients the initial clinical suspicion was within the scope of musculoskeletal injuries (gastrocnemius strain, n=3; ruptured Baker cyst, n=1), explaining the choice of MRI over ultrasound as the first diagnostic modality. All patients showed marked reactive edema in the surrounding soft tissues or muscles. Three patients showed MR evidence of branching rim-enhancing structures within intramuscular plexuses characteristic of venous thrombosis (gastrocnemius, n=1; sural, n=2); one patient showed a distended popliteal vein. Ultrasound was able to duplicate the MRI findings in three patients: one patient showed above-the-knee extension on ultrasound; neither of the two patients with intramuscular thrombosis demonstrated on ultrasound showed extension to the deep venous trunks. Intramuscular venous thrombosis can present as marked edema-like muscle changes on MRI, simulating primary musculoskeletal conditions. In the absence of clinical suspicion for deep venous thrombosis, only the identification of rim-enhancing branching intramuscular tubular structures will allow the correct diagnosis to be made. (orig.)

  2. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers

    DEFF Research Database (Denmark)

    Karlsmark, T; Agerslev, R H; Bendz, S H

    2003-01-01

    OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD: The clini......OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD......: Contreet Foam was found to be safe and performed well when used in the treatment of delayed-healing chronic venous leg ulcers, combining effective antibacterial properties with excellent exudate management. DECLARATION OF INTEREST: This study was supported by Coloplast A/S, Humlebaek, Denmark....

  3. Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Hüseyin Kuplay

    2013-03-01

    Full Text Available Introduction: Venous leg ulcer is a major health problem in terms of high prevalence and high cost for treatment. Multi-layer compression bandage systems for venous leg ulcers are supposed to be the gold standard for the treatment of venous ulcers. The aim of the current study is to investigate the effectiveness of multi-layer compression bandage systems for the treatment of venous leg ulcers.Patients and Methods: Nineteen consecutive patients diagnosed to have leg ulcers were evaluated and four patients were excluded from the study due to the peripheral arterial disease. Fifteen patients, enrolled in the study, were classified according to CEAP classification and belonged to the same class. Betaven® multi-layer compression bandage was applied to patients. Patients were followed-up in terms of wound healing and reduction in wound diameter.Results: Twelve male and three female patients underwent multi-layer bandage system. Mean age of patients was 38.2 ± 4.2 years. Ulcer size was measured planimetrically and baseline ulcer size was 4-10 cm². The location of ulcer was on medial malloelus in seven patients, lateral malleolus in three patients, anterior surface of the leg in four patients and lateral side of the leg in one patient. Patients had chronic venous insuuficiency for a mean of 5.1 ± 2.1 years. CEAP classifications were C6, Ep, As2,3-p18, Pr2,3, 18. Each bandage was changed five days after application along with wound care. Mean duration of treatment was 6 ± 2 weeks. Complete healing of the venous ulcers occurred in all patients except for one. This patient was referred to plastic surgery clinic for reconstruction.Conclusion: Multi-layer compression bandage system is an effective method of treatment for venous leg ulcers associated with chronic venous insufficiency by reducing venous return and increasing intertitial tissue pressure. This effect occurred in the shortrun as well as with a low cost and prevented loss of labor.

  4. Predicting the Likelihood of Delayed Venous Leg Ulcer Healing and Recurrence: Development and Reliability Testing of Risk Assessment Tools.

    Science.gov (United States)

    Parker, Christina N; Finlayson, Kathleen J; Edwards, Helen E

    2017-10-01

    Venous leg ulcers are characterized by a long healing process and repeated cycles of ulceration. A secondary analysis of data from multisite longitudinal studies was conducted to identify risk factors for delayed healing and recurrence of venous leg ulcers for development of risk assessment tools, and a single-site prospective study was performed to as- sess the new tools' interrater reliability (IRR). The development of the risk assessment tools was based on results from previous multivariate analyses combined with further risk factors documented in the literature from systematic reviews, randomized controlled trials, and cohort studies with regard to delayed healing and recurrence. The delayed healing tool contained 10 items, including patient demographics, living status, use of high-compression therapy, ulcer area, wound bed tissue type, and percent reduction in ulcer area after 2 weeks. The recurrence tool included 8 items, including his- tory of deep vein thrombosis, duration of previous ulcer, history of previous ulcers, body mass index, living alone, leg elevation, walking, and compression. Using consensus procedures, content validity was established by an advisory group of 21 expert multidisciplinary clinicians and researchers. To determine intraclass correlation (ICC) and IRR, 3 rat- ers assessed 26 patients with an open ulcer and 22 with a healed ulcer. IRR analysis indicated statistically signi cant agreement for the delayed healing tool (ICC 0.84; 95% con dence interval [CI], 0.70-0.92; P venous leg ulcers. Studies to examine the items with low ICC scores and to determine the predictive validity of these tools are warranted.

  5. Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach: A longitudinal study.

    Science.gov (United States)

    Finlayson, Kathleen; Wu, Min-Lin; Edwards, Helen E

    2015-06-01

    The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual's quality of life and healthcare costs. This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study. Secondary analysis of combined data collected from three previous prospective longitudinal studies. The contributing studies' participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics. Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3-36 months). Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework. The median time to recurrence was 42 weeks (95% CI 31.9-52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07-2.67, p=0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84-10.5, p=0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003-1.01, pulcer recurrence based on the chronic disease self and family management framework. These results in turn provide essential steps towards

  6. Deep venous thrombosis of the upper extremity. A review

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Broholm, R; Baekgaard, N

    2013-01-01

    to the condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis. Complications: recurrent deep venous thrombosis, pulmonary embolism and Post...... Thrombotic Syndrome (PTS) are the major complications after UEDVT. PTS is a chronic condition leading to significant functional disability and impaired quality of life. Diagnosis: compression ultrasonography is noninvasive and the most frequently used objective test with a high accuracy in experienced hands...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-05-01

    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 /sup 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.

  8. 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

  9. Ulcer recurrence after in-hospital treatment for recalcitrant venous leg ulceration.

    Science.gov (United States)

    Reeder, S; de Roos, K-P; de Maeseneer, M; Sommer, A; Neumann, H A M

    2013-05-01

    Leg ulceration caused by chronic venous disease occurs in 1% of the adult Western population. A majority of these patients is successfully treated in the outpatient setting. A minority of patients is hospitalized, most frequently because of the lack of healing tendency. The literature provides recurrence rates for ulcer disease, but lacks specific data on recurrence rates after in-hospital treatment of recalcitrant venous leg ulcers. To investigate time to ulcer recurrence after in-hospital treatment of venous leg ulceration. A multicentre, retrospective cohort study of patients admitted for leg ulceration between 1996 and 2007 was conducted. Data could be collected for 107 of the patients. Of these, 27 had conservative treatment (bed rest, local wound care, pain management) and 48 patients underwent surgical ulcer treatment with (n = 19) or without (n = 29) initial vacuum-assisted closure (VAC) treatment. The treatment method was 'miscellaneous' in the remaining 32 patients. Median admission time was 30 days, median percentage of closure at discharge was 95%, and median time to ulcer recurrence 60 days. The Mann-Whitney U-test showed significant differences between the conservative group and the surgery group, the latter having a longer length of hospital stay (P ulcer closure (P ulcer recurrence (P = 0.273). Comparable differences were demonstrated between the conservative group and the VAC plus surgery group. No significant differences could be demonstrated between the surgically treated patients and those treated by VAC and surgery. Hospital stay is significantly shorter in cases of surgical treatment of recalcitrant venous leg ulcers. Most ulcers recur within 2 months after hospital discharge. Recurrence of venous leg ulcers after hospital admission is independent of the method of treatment and cause of ulceration. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  10. Effect of collagen turnover and matrix metalloproteinase activity on healing of venous leg ulcers

    NARCIS (Netherlands)

    Meyer, F.J.; Burnand, K.G.; Abisi, S.; TeKoppele, J.M.; Els, B. van; Smith, A.

    2008-01-01

    Background: The presence of fibrous tissue in poorly healing venous leg ulcers suggests abnormal collagen metabolism. The aim was to determine whether there were differences in collagen turnover and matrix metalloproteinase (MMP) activity between ulcers that healed, those that did not heal and

  11. The use of biatain Ag in hard-to-heal venous leg ulcers

    DEFF Research Database (Denmark)

    Leaper, David; Münter, Christian; Meaume, Sylvie

    2013-01-01

    Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized...

  12. Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer.

    Science.gov (United States)

    Cuomo, Roberto; Nisi, Giuseppe; Grimaldi, Luca; Brandi, Cesare; D'Aniello, Carlo

    2017-10-23

    The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.

  13. Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study

    Science.gov (United States)

    Tamai, Nao; Nakagami, Gojiro; Kitamura, Aya; Naito, Ayumi; Hirokawa, Masayuki; Shimokawa, Chisako; Takahashi, Kazuo; Umemoto, Junichi; Sanada, Hiromi

    2016-01-01

    We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman’s correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients. PMID:27936243

  14. Unicompartmental muscle edema: an early sign of deep venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  15. Knowledge and practice of prophylaxis of deep venous thrombosis ...

    African Journals Online (AJOL)

    Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT).

  16. Knowledge and practice of prophylaxis of deep venous thrombosis ...

    African Journals Online (AJOL)

    2015-09-03

    Sep 3, 2015 ... Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein ...

  17. Risk Factors of Deep Venous Thrombosis in Duplex and Colour ...

    African Journals Online (AJOL)

    Risk Factors of Deep Venous Thrombosis in Duplex and Colour Doppler Ultrasound at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. ... Thus early, correct and definitive diagnosis is crucial in assessing thromboembolic risk and initiating therapy. In this regard Patients at risk must be identified and given ...

  18. Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.

    Science.gov (United States)

    Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia

    2014-09-01

    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

  19. Rare etiological causes of iliofemoral deep venous thrombosis: Reports of 2 cases

    Directory of Open Access Journals (Sweden)

    Emrah Ereren

    2015-09-01

    Full Text Available Deep venous thrombosis is frequently seen in lower extremities. However, when seen in the iliac level, mass effect of an underlying pathology must be considered. In this report, we present two cases with upper region deep venous thrombosis, which had underlying pathologies of appendicitis and non-Hodgkin lymphoma. Keywords: Deep venous thrombosis, Etiology, Emergency department

  20. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers

    DEFF Research Database (Denmark)

    Karlsmark, T; Agerslev, R H; Bendz, S H

    2003-01-01

    : The clinical performance of Contreet Foam was studied for four weeks in 25 patients with moderately to highly exuding delayed-healing venous leg ulcers. Healing was assessed on a weekly basis with reference to the wound-bed tissue composition, degree of odour and pain, dressing performance and the dressing......'s effect on the peri-ulcer area. Blood samples were analysed for silver content. RESULTS: Twenty-three out of 25 patients completed the study. One ulcer healed and no wound infections occurred during the study period. A mean 56% reduction in ulcer area (from 15.6 to 6.9 cm2) was recorded during the four......OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD...

  1. The bacteriology of chronic venous leg ulcer examined by culture-independent molecular methods

    DEFF Research Database (Denmark)

    Thomsen, Trine R; Aasholm, Martin S; Rudkjøbing, Vibeke B

    2010-01-01

    The bacterial microbiota plays an important role in the prolonged healing of chronic venous leg ulcers. The present study compared the bacterial diversity within ulcer material from 14 skin graft operations of chronic venous leg ulcers using culture-based methods and molecular biological methods...... was different. All the wounds contained Staphylococcus aureus, whereas Pseudomonas aeruginosa was in six out of 14 wounds. Molecular methods detected anaerobic pathogens in four ulcers that were not detected with anaerobic culture methods. Quantitative polymerase chain reaction was used to compare the abundance...... of S. aureus and P. aeruginosa at different locations in the ulcers and their numbers varied greatly between samples taken at different locations in the same ulcer. This should be considered when ulcers are investigated in routine clinical care. The differences between the results obtained with culture...

  2. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers

    DEFF Research Database (Denmark)

    Karlsmark, T; Agerslev, R H; Bendz, S H

    2003-01-01

    OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD...... weeks, and there was a mean 25% reduction in granulation tissue from dull to healthy after one week. Wound odour reduced significantly after one week. Mean dressing wear time was 3.1 days, and there were only minimal incidences of leakage. Serum silver levels did not exceed reference values. CONCLUSION......: The clinical performance of Contreet Foam was studied for four weeks in 25 patients with moderately to highly exuding delayed-healing venous leg ulcers. Healing was assessed on a weekly basis with reference to the wound-bed tissue composition, degree of odour and pain, dressing performance and the dressing...

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

    Science.gov (United States)

    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.

  4. Extensive Intracardiac and Deep Venous Thromboses in a Young Woman with Heparin-Induced Thrombocytopenia and May-Thurner Syndrome

    Directory of Open Access Journals (Sweden)

    Yekaterina Kim

    2017-01-01

    Full Text Available A 38-year-old woman with a history of recurrent deep venous thromboses (DVTs on chronic anticoagulation presented with acute left leg swelling. The patient was diagnosed with an acute left lower extremity (LLE DVT in the setting of May-Thurner syndrome for which treatment with unfractionated heparin was started. Her hospital course was complicated by a new diagnosis of heparin-induced thrombocytopenia (HIT, with an incidental discovery of a large tricuspid valve mobile mass on a transthoracic echocardiogram (TTE. Subsequent imaging confirmed multiple right atrial thrombi along with LLE venous stent thrombosis and a new right LE acute DVT. Anticoagulation with argatroban for HIT thrombosis was started. She underwent a right atrial percutaneous thrombectomy and bilateral lower extremity thrombectomy with directed angioplasty and stent placement. This presentation is a rare manifestation of HIT with extensive intracardiac and deep venous thrombi, with successful staged interventions.

  5. The perspectives of adults with venous leg ulcers on exercise: an exploratory study.

    Science.gov (United States)

    O'Brien, J; Finlayson, K; Kerr, G; Edwards, H

    2014-10-01

    Exercise has the potential to offer a range of health benefits in addition to improving healing outcomes for people with venous leg ulcers (VLUs). However, despite evidence-based recommendations, most of these individuals do not engage in regular exercise. The aim of this study was to gain an understanding of the perspectives of adults with VLUs, in relation to exercise. This was a qualitative design using semi-structured interviews and discussions. Ten participants with venous leg ulceration volunteered to participate. Recruitment was through a specialist wound clinic. Verbatim data were collected by an experienced moderator using a semi-structured guide. Data saturation was reached after three group discussions and two interviews. A random selection of transcripts was sent back to the participants for verification. Thematic content analysis was used to determine major themes and categories. Two transcripts were independently analysed, categories and themes independently developed, cross checked and found comparable. Remaining transcripts were analysed using the developed categories and codes. Regardless of their current exercise routine, participants reported exercising before venous leg ulceration and expressed an interest in either becoming active or maintaining an active lifestyle. Overall, four themes emerged from the findings: i) participant understanding of the relationship between chronic venous insufficiency and exercise patterns; ii) fear of harm impacts upon positive beliefs and attitudes to exercise; iii) perceived factors limit exercise; and iv) structured management facilitates exercise. The value of exercise in improving outcomes in VLUs lies in its capacity to promote venous return and reduce the risk of secondary conditions in this population. Despite motivation and interest in being exercise active, people with VLUs report many obstacles. Further exploration of mechanisms that assist this patient population and promote understanding about

  6. An investigation of skin perfusion in venous leg ulcer after exercise.

    Science.gov (United States)

    Mutlak, Omar; Aslam, Mohammed; Standfield, Nigel J

    2018-01-01

    A venous leg ulcer (VLU) has a major impact on the quality of life and functional ability of individuals, but no single treatment is yet effective. This study investigates the changes induced by dorsiflexion exercise on skin perfusion in VLU patients to achieve a better understanding of venous ulcer pathophysiology. Seventy-eight venous leg ulcer patients were randomised into four groups. The non-exercise groups included a control group (n = 18) and a compression therapy group (n = 20) and the exercise groups included an exercise-only group (n = 20) and a compression and exercise group (n = 20). The exercise groups were expected to perform exercise for three months. Measurements included transcutaneous oximetry (tcPO 2 ) and laser Doppler flowmetry (LDF). Skin perfusion measurements for all groups were taken twice: at the beginning and end of the three-month period. Initially, all participants showed a low level of tcPO 2 . The exercise groups showed a significant increase after three months of exercise (pvenous leg ulcer and this effect may play a role in understanding the pathophysiology of VLU.

  7. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective

    Directory of Open Access Journals (Sweden)

    White-Chu EF

    2014-02-01

    Full Text Available E Foy White-Chu,1 Teresa A Conner-Kerr2 1Oregon Health and Science University, Portland VA Medical Center, Portland, OR, 2Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA Abstract: Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. Keywords: venous insufficiency, varicose ulcer, wound, compression bandages

  8. Primary venous insufficiency increases risk of deep vein thrombosis.

    Science.gov (United States)

    Shaydakov, Maxim E; Comerota, Anthony J; Lurie, Fedor

    2016-04-01

    Varicose veins have been recognized as a risk factor for deep vein thrombosis (DVT). However, venous reflux has not carried the same correlation. This study evaluated the association between primary valvular reflux and DVT. We performed a nested case-control study with enrollment of outpatients presenting to the vascular laboratory with signs and symptoms of DVT. All patients had a complete bilateral venous duplex examination evaluating for DVT and superficial and deep venous valvular reflux. Eighty-seven patients with confirmed DVT on venous duplex were selected for the study group. The control group was randomly selected from the same cohort in a 4:1 ratio matched by age and gender (n = 348). Groups were compared for the prevalence of deep and superficial reflux. DVT outpatients were 4.7-times more likely to have primary valvular reflux than symptomatic controls (65.5% vs 29.0%; 95% confidence interval [CI], 2.8-7.7; P superficial reflux was 4.6-times more prevalent (43.7% vs 14.4%; odds ratio, 4.62; 95% CI, 2.75-7.77; P superficial reflux than non-DVT patients (13.8% vs 6.6%, 95% CI, 1.08-4.75; P = .044). The prevalence of primary valvular reflux in patients with DVT is significantly higher than expected. Reflux may be considered as a novel risk factor for DVT. Two-thirds of patients with DVT have pre-existent primary chronic venous disease, which is likely to contribute to post-thrombotic morbidity. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial.

    Science.gov (United States)

    van Gent, W B; Catarinella, F S; Lam, Y L; Nieman, F H M; Toonder, I M; van der Ham, A C; Wittens, C H A

    2015-03-01

    Leg ulcers have a large socio-economic impact. Treatment modalities are either conservative or surgical. Conservative treatment involves local treatment and compression therapy. Surgical treatment of venous ulcers is based on correcting venous hypertension, by treating incompetent superficial, deep, and perforating veins. A prospective randomized multicenter trial comparing surgical treatment (combined superficial and perforating vein surgery) with ambulatory compression therapy was conducted during 1998 and 2001. This paper presents the results of a 10-year follow-up period of this trial. All patients enrolled in the original prospective trial were approached and invited for additional examination and duplex ultrasound evaluation. Secondary, disease specific and generic quality-of-life (QoL) was assessed. Current ulcer state and recurrence during the follow-up period was assessed. After a mean of 97 months follow up, 80 (41%) out of 196 legs could be inspected. The incidence of "ulcer-free", the main outcome, was significantly (p = 0.007) higher in the surgical group (58.9%), compared to the conservative group (39.6%). Observed ulcer recurrence was 48.9% for the surgical group and 94.3% for the conservative group. The number of incompetent perforating veins appears to be a significant (p ulcer-free. Disease specific QoL showed no significant difference between the surgical and conservative groups. The addition of surgical treatment in patients with venous ulceration leads to a significantly higher chance of being ulcer-free, than just ambulatory compression therapy. This effect persists after 10 years of follow up. The number of incompetent perforating veins has a significant effect on the ulcer-state and recurrence. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  10. The experience of self-management following venous leg ulcer healing.

    Science.gov (United States)

    Kapp, Suzanne; Miller, Charne

    2015-05-01

    The aim of the study was to explore the experiences of older people as they self-managed following venous leg ulcer healing. The objectives were to describe the beliefs, attitudes, actions, enablers and barriers to self-management and to consider the impact of an e-learning client education package on how people approach recurrence prevention. Venous leg ulcers affect 1% of people worldwide and more than 3% of older people. Up to 70% of ulcers reoccur. Appreciation of the experience of self-management following healing can equip health services to more effectively prepare people for self-management in the longer term. A descriptive exploratory design was used. Older people who had received an e-learning education programme while their venous ulcer was active were interviewed after healing from July-September 2010. Interviews were recorded, transcribed and thematically analysed. Participants believed in the efficacy of compression therapy, skin care, activity and exercise and healthy eating to prevent recurrence, and engage in activities that reflect recommendations of the education. As beliefs and conduct of self-management activities can change over time, regular professional monitoring and support would assist people to refine health goals, plan self-management activities and prevent recurrence. Participation in a standardised education programme completed prior to healing informed successful self-management strategies among people who seek to prevent venous leg ulcer recurrence. Further research should consider the benefits of regular, ongoing professional monitoring and support among this group. Clinicians have a role in supporting their clients to know about, perform and believe in the importance of self-management strategies for healing and recurrence prevention. Clinicians require the capacity to support clients which standardised client education tools can facilitate. © 2014 John Wiley & Sons Ltd.

  11. Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer

    International Nuclear Information System (INIS)

    El-Hafez, Emad A.; Seleem, Mohamed I.

    2004-01-01

    To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. 36 patients (28 men and 8 women) with mean age of 42.3+-8.7, presented with a venous leg ulcer. After taking the full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index (ABPI) was measured, Venous valvular incompetence was assessed using Valsalva testand calf compression. Patients were divided into 2 groups. Group I, (n=10) assigned for long saphenous stripping, while group II (n=26) assigned for saphenofemoral ligationan and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Southern Region, Khamis Mushayt, Sadi Arabia between January 2000 and December 2001. The mean operative time and the hospital stay were significantly (p<0.05) reduced in group II compared to group I. The postoperative complications were signficantly (x=7.5, p<0.05) reduced in group II. Ulcer healing started after 3 months in group II and six months in group I, but by 12 month, group II had significant (x=6.7, p<0.05) number of healed ulcers (n=22, 84.6%), compared to group I (n=7, 70%). The isolated ligation of of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considerd to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia. (author)

  12. Association of varicosities and concomitant deep venous thrombosis in patients with superficial venous thrombosis, a systematic review

    NARCIS (Netherlands)

    Baggen, Vivan J M; Chung, Kaman; Koole, Koos; Sarneel, Michelle H J; Rutten, Frans H|info:eu-repo/dai/nl/189152753; Hajer, Gideon R

    2015-01-01

    BACKGROUND: In patients with superficial venous thrombosis (SVT) co-existence of deep venous thrombosis (DVT) can be present. Varicosities are considered as a risk factor for both SVT and DVT separately. However, current evidence is contradictory whether varicosities are associated with an increased

  13. Physical therapy in the treatment of venous leg ulcers: biophysical mechanisms.

    Science.gov (United States)

    Taradaj, Jakub; Franek, Andrzej; Blaszczak, Edward; Polak, Anna; Chmielewska, Daria; Krol, Piotr; Dolibog, Patrycja

    2012-05-01

     The present study sought to estimate the hemodynamic effects inside wounds after applying infrared thermography. Clinical results were analyzed to evaluate any correspondence with hemodynamic events occurring inside the wounds. Group 1 consisted of 20 patients with venous leg ulcers (12 women, 8 men). Patients from group 1 received 1 high-voltage stimulation (HVS) procedure. Group 2 consisted of 23 patients (16 women, 7 men). Patients from group 2 received 1 ultrasound (US) procedure. Group 3 consisted of 21 patients (13 women, 8 men). Patients from group 3 received 1 low-level laser therapy (LLLT) procedure. Group 4 consisted of 23 patients (15 women, 8 men). Patients from group 4 received 1 compression therapy (CT) procedure. Group 5 consisted of 19 patients (11 women, 8 men). Patients from group 5 received 1 quasi-CT procedure. Infrared thermography was used to monitor arterial hemodynamic effects for each ulcer. Infrared thermography, based on analysis of wound surface temperatures, was used to reflect normal or abnormal arterial circulation in capillaries. The average and maximal temperatures before and after each physical procedure were measured 5, 10, 15, and 30 minutes afterward. The application of HVS and LLLT did not change the temperature inside the wounds. A significant temperature increase was noted after application of US and CT. The quasi-CT induced a thermal effect (only for a few minutes), but was not as intense as the effect of the compression stockings. The measurements showed a prolonged and steady thermal effect. The hemodynamic effect (improvement of arterial microcirculation inside the venous leg ulcer) is one of the most significant biophysical mechanisms of healing after clinically efficient compression therapy. Hemodynamic reactions are not basic mechanisms of high voltage stimulation and ultrasound therapy during the healing of venous leg ulcers. Computed thermography is a simple and useful tool to measure hemodynamic

  14. Internet-based learning programme to increase nurses' knowledge level about venous leg ulcer care in home health care.

    Science.gov (United States)

    Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

    2017-11-01

    To test the effectiveness of an Internet-based education programme about venous leg ulcer nursing care on perceived and theoretical knowledge levels and attitudes among nurses working in home health care. Nurses have been shown to have knowledge gaps in venous leg ulcer nursing care. Internet-based learning could offer a means for flexible continuing education for home healthcare environment. Quasi-experimental study with pre- and postmeasurements and nonequivalent intervention and comparison groups. Nurses (n = 946) in home health care in two Finnish municipalities were invited to participate in the study and divided into intervention and comparison groups. The intervention group received education programme about venous leg ulcer nursing care, while the comparison group did not. Data were collected at baseline, at six weeks and at 10 weeks to test the hypotheses: nurses using education programme about venous leg ulcer nursing care will have higher level of knowledge and more positive attitudes than those not using education programme about venous leg ulcer nursing care. An analysis of variance and mixed models with repeated measures were used to test differences in knowledge and attitudes between and within the groups. There were statistically significant increases in knowledge levels in the intervention group from baseline to the first and second follow-up measurements. In the comparison group, the knowledge levels remained unchanged during the study. Attitude levels remained unchanged in both groups. Nurses' perceived and theoretical knowledge levels of venous leg ulcer nursing care can be increased with Internet-based education. However, this increase in knowledge levels is short-lived, which emphasises the need for continuous education. Internet-based education about venous leg ulcer nursing care is recommended for home healthcare nurses. Education programme about venous leg ulcer nursing care provides flexible method for nurses' learning with feasible

  15. Venous leg ulcer patient priorities and quality of care: results of a survey

    DEFF Research Database (Denmark)

    Kjaer, Monica Linda; Mainz, Jan; Sorensen, Lars Tue

    2004-01-01

    A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross...... leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.......-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history...

  16. Deep venous thrombosis and pulmonary embolism following physical restraint

    DEFF Research Database (Denmark)

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

    2005-01-01

    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...

  17. 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...... intervention in patients undergoing physical restraint....

  18. Obesity as a causal risk factor for deep venous thrombosis

    DEFF Research Database (Denmark)

    Klovaite, Jolanta; Benn, M; Nordestgaard, B G

    2015-01-01

    OBJECTIVE: To test the hypothesis that obesity is causally associated with deep venous thrombosis (DVT). DESIGN: A Mendelian randomization design. SETTING: The Copenhagen General Population Study and the Copenhagen City Heart Study combined. SUBJECTS: Body mass index (BMI) measurements were...... available for 87, 574 individuals of Danish descent from the adult general population. All subjects completed questionnaires and were genotyped for the FTO rs9939609 variant. MAIN OUTCOME MEASURE: First events of DVT with or without pulmonary embolism (PE). ANALYSIS: The results were assessed using Cox...... regression, instrumental variable analysis and Poisson regression. RESULTS: Observationally, the risk of DVT increased with increasing BMI (P-trend obese...

  19. 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.

  20. 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%).

  1. 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....... The nosographic sensitivity/specificity was 33%/75% for scintimetry, 50%/91% for scintigraphy and 33%/87% for contact thermography, respectively. It is concluded that all three tests are of no value as screening methods for deep venous thrombosis following major elective hip surgery....

  2. US evaluation of deep venous thrombosis of the lower extremity

    International Nuclear Information System (INIS)

    Vogel, P.; Laing, F.C.; Jeffrey, R.B.; Wing, V.W.

    1986-01-01

    The sensitivity of US for detecting lower extremity deep venous thrombosis (DVT) was prospectively compared with contrast venography in 53 patients. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for DVT of the common femoral vein and 94% sensitive for DVT of the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler US findings and an abnormal response of the common femoral vein to the Valsalva maneuver were only indicative of thrombi in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with DVT proximal to the deep calf veins. These results suggest that US is a sensitive screening modality for lower extremity DVT

  3. Laser irradiation effect on Staphylococcus aureus and Pseudomonas aeruginosa biofilms isolated from venous leg ulcer.

    Science.gov (United States)

    Baffoni, Marina; Bessa, Lucinda J; Grande, Rossella; Di Giulio, Mara; Mongelli, Matteo; Ciarelli, Antonio; Cellini, Luigina

    2012-10-01

    Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near-infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomonas aeruginosa PECHA9, both isolated from a chronic venous leg ulcer. Laser effect was assessed by biomass measurement, colony forming unit count and cell viability assay. It was shown that the laser treatment has not affected the biofilms biomass neither the cell viability, although a small disruptive action was observed in the structure of all biofilms tested. A reduction on cell growth was observed in S. aureus and in polymicrobial biofilms. This work represents an initial in vitro approach to study the influence of NIR laser treatment on bacterial biofilms in order to explain its potentially advantageous effects in the healing process of chronic infected wounds. © 2011 The Authors. International Wound Journal © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  4. The use of biatain Ag in hard-to-heal venous leg ulcers: meta-analysis of randomised controlled trials.

    Directory of Open Access Journals (Sweden)

    David Leaper

    Full Text Available BACKGROUND: Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized controlled trials (RCTs. AIM: To evaluate ulcer healing through a meta-analytic approach after treatment with either Biatain Ag or a non-active dressing. PATIENTS AND METHODS: 685 subjects with pure or mixed hard-to-heal venous leg ulcers were included in the meta-analysis. RESULTS: Biatain Ag showed a significant treatment effect (p<0.0001, responder rate (p<0.001, and healing rate (p = 0.002. CONCLUSION: The meta-analysis of the 4 RCTs provided statistical significant evidence to support the use of Biatain Ag dressing in treatment of hard-to-heal venous leg ulcers.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Proteolytic activity in wound fluids and tissues derived from chronic venous leg ulcers.

    Science.gov (United States)

    Moor, Andrea N; Vachon, David J; Gould, Lisa J

    2009-01-01

    Venous leg ulcers affect approximately 1% of the general population and 3.6% of those over the age of 65. The goal of the research described herein is to shorten the time to healing by developing wound care alternatives that are based on a comprehensive understanding of the venous ulcer wound environment. The proteolytic and inflammatory components in wound fluids and tissue biopsy samples were characterized in subjects with documented long-standing venous ulcers that had showed resistance to standard therapy. All wounds showed polymicrobial colonization with greater than 10(6) CFU/g. Myeloperoxidase, a measure of leukocyte infiltration, was also markedly elevated in these wounds. Zymography revealed the presence of both pro-matrix metalloproteinase (MMP)-2 and pro-MMP-9 in wound fluids and to a lesser extent in tissue biopsies. Using an immunocapture activity assay we reveal a sevenfold excess of MMP-9 in wound fluid as compared to tissue, with 73% in the activated form. In contrast, MMP-8 total protein levels were nearly equal in wound fluids and biopsies. Fibronectin, a critical component of the extracellular matrix, was shown to be degraded in both wound fluids and biopsy samples. Finally, the potential of a novel wound dressing to neutralize several constituents of this hostile wound environment is shown.

  7. Effects of low-frequency ultrasound on microcirculation in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2011-01-01

    Full Text Available Background: Therapeutic low-frequency ultrasound (US has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO 2 and relative hemoglobin concentration (rHb in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm. Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO 2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm compared to deeper parts (8 mm depth. US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized

  8. EFFECTS OF LOW-FREQUENCY ULTRASOUND ON MICROCIRCULATION IN VENOUS LEG ULCERS

    Science.gov (United States)

    Wollina, Uwe; Heinig, Birgit; Naumann, Gunther; Scheibe, Armin; Schmidt, Wolf-Dieter; Neugebauer, Reimund

    2011-01-01

    Background: Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm). Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin

  9. The deep venous system of the lower extremity: new nomenclature.

    Science.gov (United States)

    Kachlik, D; Pechacek, V; Musil, V; Baca, V

    2012-03-01

    The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

  10. The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

    Directory of Open Access Journals (Sweden)

    Alqahtani Saad

    2011-01-01

    Full Text Available Abstract Background Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE and examine the practice of deep venous thrombosis (DVT prophylaxis among hospitalized cirrhotic patients. Methods A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE. Results Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7% developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51% underlying cause of liver cirrhosis, followed by hepatitis B (22%; 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis. Conclusion Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.

  11. Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children.

    Science.gov (United States)

    Faustino, Edward Vincent S

    2018-02-01

    The presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Challenging passivity in venous leg ulcer care - the ABC model of management.

    Science.gov (United States)

    Harding, Keith

    2016-12-01

    The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Complementary and alternative medicine for older adults with venous leg ulcer pain.

    Science.gov (United States)

    Tobón, Jeniffer

    2010-11-01

    Chronic pain management is an important, and often under-addressed, component in the care of older adults with venous leg ulcers (VLUs). Clinicians caring for older adults with VLUs must consider and address both the physiological and psychosocial aspects of chronic pain. Traditional pharmacological approaches to pain management are only part of the solution. One strategy is to adopt a more holistic approach to chronic pain management that includes complementary and alternative medicine (CAM) therapies. Unfortunately, there is a paucity of CAM research that focuses on the pain management of older adults with VLUs. Despite these limitations, pain management that includes discussion of relevant CAM modalities must be a priority for clinicians caring for older adults living with VLUs.

  14. Prospective randomized study comparing the debriding effect of krill enzymes and a non-enzymatic treatment in venous leg ulcers

    NARCIS (Netherlands)

    Westerhof, W.; van Ginkel, C. J.; Cohen, E. B.; Mekkes, J. R.

    1990-01-01

    The debriding potential of a recently discovered potent enzyme preparation derived from Antarctic krill (Euphausia superba) was compared to a routine non-enzymatic treatment in 31 patients with venous leg ulcers. To assure a reliable interpretation of the cleaning effect, computer image analysis was

  15. Grafting of venous leg ulcers. An intraindividual comparison between cultured skin equivalents and full-thickness skin punch grafts

    NARCIS (Netherlands)

    Mol, M. A.; Nanninga, P. B.; van Eendenburg, J. P.; Westerhof, W.; Mekkes, J. R.; van Ginkel, C. J.

    1991-01-01

    Skin equivalents that consisted of a noncontracted collagen gel populated with allogeneic fibroblasts and covered with autologous cultured keratinocytes were used for grafting venous leg ulcers. The results were compared in the same patient with those obtained with a routinely used standard method

  16. The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers

    DEFF Research Database (Denmark)

    Jørgensen, Bo; Price, Patricia; Andersen, Klaus E

    2005-01-01

    , Contreet Foam, compared with a traditional moist foam wound healing dressing in the treatment of critically colonised, chronic venous leg ulcers. The results of this randomised, controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised...

  17. 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

  18. Chosen aspects of quality of life in patients with venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Michaela Miertová

    2016-12-01

    Full Text Available Aim: The aim of the paper was to describe chosen aspects of quality of life in patients with venous leg ulcers treated at home in the Turiec region, and to find differences in assessing quality of life in relation to degree of adherence to external compression therapy. Design: A quantitative cross-sectional study. Methods: There were 61 patients with venous leg ulcers at 68.59 ± 9.49 years of age, with an average length of wound treatment of 6.34 ± 5.51 years. The adapted self-assessment questionnaire, the Freiburg Life Quality Assessment wound module (FLQA-w, was used to gain empirical data. Results: The findings revealed that the worst score was achieved in the category of everyday life (3.61 ± 0.93. Statistically significant differences were found between the group of respondents who apply bandages on a daily basis and those who did not use them at all. Regular bandage application is closely connected with positive assessment of wound therapy (p = 0.043, psychosocial life (p = 0.023, verbalisation of well-being in various categories (p = 0.001, assessment of state of the wound (p = 0.032, assessment of health condition (p = 0.019, and overall quality of life (p = 0.014. Length of wound treatment is related to assessments of quality of life. Conclusion: Non-healing wounds, the associated therapy and financial means required to treat them, and the pain resulting from them, are connected with physical difficulty, experience of negative emotions, and, thus, the worsening of patientsʼ quality of life. The results of the study could form the basis for further studies on similar issues.

  19. Can different primary care databases produce comparable estimates of burden of disease: results of a study exploring venous leg ulceration.

    Science.gov (United States)

    Petherick, Emily S; Pickett, Kate E; Cullum, Nicky A

    2015-08-01

    Primary care databases from the UK have been widely used to produce evidence on the epidemiology and health service usage of a wide range of conditions. To date there have been few evaluations of the comparability of estimates between different sources of these data. To estimate the comparability of two widely used primary care databases, the Health Improvement Network Database (THIN) and the General Practice Research Database (GPRD) using venous leg ulceration as an exemplar condition. Cross prospective cohort comparison. GPRD and the THIN databases using data from 1998 to 2006. A data set was extracted from both databases containing all cases of persons aged 20 years or greater with a database diagnosis of venous leg ulceration recorded in the databases for the period 1998-2006. Annual rates of incidence and prevalence of venous leg ulceration were calculated within each database and standardized to the European standard population and compared using standardized rate ratios. Comparable estimates of venous leg ulcer incidence from the GPRD and THIN databases could be obtained using data from 2000 to 2006 and of prevalence using data from 2001 to 2006. Recent data collected by these two databases are more likely to produce comparable results of the burden venous leg ulceration. These results require confirmation in other disease areas to enable researchers to have confidence in the comparability of findings from these two widely used primary care research resources. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Factor V Leiden Is Associated with Higher Risk of Deep Venous Thrombosis of Large Blood Vessels

    Science.gov (United States)

    Arsov, Todor; Miladinova, Daniela; Spiroski, Mirko

    2006-01-01

    Aim To determine the prevalence of factor V Leiden mutation in patients with different presentation of venous thromboembolic disease and healthy individuals in the Republic of Macedonia. Methods The retrospective case-control study involved 190 patients with venous thromboembolic disease and 200 healthy individuals, who were screened for the presence of factor V Leiden mutation, using a polymerase chain reaction-restriction fragment length polymorphism method. The prevalence of factor V Leiden was analyzed according to the localization of thrombosis, presence of risk factors, and family history of thrombosis. The odds of deep venous thrombosis were calculated with respect to the presence of factor V Leiden mutation. Results The prevalence of factor V Leiden mutation among patients with venous thromboembolic disease was 21.1%, compared with 5.5% in the healthy individuals. Factor V Leiden positive patients had the first episode of deep venous thrombosis at a younger age, and the prevalence of the mutation was the highest among patients with a positive family history of thrombosis (33.9%, P = 0.003) and in patients with deep venous thrombosis affecting a large blood vessel (37.7%, P = 0.001). The prevalence of factor V Leiden mutation was lower in patients with calf deep venous thrombosis and primary thromboembolism (13.3% and 13.1%, respectively; P>0.05). The odds ratio for iliofemoral or femoral deep venous thrombosis in factor V Leiden carriers was 10.4 (95% confidence interval, 4.7-23.1). Conclusion The prevalence of factor V Leiden mutation was high in patients with venous thromboembolic disease and healthy individuals in the Republic of Macedonia. Factor V Leiden carriers have the highest odds of developing deep venous thrombosis affecting a large venous blood vessel. PMID:16758522

  1. Presentación de un caso: trombosis venosa profunda bilateral de etiología infrecuente Case report: rare bilateral deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Mónica Fernández del Castillo Ascanio

    2012-03-01

    Full Text Available La agenesia de vena cava inferior (VCI es una patología poco frecuente que suele diagnosticarse a raíz de una trombosis venosa secundaria sintomática de las venas ilíacas. Presentamos el caso de un varón de 28 años que acude al centro de salud por dolor en miembros inferiores y datos de insuficiencia venosa. Se visualiza mediante ecografía trombosis venosa profunda (TVP bilateral.Agenesis of the inferior vena cava (IVC is a rare condition usually diagnosed as secondary to symptomatic deep venous thrombosis of iliac veins. We report a 28-year-old male that was admitted in the medical center due to pain in both legs and history of venous insufficiency. Ultrasound reveáis bilateral deep venous thrombosis.

  2. Risk factors for cerebral venous thrombosis and deep venous thrombosis in patients aged between 15 and 50 years

    NARCIS (Netherlands)

    Koopman, Karen; Uyttenboogaart, Maarten; Vroomen, Patrick C A J; van der Meer, Jannes; De Keyser, Jacques; Luijckx, Gert-Jan

    2009-01-01

    Cerebral venous thrombosis (CVT) and deep vein thrombosis or pulmonary embolism (DVT/PE) are associated with many risk factors. It is unclear why CVT occurs less often than DVT/PE. Age dependent risk factors may play a role. The aim of our study was to compare risk factors in a uniform age group of

  3. 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

  4. The Effect of Local Platelet Rich Plasma Therapy on the Composition of Bacterial Flora in Chronic Venous Leg Ulcer.

    Science.gov (United States)

    Woźniak, Witold; Tarnas, Monika; Miłek, Tomasz; Mlosek, Krzysztof R; Ciostek, Piotr

    2016-08-26

    Microbial colonisation of chronic venous ulcers and synergism between bacterial species slow down the healing process. The study aimed at performing qualitative analysis of microbial flora in venous leg ulcers treated with platelet rich plasma (PRP). Twenty two women and twelve men aged 47-90 years were treated with PRP at our department between 2012 and 2015. Ulcer cultures collected before and after PRP therapy yielded 83 and 110 microbial isolates, respectively, of Gram positive, Gram negative bacteria and candida. Pseudomonas aueruginosa and Staphylococcus aureus were the most common pre- and post-treatment isolates. PRP therapy and increased the variety of microbial flora.

  5. 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.

  6. Chronic Stress Facilitates the Development of Deep Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    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.

  7. Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, K; Pinholt, E M

    2010-01-01

    Prior studies have associated raloxifene and strontium ranelate with deep venous thromboembolism and pulmonary embolism. In a cohort study, we observed an increased risk also with the bisphosphonates. However, the increase was present already before the start of bisphosphonates pointing...

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

    OpenAIRE

    Koppisetty, Shalini; Smith, Alton G.; Dhillon, Ravneet K.

    2015-01-01

    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

  9. [Complications of superficial venous surgery of the legs: thigh hematomas and abscess].

    Science.gov (United States)

    Millien, J P; Coget, J M

    1993-01-01

    A series of 1,000 patients has been studied. I. HEMATOMAE: They are nearly continuous during internal saphena stripping but depend on various parameters. 1) Anatomical: a) Varicose veins topography. Perforating veins. Perforating veins of the thigh cause haemorrhage but reactions of venous construction are quite important and precocious not to observe subcutaneous bleedings. More or less "soft" stripping creates a reaction of reflex vasoconstriction. Fore saphenous vein of the thigh Hematomae are more and more numerous and important because the fore saphenous vein is a vein whose wall is thinner, more fragile and almost more superficial. b) Type of patient. In an obese patient, hematoma seems to be more spectacular. In the thin patient, it appears faster, if hematic expression is too late. 2) Stripping techniques: It is possible to propose different techniques of stripping, but none of them can lower specifically post-surgical hematomae. 3) Anaesthesiae: a) General anaesthesia. A bilateral surgery under general anaesthesia was helpful to observe in some cases a less important hematoma at the level of the second operated leg. b) Rachi-anaesthesia. Physiological vasoconstriction requires a latent period for this kind of anaethesia which causes a vasomotor paralysis due to a blockade of the sympathetic nerve. c) Local anaesthesia. It is obtained by crural block in association with injection of Xylocaine Adrenalina at the level of perforating veins of the thigh. This technique causes less hematomae. II. ABSCESSES: Only 4 cases out of 1,000 operated legs have been reported. No related pathology have been observed particularly about lymphatic disorders (erysipelas or lymphoedema), no previous infection known which could not have explained such complications. Therapy was simple: incision at mid-thigh and draining by lamina. The patient recovered within two weeks.

  10. Pregnancy after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis

    DEFF Research Database (Denmark)

    Jørgensen, M; Broholm, R; Bækgaard, N

    2013-01-01

    To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT).......To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT)....

  11. Impact of leg lengthening on viscoelastic properties of the deep fascia

    Science.gov (United States)

    Wang, Hai-Qiang; Wei, Yi-Yong; Wu, Zi-Xiang; Luo, Zhuo-Jing

    2009-01-01

    Background Despite the morphological alterations of the deep fascia subjected to leg lengthening have been investigated in cellular and extracellular aspects, the impact of leg lengthening on viscoelastic properties of the deep fascia remains largely unknown. This study aimed to address the changes of viscoelastic properties of the deep fascia during leg lengthening using uniaxial tensile test. Methods Animal model of leg lengthening was established in New Zealand white rabbits. Distraction was initiated at a rate of 1 mm/day and 2 mm/day in two steps, and preceded until increases of 10% and 20% in the initial length of tibia had been achieved. The deep fascia specimens of 30 mm × 10 mm were clamped with the Instron 1122 tensile tester at room temperature with a constant tensile rate of 5 mm/min. After 5 load-download tensile tests had been performed, the specimens were elongated until rupture. The load-displacement curves were automatically generated. Results The normal deep fascia showed typical viscoelastic rule of collagenous tissues. Each experimental group of the deep fascia after leg lengthening kept the properties. The curves of the deep fascia at a rate of 1 mm/day with 20% increase in tibia length were the closest to those of normal deep fascia. The ultimate tension strength and the strain at rupture on average of normal deep fascia were 2.69 N (8.97 mN/mm2) and 14.11%, respectively. The increases in ultimate tension strength and strain at rupture of the deep fascia after leg lengthening were statistically significant. Conclusion The deep fascia subjected to leg lengthening exhibits viscoelastic properties as collagenous tissues without lengthening other than increased strain and strength. Notwithstanding different lengthening schemes result in varied viscoelastic properties changes, the most comparable viscoelastic properties to be demonstrated are under the scheme of a distraction rate of 1 mm/day and 20% increase in tibia length. PMID:19698092

  12. Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial.

    Science.gov (United States)

    Miller, C; McGuiness, W; Wilson, S; Cooper, K; Swanson, T; Rooney, D; Piller, N; Woodward, M

    2017-03-02

    Compression therapy is a gold standard treatment to promote venous leg ulcer (VLU) healing. Concordance with compression therapy is, however, often sub-optimal. The aim of this study was to evaluate the effectiveness of electric stimulation therapy (EST) to facilitate healing of VLUs among people who do not use moderate-to-high levels of compression (>25 mmHg). A pilot multicentre, single-blinded randomised controlled trial was conducted. Participants were randomised (2:1) to the intervention group or a control group where EST or a sham device was used 4 times daily for 20 minutes per session. Participants were monitored fortnightly for eight weeks. The primary outcome measure was percentage of area (wound size) change. In the 23 patients recruited, an average redution in wound size of 23.15% (standard deviation [SD]: 61.23) was observed for the control group compared with 32.67 % (SD: 42.54) for the intervention. A moderate effect size favouring the intervention group was detected from univariate [F(1,18)=1.588, p=0.224, partial eta squared=0.081] and multivariate repeated measures [F(1,18)=2.053, p=0.169, partial eta squared=0.102] analyses. The pilot study was not powered to detect statistical significance, however, the difference in healing outcomes are encouraging. EST may be an effective adjunct treatment among patients who have experienced difficulty adhering to moderate-to-high levels of compression therapy.

  13. Therapeutic effectiveness of a Calendula officinalis extract in venous leg ulcer healing.

    Science.gov (United States)

    Buzzi, M; de Freitas, F; de Barros Winter, M

    2016-12-02

    Non-healing venous leg ulcers (VLUs) have a significant effect on patients' quality of life and substantially increase expenditures in health-care systems. The aim of this study was to evaluate the clinical efficacy of the Calendula officinalis extract, Plenusdermax, in the treatment of VLUs. Patients treated with Calendula officinalis extract (n=38) and control patients (n=19) were evaluated every two weeks for 30 weeks or until their ulcers healed. Assessments included determination of the wound area by planimetry, infection control, and evaluation of the clinical aspects of the wounds. The percentage of healing velocity per week (%HVw), taking the initial area at baseline into account, was also determined. The proportion of the treatment patients achieving complete epithelialisation was 72 % and 32 % in the treatment and control groups, respectively. The average healing time was approximately 12 weeks in the treatment group and 25 % in control patients. Patients with ulcers treated with Calendula officinalis extract had a significant 4-fold increase in percentage healing velocity per week, 7.4 %, compared with 1.7 % in the control group. No adverse events were observed during the Calendula officinalis extract treatment. Our findings indicate that Calendula officinalis extract is an effective treatment for VLUs. The authors have no conflict of interest.

  14. Transplantation of autologous keratinocyte suspension in fibrin matrix to chronic venous leg ulcers: improved long-term healing after removal of the fibrin carrier.

    NARCIS (Netherlands)

    Hartmann, A.; Quist, J.; Hamm, H.; Brocker, E.B.; Friedl, P.H.A.

    2008-01-01

    BACKGROUND: The transplantation of keratinocytes suspended in fibrin carrier represents a candidate regimen for chronic ulcer treatment in an outpatient setting. We evaluated the integration and survival of autologous individualized keratinocytes applied within fibrin matrix onto chronic venous leg

  15. Impact of compression therapy using Unna's boot on the self-esteem of patients with venous leg ulcers.

    Science.gov (United States)

    Salome, G M; de Brito, M J A; Ferreira, L M

    2014-09-01

    To assess self-esteem in patients with venous leg ulcers treated with Unna's boot. • A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8-1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna's boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna's boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. • The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score=24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna's boot. • Patients with venous leg ulcers treated with Unna's boot for 12 months showed a significant improvement in self-esteem • All authors declare that no competing financial interests exist. There was no external funding for this study.

  16. Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions.

    NARCIS (Netherlands)

    Heinen, M.M.; Achterberg, T. van; Reimer, W.S. op; Kerkhof, P.C.M. van de; Laat, H.E.W. de

    2004-01-01

    BACKGROUND: Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. AIMS AND OBJECTIVES: Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered.

  17. Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    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

  18. VenUS IV (Venous leg Ulcer Study IV) - compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model.

    Science.gov (United States)

    Ashby, Rebecca L; Gabe, Rhian; Ali, Shehzad; Saramago, Pedro; Chuang, Ling-Hsiang; Adderley, Una; Bland, J Martin; Cullum, Nicky A; Dumville, Jo C; Iglesias, Cynthia P; Kang'ombe, Arthur R; Soares, Marta O; Stubbs, Nikki C; Torgerson, David J

    2014-09-01

    Compression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering 'high' compression with the 4LB. Part I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers. Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC). Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers. Part I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation. Part II MTC using all relevant RCT data - including Venous leg Ulcer Study IV (VenUS IV). Part III A decision-analytic Markov model. Part I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland. Part I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high compression. Part I Participants in the

  19. The Impact of Venous Leg Ulcers on Body Image and Self-esteem.

    Science.gov (United States)

    Salomé, Geraldo Magela; de Almeida, Sergio Aguinaldo; de Jesus Pereira, Maria Teresa; Massahud, Marcelo Renato; de Oliveira Moreira, Carmelita Naira; de Brito, Maria José Azevedo; Ferreira, Lydia Masako

    2016-07-01

    To evaluate self-esteem and body image in patients with venous leg ulcers (VLUs). A multicenter, prospective, descriptive, analytical, clinical study. A nursing care and education center of a university hospital, a health center, and an outpatient wound care clinic in Brazil. Fifty-nine consecutive adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 were recruited for the study. Exclusion criteria were mixed ulcers, arterial ulcers, and diabetic foot ulcers. A questionnaire assessing sociodemographic and clinical characteristics of patients, the Brazilian version of the Body Investment Scale, and the Rosenberg Self-esteem (RSE)/UNIFESP-EPM (São Paulo da Universidade Federal de São Paulo-Escola Paulista de Medicina) scale were administered to all patients. Most participants were women, aged between 60 and 70 years, and smokers; 33 (56%) were divorced, widowed, or single, and 26 (44%) were married. The patients had the ulcer for a mean of 5.42 years. Exudate and foul odor were present in most cases. Twenty-one ulcers (36%) measured 29 cm or less in surface area, and 17 (29%) ulcers measured between 30 and 49 cm (mean, 3.39 cm). The mean RSE score was 22.66, indicating low self-esteem. The mean Body Investment Scale total score was 27.49, and the scores on the body image and body touch subscales were also low, indicating negative feelings about the body. Patients with VLUs had low self-esteem and negative feelings about their bodies.

  20. Stress, Illness Perceptions, Behaviors, and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study.

    Science.gov (United States)

    Walburn, Jessica; Weinman, John; Norton, Sam; Hankins, Matthew; Dawe, Karen; Banjoko, Bolatito; Vedhara, Kavita

    2017-06-01

    The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers. A prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire, and Short-Form Health Survey). Controlling for sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = -0.61, p = .008), depression (standardized β = -0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = -1.4, p = .045). By 24 weeks, 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline (i.e., emotional representation of the ulcer) was associated with a greater number of weeks to heal (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37-7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06-1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) predicted weeks to heal. Alongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables.

  1. Stress, Illness Perceptions, Behaviors, and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study

    Science.gov (United States)

    Walburn, Jessica; Weinman, John; Norton, Sam; Hankins, Matthew; Dawe, Karen; Banjoko, Bolatito; Vedhara, Kavita

    2017-01-01

    ABSTRACT Objective The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers. Methods A prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire, and Short-Form Health Survey). Results Controlling for sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = −0.61, p = .008), depression (standardized β = −0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = −1.4, p = .045). By 24 weeks, 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline (i.e., emotional representation of the ulcer) was associated with a greater number of weeks to heal (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37–7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06–1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) predicted weeks to heal. Conclusions Alongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables. PMID:27941577

  2. Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database.

    Directory of Open Access Journals (Sweden)

    Emily S Petherick

    Full Text Available There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.Using The Health Improvement Network (THIN database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile. We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78. Documented provision of compression therapy did not vary with deprivation.A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006 were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the

  3. Proof in nuclear medicine of venous flow impairments in the area of the legs and the pelvic

    International Nuclear Information System (INIS)

    Mostbeck, A.; Lofferer, O.; Partsch, H.

    1976-01-01

    Based upon experience with 563 patients, the 131I fibrinogen test has proven a reliable method for the diagnosis of acute leg vein thrombosis. Investigations correlated by means of roentgenological phlebography performed by routine technique in 83 patients showed similar results in 77% of the cases. Analyzing the negative results of 23%, we consider 19% of the discrepancies to be due to faulty phlebographic and 4% to faulty fibrinogen results. Phlebography may reveal false positive results in recurrent thrombosis of the lower legs. The fibrinogen test may reveal false positive results after trauma, fractures, and in cases of superficial phlebitis and arthritis. Pelvic venous occlusions are detectable by radionuclid venography. This method is non-invasive (injection of 99m Tc albumin particles or microspheres in less than 1 ml, by means of a very thin needle into a dorsal foot vein). A lung scan is obtained in every examination. The results conformed in 89% of 250 patients with those obtained from Doppler ultrasonic investigations. Two thirds of all pelvic vein thromboses were located on the left side. Perfusion defects of the lungs were probably caused by pulmonary embolism (lung scanning) and were found in an average of 54% of all leg and pelvic vein thromboses (in thrombosis of the lower legs in 35%, of the thigh in 57% and of the pelvic vein in 70%). These figures are in good conformity with pathological-anatomical data concerning the frequency of pulmonary emboli and infarctions in leg and pelvic vein thrombosis. (Author)

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Supervised exercise training as an adjunctive therapy for venous leg ulcers: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Tew, Garry A; Michaels, Jonathan; Crank, Helen; Middleton, Geoff; Gumber, Anil; Klonizakis, Markos

    2015-10-06

    Venous leg ulcers are common, chronic wounds that are painful and reduce quality of life. Compression therapy is known to assist in the healing of venous leg ulceration. Supervised exercise training that targets an improvement in calf muscle pump function might be a useful adjunctive therapy for enhancing ulcer healing and other aspects of physical and mental health. However, the evidence of exercise for individuals with venous ulcers is sparse. Here, we describe the protocol for a study that aims to assess the feasibility of undertaking a randomised controlled trial of a supervised exercise programme in people who are receiving compression for venous ulceration. This is a randomised, controlled, assessor-blinded, two-centre, feasibility trial with two parallel groups. Eighty adults who are receiving lower-limb compression for a venous leg ulcer will be randomly assigned to receive usual care (compression only) or usual care plus a 12-week supervised exercise programme. Participants in the exercise group will be invited to undertake three, 60-minute sessions of supervised exercise each week, and each session will involve a combination of treadmill walking, upright cycling and strength and flexibility exercises for the lower limbs. Participants will be assessed before randomisation and 3, 6 and 12 months after randomisation. Primary outcomes include rates of recruitment, retention and adherence. Secondary outcomes include time to ulcer healing, proportion of participants healed, percentage and absolute change in ulcer size, health-related quality of life (EQ-5D-5L and VEINES-QOL/Sym), lower-limb cutaneous microvascular function (laser Doppler flowmetry coupled with iontophoresis) and physical fitness (30-second sit-to-stand test, chair sit and reach test, 6-minute walk test and ankle range of motion). The costs associated with the exercise programme and health-care utilisation will be calculated. We will also complete interviews with a sub-sample of participants to

  6. Venous plethysmography

    International Nuclear Information System (INIS)

    Barnes, R.W.; Middleton, J.; Turley, D.G.

    1984-01-01

    Venous plethysmography provides an objective, versatile, and accurate method of defining those alterations that may result from acute or chronic venous disease, namely venous outflow obstruction and venous reflux through incompetent venous valves. Impedance or strain-gauge plethysmography provides the most accurate means of quantifying abnormal venous outflow in acute deep venous thrombosis. Venous volume plethysmography, using the phleborheograph, provides very sensitive determination of altered venous hemodynamics in acute deep venous thrombosis; it also serves to assess some patients with chronic venous insufficiency. Combinations of strain-gauge and photoplethysmography lead to useful measures of venous reflux in deep, perforating, and superficial veins. This information, along with measurements of maximum venous outflow, may provide the most versatile means of establishing altered hemodynamics in patients with chronic venous insufficiency

  7. PredyCLU: a prediction system for chronic leg ulcers based on fuzzy logic; part I - exploring the venous side.

    Science.gov (United States)

    de Franciscis, Stefano; Fregola, Salvatore; Gallo, Alessandro; Argirò, Giuseppe; Barbetta, Andrea; Buffone, Gianluca; Caliò, Francesco G; De Caridi, Giovanni; Amato, Bruno; Serra, Raffaele

    2016-12-01

    Chronic leg ulcers (CLUs) are a common occurrence in the western population and are associated with a negative impact on the quality of life of patients. They also cause a substantial burden on the health budget. The pathogenesis of leg ulceration is quite heterogeneous, and chronic venous ulceration (CVU) is the most common manifestation representing the main complication of chronic venous disease (CVD). Prevention strategies and early identification of the risk represent the best form of management. Fuzzy logic is a flexible mathematical system that has proved to be a powerful tool for decision-making systems and pattern classification systems in medicine. In this study, we have elaborated a computerised prediction system for chronic leg ulcers (PredyCLU) based on fuzzy logic, which was retrospectively applied on a multicentre population of 77 patients with CVD. This evaluation system produced reliable risk score patterns and served effectively as a stratification risk tool in patients with CVD who were at the risk of developing CVUs. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  8. Ultrasound in the diagnosis of deep venous thrombosis; A comparison with venography. Ultralyddiagnostikk ved dyp venetrombose; En sammenligning med venografi

    Energy Technology Data Exchange (ETDEWEB)

    Braband, K.; Sortland, O. (Sentralsykehuset i Akershus, Loerenskog (Norway))

    1989-10-01

    In a prospective study ultrasonography (US) was compared with venography for diagnosis of deep venous thrombosis of the leg. Using venography, thrombosis was demonstrated in 25 patients. Based on two criteria, non-compressible vein and intraluminal echoes, US showed thrombosis in 23 patients, i.e. the sensitivity was 92%. Isolated calf vein thrombosis was demonstrated in 2 out 4 patients. In 18% of the patients with negative venography, other pathological conditions were demonstrated by US, (i.e. Baker's cysts, calf vein hematomas and superficial calf vein thrombosis) which could explain the clinical condition. Venography is a somewhat costly procedure. The cost of film and non-ionic contrast medium is approximately NOK 400, while the cost of film for an US examination is about NOK 10.

  9. 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

  10. A prospective case series evaluating the safety and efficacy of the Klox BioPhotonic System in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Nikolis A

    2016-09-01

    Full Text Available Andreas Nikolis,1 Doria Grimard,2 Yves Pesant,3 Giovanni Scapagnini,4 Denis Vézina5 1Division of Plastic Surgery, Victoria Park Research Centre, Montreal, 2Q&T Research Chicoutimi, Chicoutimi, 3St-Jerome Medical Research Inc., St-Jerome, Quebec, Canada; 4Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; 5Klox Technologies, Laval, Quebec, Canada Purpose: To investigate the safety and efficacy of the BioPhotonic System developed by Klox Technologies in a case series of ten patients with venous leg ulcers.Patients and methods: Ten patients with chronic venous leg ulcers, having failed on at least one previous therapy, were enrolled into this case series.Results: Nine patients were evaluable for efficacy. A response (defined as decrease in wound surface area was observed in seven patients (77.8%. Of these, four patients (44.4% achieved wound closure on average 4 months (127.5 days following the beginning of the treatment. Two patients did not respond to the investigational treatment. Quality of life improved over time throughout the study. Compliance was excellent, with 93.2% of visits completed as per protocol. Safety was unremarkable, with only four treatment-emergent-related adverse events, for which no specific intervention was required.Conclusion: The BioPhotonic System was shown to be safe and extremely well tolerated. It also demonstrated potential in terms of wound closure, wound surface area decrease, and wound bed preparation. Keywords: biophotonics, light, photobiomodulation, venous leg ulcers

  11. Clinically silent deep vein thrombosis in patients with superficial thrombophlebitis and varicose veins at legs.

    Science.gov (United States)

    Jerkic, Zoran; Karic, Alen; Karic, Amela

    2009-01-01

    Although superficial thrombophlebitis is a common disorder until recently it was considered as benign disorder. Also it is associated with varicose vein at legs and it was treated effectively with conservative methods, walking and non-steroid anti-inflammatory drugs. Aims of our investigation were: determine frequency of clinically silent deep vein thrombosis at legs in patient with and without superficial thrombophlebitis, determine correlation between superficial thrombophlebitis and deep vein thrombosis regardless of localization of superficial thrombophlebitis in superficial veins of legs and determine adequacy and safety vein phlebography in early diagnosis clinically silent deep vein thrombosis in patients with superficial thrombophlebitis. Using flebography in prospective study was evaluated incidence of clinically silent deep vein thrombosis in 92 patients with varicose veins at legs. By phlebograpy in patients with varicose veins at legs and superficial thrombophlebitis at legs and without clinical signs of DVT at legs of the 49 patients we detected DVT in 12 patients (24, 48%), in three male and nine female. We detected localization of DVT in ilijacofemoral junction in 4,08% patients, although localization of DVT in femoropopliteal region was observed in 6, 12% patients and localization in crural region was in 14.28% patients. Localization of DVT at legs was detected in iliac vein in 16.66% patients, in femoral vein in 25% patients, popliteal vein 8.33% patients, anterior tibial vein 16.66%, posterior tibial vein in 25% and crural veins 8.33% patients. Also we deduced significant difference between two group of patients (chi2 = 10, 76). Such result proves thesis that in most patients with superficial thrombophlebitis and varicose veins is possibility of developing of DVT.

  12. Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

    Directory of Open Access Journals (Sweden)

    van de Glind Irene M

    2012-10-01

    Full Text Available Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer

  13. Painful swollen leg – think beyond deep vein thrombosis or Baker's cyst

    Directory of Open Access Journals (Sweden)

    Babu Vinayagam

    2008-01-01

    Full Text Available Abstract Background The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation. Case presentation This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented. Conclusion A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.

  14. A comparison of impedance plethysmography and strain gauge plethysmography in the diagnosis of deep venous thrombosis in symptomatic outpatients

    NARCIS (Netherlands)

    Huisman, M. V.; Büller, H. R.; Basart, D. C.; ten Cate, J. W.

    1985-01-01

    Strain gauge plethysmography and impedance plethysmography are non-invasive diagnostic techniques for deep venous thrombosis. In 145 consecutive out-patients presented with suspected acute deep venous thrombosis we compared these two techniques. Venography was performed if one or both tests were

  15. Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial.

    Science.gov (United States)

    Ashby, Rebecca L; Gabe, Rhian; Ali, Shehzad; Adderley, Una; Bland, J Martin; Cullum, Nicky A; Dumville, Jo C; Iglesias, Cynthia P; Kang'ombe, Arthur R; Soares, Marta O; Stubbs, Nikki C; Torgerson, David J

    2014-03-08

    Drawbacks exist with the standard treatment (four-layer compression bandages) for venous leg ulcers. We have therefore compared the clinical effectiveness and cost-effectiveness of two-layer compression hosiery with the four-layer bandage for the treatment of such ulcers. We undertook this pragmatic, open, randomised controlled trial with two parallel groups in 34 centres in England and Northern Ireland. The centres were community nurse teams or services, family doctor practices, leg ulcer clinics, tissue viability clinics or services, and wound clinics. Participants were aged 18 years or older with a venous leg ulcer and an ankle brachial pressure index of at least 0·8, and were tolerant of high compression. We randomly allocated participants (1:1) to receive two-layer compression hosiery or a four-layer bandage, using a remote randomisation service and prevalidated computer randomisation program. Participants were stratified by ulcer duration and ulcer area with permuted blocks (block sizes four and six). The primary endpoint was time to ulcer healing, with a maximum follow-up of 12 months. Although participants and health-care providers were not masked to treatment allocation, the primary endpoint was measured by masked assessment of photographs. Primary analysis was intention to treat with Cox regression, with adjustment for ulcer area, ulcer duration, physical mobility, and centre. This trial is registered with the ISRCTN register, number ISRCTN49373072. We randomly allocated 457 participants to the two treatment groups: 230 to two-layer hosiery and 227 to the four-layer bandage, of whom 453 (230 hosiery and 223 bandage) contributed data for analysis. Median time to ulcer healing was 99 days (95% CI 84-126) in the hosiery group and 98 days (85-112) in the bandage group, and the proportion of ulcers healing was much the same in the two groups (70·9% hosiery and 70·4% bandage). More hosiery participants changed their allocated treatment (38·3% hosiery vs 27

  16. Behaviour of venous flow rates in intermittent sequential pneumatic compression of the legs using different compression strengths

    International Nuclear Information System (INIS)

    Fassmann-Glaser, I.

    1984-01-01

    A study with 25 patients was performed in order to find out whether intermittent, sequential, pneumatic leg compression is of value in the preventive management of thrombosis due to its effect on the venous flow rates. For this purpose, xenon 133 was injected into one of the foot veins and the flow rate in each case determined for the distance between instep and inguen using different compression strengths, with pressure being exerted on the ankle, calf and thigh. Increased flow rates were already measured at an average pressure value of 34.5 mmHg, while the maximum effect was achieved by exerting a pressure of 92.5 mmHg, which increased the flow rate by 366% as compared to the baseline value. The results point to a significant improvement of the venous flow rates due to intermittent, sequential, pneumatic leg compression and thus provide evidence to prove the value of this method in the prevention of hemostasis and thrombosis. (TRV) [de

  17. Incidence of deep venous thrombosis and stratification of risk groups in a university hospital vascular surgery unit

    Directory of Open Access Journals (Sweden)

    Alberto Okuhara

    2015-06-01

    Full Text Available BACKGROUND: There is a knowledge gap with relation to the true incidence of deep vein thrombosis among patients undergoing vascular surgery procedures in Brazil. This study is designed to support the implementation of a surveillance system to control the quality of venous thromboembolism prophylaxis in our country. Investigations in specific institutions have determined the true incidence of deep vein thrombosis and identified risk groups, to enable measures to be taken to ensure adequate prophylaxis and treatment to prevent the condition.OBJECTIVE: To study the incidence of deep venous thrombosis in patients admitted to hospital for non-venous vascular surgery procedures and stratify them into risk groups.METHOD: This was a cross-sectional observational study that evaluated 202 patients from a university hospital vascular surgery clinic between March 2011 and July 2012. The incidence of deep venous thrombosis was determined using vascular ultrasound examinations and the Caprini scale.RESULTS: The mean incidence of deep venous thrombosis in vascular surgery patients was 8.5%. The frequency distribution of patients by venous thromboembolism risk groups was as follows: 8.4% were considered low risk, 17.3% moderate risk, 29.7% high risk and 44.6% were classified as very high risk.CONCLUSION: The incidence of deep venous thrombosis in vascular surgery patients was 8.5%, which is similar to figures reported in the international literature. Most vascular surgery patients were stratified into the high and very high risk for deep venous thrombosis groups.

  18. Deep cerebral venous thrombosis associated with oral contraceptives: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ja; Lee, Sang Bong; Lee, Yeon Soo; Kang, Si Won [The Catholic Univ. Mary' s Hospital, Taejon (Korea, Republic of)

    1998-10-01

    Deep cerbral venous thrombosis(DCVT) is a rare category of stroke that can be caused by various conditions. We report a case of spontaneous DCVT in a 34-year-old female using oral contraceptives;clinical and radiologic manifestations were characteristic.=20.

  19. Role of Color Flow Ultrasound in Detection of Deep Venous Thrombosis

    Science.gov (United States)

    Mohammed, Shelan Hakeem; AL-Najjar, Salwa A.

    2016-01-01

    Background: Deep vein thrombosis (DVT) of lower limbs is one of the most causes for the majority of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and squeal of…

  20. 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

    -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...

  1. The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis

    NARCIS (Netherlands)

    van den Bergh, Walter M.; van der Schaaf, Irene; van Gijn, Jan

    2005-01-01

    The classic features of thrombosis of the deep cerebral venous system are severe dysfunction of the diencephalon, reflected by coma and disturbances of eye movements and pupillary reflexes, resulting in poor outcome. However, partial syndromes without a decrease in the level of consciousness or

  2. The diagnosis of deep venous thrombosis using laser Doppler skin perfusion measurements

    NARCIS (Netherlands)

    de Graaff, J. C.; Ubbink, D. T.; Büller, H. R.; Jacobs, M. J.

    2001-01-01

    Compression ultrasonography (CUS) falls short in the diagnosis of deep venous thrombosis in asymptomatic patients and thrombi limited to the calf veins. Alternatively, laser Doppler fluxmetry (LDF) may be useful for this purpose, as it can measure the peripheral vasoconstriction response upon an

  3. Detection of lower limb deep venous thrombosis in asymptomatic high risk patients using a new radiolabelled thrombus specific agent

    Energy Technology Data Exchange (ETDEWEB)

    Butler, S.P.; Rahman, T.; Boyd S.J. [George Hospital, Sydney (Australia)] [and others

    1995-05-01

    Deep venous thrombosis is a serious consequence of major orthopaedic surgery and non invasive screening with either venous ultrasound or impedance plethysmography is unreliable for detecting or excluding DVT in this group. A new method of thrombus detection has been devised using Tc-99m labelled inhibited recombinant tissue plasminogen activator. The accuracy of scanning with this new radiopharmaceutical in asymptomatic high risk patients was evaluated using venography as the gold standard. 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 days following operation. Scintigraphic imaging was performed at 4 hours post injection. 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. 57 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. Thus in detecting lower limb thrombosis, scanning had a sensitivity of 92% and a specificity of 91%. Scintigraphic scanning with this new radiopharmaceutical permits accurate detection of thrombus in high risk patients.

  4. The expression of inflammatory cytokines, TAM tyrosine kinase receptors and their ligands is upregulated in venous leg ulcer patients: a novel insight into chronic wound immunity.

    Science.gov (United States)

    Filkor, Kata; Németh, Tibor; Nagy, István; Kondorosi, Éva; Urbán, Edit; Kemény, Lajos; Szolnoky, Győző

    2016-08-01

    The systemic host defence mechanisms, especially innate immunity, in venous leg ulcer patients are poorly investigated. The aim of the current study was to measure Candida albicans killing activity and gene expressions of pro- and anti-inflammatory cytokines and innate immune response regulators, TAM receptors and ligands of peripheral blood mononuclear cells separated from 69 venous leg ulcer patients and 42 control probands. Leg ulcer patients were stratified into responder and non-responder groups on the basis of wound healing properties. No statistical differences were found in Candida killing among controls, responders and non-responders. Circulating blood mononuclear cells of patients overexpress pro-inflammatory (IL-1α, TNFα, CXCL-8) and anti-inflammatory (IL-10) cytokines as well as TAM receptors (Tyro, Axl, MerTK) and their ligands Gas6 and Protein S compared with those of control individuals. IL-1α is notably overexpressed in venous leg ulcer treatment non-responders; in contrast, Axl gene expression is robustly stronger among responders. These markers may be considered as candidates for the prediction of treatment response among venous leg ulcer patients. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Langer Astrid

    2009-07-01

    Full Text Available Abstract Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1 Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies; (2 Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study; (3 REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies. The studies considered in this review were of varying and partly low

  6. A Comparison of the Efficacy and Cost of Different Venous Leg Ulcer Dressings: A Retrospective Cohort Study

    Science.gov (United States)

    Hussain, Syed M. Asim

    2015-01-01

    Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers. Study Design. Retrospective cohort study. Location. The leg ulcer clinic at the University Hospital of South Manchester. Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings (e.g., NA Ultra) were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost. Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient. Results. Simple nonadherent dressings had a mean healing rate of 0.353 cm2/week (standard deviation ± 0.319) compared with a mean of 0.415 cm2/week (standard deviation ± 0.383) for more expensive dressings. This resulted in a one-tailed p value of 0.251 and a two-tailed p value of 0.508. Multiple regression analysis gave a significance F of 0.8134. Conclusion. The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection. PMID:25954532

  7. The effect of lymphatico-venous anastomosis for an intractable ulcer at the lower leg in a marked obese patient.

    Science.gov (United States)

    Mihara, Makoto; Hara, Hisako; Todokoro, Takeshi; Seki, Yukio; Iida, Takuya; Koshima, Isao; Murai, Noriyuki

    2014-01-01

    Secondary lymphedema occurs after trauma, cancer surgery, or obesity, and wounds in lymphedema can easily become intractable. We report positive results using lymphatico-venous anastomosis (LVA) to treat a post-traumatic lymph fistula and an intractable ulcer in a severely obese patient. A 41-year-old male (BMI 51.8), one year prior, had a traffic injury, and had an 18-cm contusion in his right leg. Six months later, lymph leakage in a 14 cm × 8 cm region and a 5 cm × 3 cm skin ulcer occurred in the center of the wound. We made a diagnosis of lymphedema resulting from obesity, accompanied with lymphorrhea and intractable ulcer. He was unable to reach his legs owing to obesity, making complex physical therapy impossible. We performed LVA under local anesthesia. The lymphorrhea healed 2 weeks after the operation and had not recurred 3 months after the operation. The leg lymphedema improved after the surgery without the compression therapy. In cases of intractable ulcers, suspected of being caused by lymphostasis, treatments indicated for lymphedema, for example LVA, may possibly allow satisfactory wound healing. © 2013 Wiley Periodicals, Inc. Microsurgery 34:64-67, 2014. © 2013 The Authors. Microsurgery Published by Wiley Periodicals, Inc.

  8. [Management of patients with varicose veins presenting with a history of deep venous thrombosis].

    Science.gov (United States)

    Battino, A; Battino, J

    1989-01-01

    The notion of a history of deep venous thrombosis in patients with varicose veins has often been at the origin of a contemplative attitude toward this pathology. What used to be an act of vigilance has now become plain negligence, if not a therapeutic error. Indeed, the difficulty in diagnosing an acute episode explains the many false positive results obtained; moreover, the variability of the evolution of true venous thrombosis should no longer cause one to adopt a monolithic attitude. In this indication, noninvasive investigating procedures allow distinguishing quite different situations occurring in these patients. In a substantial number of cases, no deep vein circulatory abnormality can be found. Treatment should address primary varicose veins. For those patients with deep venous thrombosis sequelae, such studies allow us to differentiate between occlusion/restriction states from devalvulation, and to detect the precise location of such sequelae, as well as their impact on circulatory function. When occlusion is found, varicose veins, which may be supplementary veins, are left untouched. When devalvulation occurs as an isolated phenomenon, superficial vein insufficiency is of primary importance. Treatment is the more complete that deep reflux will promote relapse through all existing leakage points. If, regardless of this treatment, deep reflux causes significant disturbances, surgical revalvulation should be recommended. More complex cases combining persisting occlusion with devalvulation call for a graded attitude. Noninvasive investigating procedures coupled with phlebography allow us to assess the part played by the various anomalies in causing the disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. 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)

  10. Low dose aspirin as adjuvant treatment for venous leg ulceration: pragmatic, randomised, double blind, placebo controlled trial (Aspirin4VLU).

    Science.gov (United States)

    Jull, Andrew; Wadham, Angela; Bullen, Chris; Parag, Varsha; Kerse, Ngaire; Waters, Jill

    2017-11-24

    Objective  To determine the effect of low dose aspirin on ulcer healing in patients with venous leg ulcers. Design  Pragmatic, community based, parallel group, double blind, randomised controlled trial. Setting  Five community nursing centres in New Zealand. Participants  251 adults with venous leg ulcers who could safely be treated with aspirin or placebo: 125 were randomised to aspirin and 126 to placebo. Interventions  150 mg oral aspirin daily or matching placebo for up to 24 weeks treatment, with compression therapy as standard background treatment. Main outcome measures  The primary outcome was time to complete healing of the reference ulcer (largest ulcer if more than one ulcer was present). Secondary outcomes included proportion of participants healed, change in ulcer area, change in health related quality of life, and adverse events. Analysis was by intention to treat. Results  The median number of days to healing of the reference ulcer was 77 in the aspirin group and 69 in the placebo group (hazard ratio 0.85, 95% confidence interval 0.64 to 1.13, P=0.25). The number of participants healed at the endpoint was 88 (70%) in the aspirin group and 101 (80%) in the placebo group (risk difference -9.8%, 95% confidence interval -20.4% to 0.9%, P=0.07). Estimated change in ulcer area was 4.1 cm 2 in the aspirin group and 4.8 cm 2 in the placebo group (mean difference -0.7 cm 2 , 95% confidence interval -1.9 to 0.5 cm 2 , P=0.25). 40 adverse events occurred among 29 participants in the aspirin group and 37 adverse events among 27 participants in the placebo group (incidence rate ratio 1.1, 95% confidence interval 0.7 to 1.7, P=0.71). Conclusion  Our findings do not support the use of low dose aspirin as adjuvant treatment for venous leg ulcers. Trial registration  ClinicalTrials.gov NCT02158806. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. [Hemosiderin and siderophages in inguinal lymph nodes in chronic venous insufficiency of the legs].

    Science.gov (United States)

    Maĭborodin, I V; Pavliuk, E G; Egorov, V A; Shevela, A I; Maĭborodina, V I; Savchenko, S V

    2006-01-01

    Inguinal lymph nodes of patients with venous insufficiency of the lower extremities were studied by light microscopy. Presence of erythrocytes was found in all structural parts of these organs. In cortical region and paracortical zone siderophages with hemosiderin were observed. The origin of hemosiderin is discussed.

  12. Current State of Anticoagulants to Treat Deep Venous Thrombosis

    OpenAIRE

    Vo, Timothy; Vazquez, Sara; Rondina, Matthew T.

    2014-01-01

    Anticoagulation remains the cornerstone of treatment in patients with deep vein thrombosis (DVT). While parenteral anticoagulants and oral vitamin K antagonists (e.g. warfarin) have been used for many decades, the recent development of novel oral anticoagulants have provided clinicians with an expanding set of therapeutic options for DVT. This review summarizes the pharmacology and clinical trial results of these new oral anticoagulants. Several practical considerations to the use of these or...

  13. 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.

  14. Clinical efficacy of a silver-releasing foam dressing in venous leg ulcer healing: a randomised controlled trial.

    Science.gov (United States)

    Senet, Patricia; Bause, Renzo; Jørgensen, Bo; Fogh, Karsten

    2014-12-01

    Biatain and Biatain-Ag are two identical wound dressings except the fact that Biatain-Ag releases silver. In the present multinational double-blinded randomised controlled trial the effect of the two dressings were compared for treatment of venous leg ulcers. A total of 181 patients were treated for 6 weeks with either Biatain or Biatain-Ag followed by 4 weeks treatment with Biatain. Biatain-Ag showed superior performance in relative wound area reduction after 6 weeks treatment and the estimated treatment difference increased after 10 weeks indicating that the effect of silver continues at least for 4 weeks after treatment. A subgroup of the patients differed significantly from the others with respect to parameters associated with a poor healing prognosis; patients were older, had significant history of venous thrombosis, larger ulcers with longer duration and more often recurrent. For this subgroup of patients Biatain-Ag showed significant (P silver-releasing dressing Biatain in particular for patients having ulcers associated with a poor healing prognosis. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  15. Bilateral thalamic infarction that is secondary thrombosis to the deep venous structures: report of two cases

    Directory of Open Access Journals (Sweden)

    Serdar Oruc

    2016-12-01

    Full Text Available Deep cerebral venous thrombosis cases are the %6 of the cerebral venous thrombosis (CVT cases. The recognition of these patients is difficult since this disease is rarely observed and its clinical presentation is nonspecific and variable. In its etiology, the most frequently observed reasons are hypercoagulopathy, oral contraceptive use, pregnancy, puerperium, dehydration, and head trauma. Less frequently observed reasons are vasculitis, inflammatory bowel disease, malignancies, anemia, and tumor invasion through venous sinuses. In this report, were presented two cases who were admitted to the hospital with headache complaint and cognitive changes.According to the advanced magnetic resonance imaging, acute infarction was detected in bilateral thalamus. We observed CVT with adversely affected deep cerebral venous system structures. CVT development was associated with the use of oral contraceptives in the first case and it was associated with anemia in the second case. Both patients were discharged from the hospital upon healing with anticoagulant therapy. In this study, it has been emphasized by representing these two patients that CVT should be thought in the etiology of bilateral thalamic ischemia. Furthermore, it is also crucial to known that these patients can be fully improved clinically and radiologically in case appropriate medical treatment is applied.

  16. Recovery from primary deep cerebral venous sinus thrombosis with recanalisation

    International Nuclear Information System (INIS)

    Nagatomo, Y.; Yanaka, K.; Kamezaki, T.; Kobayashi, E.; Matsumura, A.; Nose, T.

    1995-01-01

    A 50-year-old woman with idiopathic deep cerebral sinus and vein thrombosis (DCVT) had cerebellar disturbance prior to impaired consciousness. CT and MRI revealed haemorrhagic infarction in the cerebellum and signal changes suggesting infarction in the thalamus and basal ganglia bilaterally. The straight sinus and internal cerebral vein (ICV) were dense on CT. On angiography, the vein of Galen (VG) and straight sinus were not seen. Following clinical recovery, CT and MRI became normal, and angiography showed recanalization of the VG and ICV. The relationship between cerebellar infarction and DCVT, and signal changes on CT and MRI are discussed. (orig.). With 4 figs., 1 tab

  17. The upper extremity deep venous thrombosis and its interventional treatment

    International Nuclear Information System (INIS)

    Yang Chao; Ni Caifang

    2011-01-01

    Upper extremity deep vein thrombosis (UEDVT) was once regarded as a kind of disorder that was not serious. With the development of medical knowledge and research, it is now has been well recognized that UEDVT is an important risk factor that can bring about the pulmonary embolus, even cause death in severe patients. This article aims to make a comprehensive review of UEDVT, focusing on the etiology, epidemiology, the clinical features, the diagnosis, the interventional treatment options, the nursing care, the complications as well as prevention strategies, etc. (authors)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  1. 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

  2. Upper extremity compartment syndrome in the setting of deep venous thrombosis and phlegmasia cerulea dolens: case report.

    Science.gov (United States)

    Bedri, Mazen I; Khosravi, Abtin H; Lifchez, Scott D

    2009-12-01

    Forearm compartment syndrome is an uncommon but emergent condition that can threaten limb and life. An uncommon cause of compartment syndrome is deep venous thrombosis, usually in the setting of phlegmasia cerulea dolens of the lower extremity. We present a case of compartment syndrome secondary to venous occlusion of the upper extremity due to phlegmasia cerulea dolens in a patient with metastatic lung cancer.

  3. The venous anatomy of the abdominal wall for Deep Inferior Epigastric Artery (DIEP) flaps in breast reconstruction

    Science.gov (United States)

    Ashton, Mark W

    2012-01-01

    Background Despite improving outcomes, venous problems in the harvest of deep inferior epigastric artery perforator (DIEP) flaps remain the more common vascular complications. However, it is apparent that the venous anatomy of the anterior abdominal wall has not been described to the same extent as the arterial anatomy. Cadaveric dissection studies of venous anatomy frequently lack the detail of their arterial counterparts. Venous valves complicate retrograde injection, resulting in poor quality studies with limited anatomical information. Methods The current manuscript comprises a review of the literature, highlighting key features of the anatomy of the venous drainage of the abdominal wall integument, with particular pertinence to DIEP flaps. Both cadaveric and clinical studies are included in this review. Our own cadaveric and in-vivo studies were undertaken and included in detail in this manuscript, with the cadaveric component utilizing direct catheter venography and the in-vivo studies were undertaken using preoperative computed tomographic angiography (CTA), mapping in-vivo venous flow. Results Several key features of the venous anatomy of the abdominal wall render it different to other regions, and are of particular importance to DIEP flap transfer. Conclusions The cause of venous compromise is multi-factorial, with perforator diameter, midline crossover, and deep-superficial venous communications all important. Venous cadaveric studies as well as clinical CTA preoperatively can identify these anomalies. PMID:25083432

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

    OpenAIRE

    Blaivas, Michael; Stefanidis, Konstantinos; Nanas, Serafim; Poularas, John; Wachtel, Mitchell; Cohen, Rubin; Karakitsos, Dimitrios

    2012-01-01

    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. Additionall...

  5. 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

  6. Medical management of venous ulcers.

    Science.gov (United States)

    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.

  7. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort*

    Science.gov (United States)

    Scotton, Marilia Formentini; Miot, Hélio Amante; Abbade, Luciana Patricia Fernandes

    2014-01-01

    BACKGROUND Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates. OBJECTIVES To identify clinical and therapeutic factors that influence healing of venous ulcers. METHODS Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects. RESULTS Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95%CI 31.9 to 48.4%) at T6 and 49.6% (95%CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95%CI 10.5 to 23.1%) at T6 and 27% (95%CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95%CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95%CI 1.31 to 12.41), and infection episodes (RR= 0.42; 95%CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95%CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95%CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95%CI 0.40 to 0.99). CONCLUSIONS Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates. PMID:24937814

  8. [Identifying clinical risk factors in recurrent idiopathic deep venous thrombosis].

    Science.gov (United States)

    Del Río Solá, M Lourdes; González Fajardo, José Antonio; Vaquero Puerta, Carlos

    2016-03-18

    Oral anticoagulant therapy for more than 6 months in patients with an episode of idiopathic thromboembolic disease is controversial. The objective was to determine predictive clinical signs that identify patients at increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic deep vein thrombosis (DVT). A prospective study which included 306 consecutive patients with a first episode of idiopathic DVT from June 2012 to June 2014. Predictor variables of recurrent thromboembolic disease and episodes of recurrence during follow-up of the patients (28.42 months) were collected. We performed a multivariate analysis to analyze possible predictors (P<.20) and an analysis of Kaplan-Meier to establish mean recurrence-free survival. We identified 91 episodes of residual vein thrombosis on follow-up of the patients (37.5% men and 20.3% women) (OR 1.84; 95% CI 1.25-2.71). In the Cox regression analysis stratified by gender, variables showed significant presence of hyperechoic thrombus (P=.001) in males, and persistence of residual thrombus in women (P=.046). The mean recurrence-free survival was shorter in both groups. The presence of echogenic thrombus in men and the existence of residual DVT in women were 2 clinical signs associated with increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic DVT in our study. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

    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.

  10. Which frog's legs do froggies eat? The use of DNA barcoding for identification of deep frozen frog legs (Dicroglossidae, Amphibia) commercialized in France

    OpenAIRE

    Ohler, Annemarie; Nicolas, Violaine

    2017-01-01

    International audience; Several millions frogs captured in the wild in Indonesia are sold for food yearly in French supermarkets, as deep frozen frog legs. They are commercialized as Rana macrodon, but up to 15 look-alike species might also be concerned by this trade. From December 2012 to May 2013, we bought 209 specimens of deep frozen frog legs, and identified them through a barcoding approach based on the 16S gene. Our results show that 206 out of the 209 specimens belong to Fejervarya ca...

  11. Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia

    Directory of Open Access Journals (Sweden)

    José Luiz Orlando

    2010-01-01

    Full Text Available INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4% and 10 were male (25.6%, with ages ranging from 11 to 59 years (median of 24 years. All of the lesions affected limbs, and the main symptom reported was pain (97.4%. Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients; medium, between 3 and 15 cm (27 patients; and large, greater than 15 cm (8 patients. RESULTS: The symptoms completely disappeared in 14 patients (35.9% and improved in 24 (61.5%. The lesion size reduced to zero in 6 patients (15.4% and decreased in 32 (82%. The median number of sessions was 7. There were no complications in 32 patients (82%, while 3 presented local paresthesia (7.7%, 2 superficial trombophlebites (5.1%, 1 skin ulcer (2.6%, and 1 case of hyperpigmentation (2.6%. CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.

  12. Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

    Science.gov (United States)

    Jankūnas, Vytautas; Rimdeika, Rytis; Jasenas, Marius; Samsanavicius, Donatas

    2004-01-01

    Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also

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

    International Nuclear Information System (INIS)

    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)

  14. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study

    DEFF Research Database (Denmark)

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing

    2011-01-01

    that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous...... and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P...

  15. Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-Heal Chronic Venous Leg Ulcers

    Science.gov (United States)

    Jemec, Gregor B. E.; Kerihuel, Jean Charles; Ousey, Karen; Lauemøller, Sanne Lise; Leaper, David John

    2014-01-01

    Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healed ulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (£141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs. PMID:24945381

  16. Abordagem de pacientes com úlcera da perna de etiologia venosa Management of patients with venous leg ulcer

    Directory of Open Access Journals (Sweden)

    Luciana Patrícia Fernandes Abbade

    2006-12-01

    limbs. Doppler must be used to determine the ankle-arm index, and non-invasive exams, such as duplex scan, are requested to evaluate the superficial, deep and perforating venous systems. Accurate clinical and laboratory diagnosis of venous ulcers, as well as appropriate treatment of their complications are fundamental for successful therapy. Efforts must be directed towards healing and avoiding recurrences. Advanced knowledge on the venous ulcer physiopathogenesis has led to development of new clinical and surgical treatments.

  17. Do ready-made compression stockings fit the anatomy of the venous leg ulcer patient?

    DEFF Research Database (Denmark)

    Nørregaard, S; Bermark, S; Gottrup, F

    2014-01-01

    OBJECTIVE: How usable two standardised measuring methods are for the selection of three different brands of ready-made below-knee compression stockings. Furthermore, this study aims to determine how many of the included patients fit into a ready-made compression stocking in a limited selection...... compression stockings. The circumference was measured at three points and seven points below the knee. The results of these measurements were compared to three selected brands of ready-made compression stockings. RESULTS: Together, 43 consecutive patients (25 men and 18 women) were included in the study. When...... the leg was measured at three points, 53.5%, 34.9% and 0% of the patients fitted into brand 1, brand 2 and brand 3 of the ready-made compression stockings, respectively. When measured at seven points, only 4.7% of the patients fitted into brand 1, 7% in brand 2 and 0% of the patients fitted into brand 3...

  18. 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.

  19. [Questionable effectiveness of autologous platelet growth factors (PDWHF) in treatment of venous ulcers of the leg].

    Science.gov (United States)

    Reutter, H; Bort, S; Jung, M F; Klyscz, T; Schippert, W; Zuder, D; Jünger, M

    1999-12-01

    Chronic venous insufficiency (CVI) can cause ulcers of the lower limb having the character of a full thickness wound involving the subcutaneous tissues and fat. Healing requires wound contraction, connective tissue formation and finally reepithelialization. To induce wound healing, on an underlying disturbed environment due to longterm effects of CVI, artificial stimuli may be needed. In a placebo controlled study we tried topical application of autologous PDWHF (platelet derived wound healing factors), to achieve ulcer healing and improve the microangiopathy surrounding of the ulcer area, as there are decreased number of skin capillaries and reduction in cutaneous vascular reserve. Alterations of cutaneous circulation during the course of the study were documented by capillaroscopy, transcutaneous oxygen pressure and laser Doppler flux (LDF) measurements. We were able to recruit 15 patients a I suffering from chronic nonhealing venous stasis ulcers. Eleven of the 15 patients agreed to participate in a placebo-controlled double blind study, whereas 4 patients agreed to participate only if they would be treated with PDWHF. The median age and duration of ulceration of the 6 patients (3 male/3 female) treated with placebo were 71 years and 1089 days. The median age and duration of ulceration of the 9 patients (1 male/8 females) treated with PDWHF were 66 years and 732 days. Duration of therapy for the PDWHF group was 91 days, as compared to 154 days for the placebo group. Despite 2 completely healed ulcers, the expensive treatment did not reveal any significant clinical advantage. In den PDWHF group an ulcer area of 26.9 cm2 was measured at the beginning, of 26.2 cm2 at the end; in the placebo group, 34.7 cm2 and 35.5 cm2. The nonsignificant increase of the capillary density at the ulcer border in the active group as well as the increase in the tcPO2, in contrast to little change in both parameters in the placebo group, suggests neoangiogenic abilities to PDWHF

  20. Ultrasound Screening for Deep Venous Thrombosis Detection: A Prospective Evaluation of 200 Plastic Surgery Outpatients

    Directory of Open Access Journals (Sweden)

    Eric Swanson, MD

    2015-03-01

    Conclusions: The natural history of thromboembolism in plastic surgery outpatients differs from orthopedic patients. The risk of a deep venous thrombosis in a patient treated with Spontaneous breathing, Avoid gas, Face up, Extremities mobile anesthesia is approximately 0.5%. Thromboses are unlikely to develop intraoperatively. In the single affected patient, the thrombosis was located distally, in a location that is less prone to embolism and highly susceptible to anticoagulation. Ultrasound screening is an effective and highly feasible method to identify affected patients for treatment.

  1. Venous insufficiency

    Science.gov (United States)

    ... a large vein in the leg called the superficial saphenous vein. Outlook (Prognosis) Chronic venous insufficiency tends ... the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should ...

  2. Incidence and risk factors for deep venous thrombosis and pulmonary embolus after liver transplantation.

    Science.gov (United States)

    Emuakhagbon, Valerie; Philips, Prejesh; Agopian, Vatche; Kaldas, Fady M; Jones, Christopher M

    2016-04-01

    Omitting chemical venous thromboembolism prophylaxis in liver transplant recipients may lead to an increase incidence of deep venous thrombosis (DVT) and/or pulmonary embolus (PE). A retrospective comparison of liver transplant recipients who developed postoperative DVT/PE to an age-matched population. Forty-three of eight hundred sixty-seven patients developed a DVT/PE. Study group patients received higher amounts of cryoprecipitate and fresh frozen plasma. Study group international normalized ratio (INR) was significantly higher, as was the incidence of postoperative complications. High-grade complication rates (bleeding, respiratory failure, and renal insufficiency) were increased in the study group at 16% vs 0%. The present study demonstrates that the rate of DVT/PE after liver transplantation is similar to the rate after other major operations. Patients were more likely to develop DVT/PE if they received increased amounts of intraoperative cryoprecipitate/fresh frozen plasma (FFP) or had an elevated postoperative INR. Furthermore, patients with a complicated postoperative course have the highest risk of venous thromboembolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. [Information needs of people suffering from venous leg ulcer. Expertise of people concerned as a basis of patient-centered information].

    Science.gov (United States)

    Schmitz, Astrid

    2011-06-01

    Patient-centred information is orientated on the needs. The main objective of such information is coping with every-day life and learning to live with the chronic disease. Regarding the current knowledge, such information does not exist in German speaking countries for people suffering from venous leg ulceration. In order to generate the subject matter of such information, a literature search and a secondary analysis of 27 transcripts of interviews, given by people living with chronic leg ulceration, were conducted. Both analyses show the complex impact of leg ulceration on every-day live. The dimensions competences in every-day live, knowledge, techniques and skills and the meaning of family were generated. The secondary analysis points out that family members are an important part of the supporting system and are concerned by effects of chronic disease as well. After long-lasting disease-experience people consider themselves as experts. They obtain special competences in dealing with their disease and judge their experience-based knowledge higher than the knowledge of healthcare professionals. The participants describe individual concepts about their disease. Medical knowledge constitutes just one source of knowledge among others. People know about alternative medicine and use it. They feel that the healthcare professionals do not take them seriously in most cases. Patient-centred information can be a guide to people suffering from venous leg ulceration and their family members, but also a support for healthcare professionals to reflect their professional behaviour and understanding.

  4. Superficial venous thrombosis: role of inherited deficiency of natural anticoagulants in extension to deep veins.

    Science.gov (United States)

    Milio, G; Siragusa, S; Malato, A; Grimaudo, S; Pinto, A

    2009-08-01

    Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition of low importance, but this approach has changed in recent years, when several studies demonstrated that extension to deep veins occurs in 7.3 to 44% of patients, with high prevalence of pulmonary embolism. The aim of this study was to evaluate the prevalence of inherited deficiency of natural coagulation inhibitors in patients suffering from SVT in both normal and varicose veins, and to understand their role in extension to deep veins. The study included 83 patients with SVT, without clinically obvious risk factors. Ultrasound examination was performed, and deficiencies of Protein C, Protein S and Antithrombin (AT) were investigated. In the patients where SVT occurred in normal veins, coagulation inhibitor deficiencies were 6.45% in the absence of extension and 62.5% in patients with extension to deep veins. In the patients with varicose vein SVT, the presence of these factors was less evident, but their prevalence was considerably higher in those with extension to deep veins (36.3%) than in non-extension (6.06%). Present data confirm the role of inherited thrombophilic states related to inhibitor deficiency, considering them as risk factors for SVT in normal veins. Furthermore, an association has been found between their presence and the progression of SVT to deep veins.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Low incidence of pulmonary embolism associated with upper-extremity deep venous thrombosis.

    Science.gov (United States)

    Levy, Mark M; Albuquerque, Francisco; Pfeifer, Justin D

    2012-10-01

    Most recent Chest 2008 guidelines counsel at least 3 months of anticoagulation for acute upper-extremity deep venous thrombosis (UEDVT). These guidelines are inconsistently followed, perhaps owing to relatively limited information regarding clinical outcomes among patients with UEDVT. Our institution maintains an UEDVT registry of consecutively encountered patients with sonographically confirmed UEDVT. We analyzed patient characteristics, treatment, and outcomes among these patients. Between April 2005 and November 2008, 300 consecutively encountered peripheral vascular laboratory patients with UEDVTs were identified. Data on UEDVT sonographic characteristics, patient demographics, anticoagulation treatment, pulmonary embolism (PE) incidence and diagnostic modality, hemorrhagic complications, and mortality were then extracted. Among the 300 patients, there was deep venous obstruction in the distal innominate (n = 69), internal jugular (n = 146), subclavian (n = 161), axillary (n = 107), and brachial (n = 91) veins. Two hundred forty-six patients (82%) had UEDVTs identified as clearly acute or acute on chronic, based on sonographic appearance. Most patients with UEDVTs were symptomatic (n = 265, 88%). One hundred six patients had documented malignancy (35%), 92 were postoperative or trauma patients (31%), and 76 patients were obese (body mass index: >30, 25%). Additionally, 240 patients had associated or previous indwelling central venous lines or leads (80%). One hundred twenty-eight patients (43%) were initially anticoagulated with heparin, whereas 121 of these patients were converted to warfarin therapy (40%) for variable lengths of time. One hundred sixty-seven patients were not treated with anticoagulation (56%), of whom 16 had documented contraindication to anticoagulation. Although the anticoagulated subset of patients tended to be younger, the decision to anticoagulate patients correlated significantly with the sonographically documented acute nature of the

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

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

    Science.gov (United States)

    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).

  9. What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review.

    Science.gov (United States)

    Smith, Daisy; Lane, Rebecca; McGinnes, Rosemary; O'Brien, Jane; Johnston, Renea; Bugeja, Lyndal; Team, Victoria; Weller, Carolina

    2018-02-15

    Standard best practice for the treatment of venous leg ulcers (VLUs) is compression bandaging of the lower leg to reduce hydrostatic pressure. There is considerable variation in reported healing rates when using this gold-standard approach; therefore, a systematic and robust evaluation of other interventions is required. Exercise interventions, in addition to standard compression therapy, could improve wound-healing time and prevent their recurrence. We have conducted a systematic review to examine the effects of exercise on wound characteristics, including time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. This review was registered with PROSPERO 2016:CRD42016046407. A systematic search of Ovid Medline, Ovid EMBASE, Ovid CINAHL, The Cochrane Library, PsycINFO, Web of Science, and PEDro was conducted on January 30, 2017, for randomised control trials to examine the effects of exercise on time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. Six studies met the inclusion criteria, but all had design flaws leading to biases, most commonly performance and selective reporting bias. Three studies compared a progressive resistance exercise programme (PREG) plus compression with compression alone for a period of 12 weeks. Low-quality evidence indicates the following: possibly no difference in the proportion of ulcers healed (risk ratio [RR] 1.14, 95% CI 0.71 to 1.84, I 2 36%; 3 trials, 116 participants); probably no difference in quality of life (mean difference [MD] 3 points better on 100 point scale with exercise, 95% CI -1.89 to 7.89, 1 trial, 59 participants); possible increase in the risk of adverse events with exercise (OR 1.32, 95% CI 0.95 to 1.85, 1 RCT, 40 participants); and no difference in ankle range of motion and calf muscle pump. Evidence was downgraded due to susceptibility to bias and imprecision. Recurrence, pain, and economic outcomes were not measured in these

  10. 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.

  11. 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.

  12. A review of a bi-layered living cell treatment (Apligraf® in the treatment of venous leg ulcers and diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Larissa Zaulyanov

    2007-04-01

    Full Text Available Larissa Zaulyanov, Robert S Kirsner Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine, Miami, Florida, USAAbstract: Apligraf® (Organogenesis, Canton, MA is a bi-layered bioengineered skin substitute and was the first engineered skin US Food and Drug Administration (FDA-approved to promote the healing of ulcers that have failed standard wound care. Constructed by culturing human foreskin-derived neonatal fibroblasts in a bovine type I collagen matrix over which human foreskin-derived neonatal epidermal keratinocytes are then cultured and allowed to stratify, Apligraf provides both cells and matrix for the nonhealing wound. Its exact mechanism of action is not known, but it is known to produce cytokines and growth factors similar to healthy human skin. Initially approved by the FDA in 1998 for the treatment of venous ulcers greater than one-month duration that have not adequately responded to conventional therapy, Apligraf later received approval in 2000 for treatment of diabetic foot ulcers of greater than three weeks duration. Herein, we review the use of Apligraf in the treatment of chronic venous leg ulcers and diabetic foot ulcers. Our goal is to provide a working understanding of appropriate patient selection and proper use of the product for any physician treating this segment of the aging population.Keywords: wound healing, Apligraf®, venous leg ulcer, diabetic foot ulcer

  13. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis : a prospective management study

    NARCIS (Netherlands)

    Kleinjan, Ankie; Di Nisio, Marcello; Beyer-Westendorf, Jan; Camporese, Giuseppe; Cosmi, Benilde; Ghirarduzzi, Angelo; Kamphuisen, Pieter W.; Otten, Hans-Martin; Porreca, Ettore; Aggarwal, Anita; Brodmann, Marianne; Guglielmi, Maria Domenica; Iotti, Matteo; Kaasjager, Karin; Kamvissi, Virginia; Lerede, Teresa; Marschang, Peter; Meijer, Karina; Palareti, Gualtiero; Rickles, Frederick R.; Righini, Marc; Rutjes, Anne W.S.; Tonello, Chiara; Verhamme, Peter; Werth, Sebastian; Van Wissen, Sanne; Büller, Harry R.

    2014-01-01

    Background: Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, D-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). Objective: To assess the safety and

  14. Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

    Science.gov (United States)

    Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

    2015-10-01

    To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

  15. Economic benefit of a polyacrylate-based hydrogel compared to an amorphous hydrogel in wound bed preparation of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Kaspar D

    2015-04-01

    Full Text Available Daniela Kaspar,1 Jörg Linder,1 Petra Zöllner,1 Ulrich Simon,2 Hans Smola1,31Medical Competence Centre, Paul Hartmann AG, Heidenheim, Germany; 2Scientific Computing Centre, Ulm University, Ulm, Germany; 3Department of Dermatology, University of Cologne, Cologne, GermanyObjective: To assess the cost-effectiveness of a polyacrylate (PA-based hydrogel compared to an amorphous hydrogel in wound bed preparation for venous leg ulcers.Method: A cost-effectiveness analysis was undertaken alongside a multicenter, randomized controlled trial performed in France. A total of 75 patients with venous leg ulcers extensively covered with fibrin and necrotic tissue were randomized to a PA-containing hydrogel or an amorphous hydrogel. Wounds were treated for 14 days and costs were estimated from the German payer's perspective. Medical costs included study treatment, wound treatment supply, and labor time. The clinical benefit was expressed as the number of patients with wounds >50% covered with granulation tissue within 14 days. The incremental cost-effectiveness ratio (ICER was expressed as the additional cost spent with >50% granulation tissue per day per patient within 14 days of leg ulcer care.Results: Because of individual pricing of wound dressings in hospitals, cost data were derived from the outpatient sector. A total of 33 patients were treated using the PA-based hydrogel and 37 patients using the amorphous hydrogel. The estimated total direct costs per patient and per 14 days of therapy were €306 for both treatment groups. However, with the PA-based hydrogel, 2.5 additional days with wounds covered >50% with granulation tissues were gained within 14 days of leg ulcer care compared to the comparator. The ICER was €0 per additional day spent with >50% granulation tissue.Conclusion: Although there were a greater number of dressing changes in the PA-based hydrogel treatment, the total treatment cost for 14 days of leg ulcer care was the same for both

  16. A retrospective study comparing two approaches to catheter-directed thrombolysis for acute deep venous thrombosis.

    Science.gov (United States)

    Wang, Haiyang; Qi, Xiaotong; Chen, Yikuan; Sun, Jianming

    2018-03-05

    To compare the clinical efficacy and safety of catheter-directed thrombolysis (CDT) using the anterior tibial vein approach and popliteal vein approach for acute lower-extremity deep venous thrombosis (LEDVT). From March 2014 to October 2015, 63 patients with unilateral acute extensive LEDVT were enrolled in this study: 36 patients received CDT via the popliteal vein approach (PVA) group, and 27 patients received CDT via the anterior tibial vein approach (ATVA) group. Limb circumference, thrombus score, complications, thrombolytic time and the amount of thrombolytic agents administered were recorded. Post-thrombotic syndrome and venous insufficiency were assessed at 1 year after treatment. Thrombus scores were significantly decreased in both groups after CDT therapy (each p0.050). The limb circumference difference below the knee in the ATVA group was lower than that in the PVA group (p=0.029), and the anterior tibial vein approach resulted in fewer complications, especially sheath bleeding (p=0.025). At the 1-year follow-up, popliteal venous insufficiency was present in 36.11% of the PVA group and 25.93% of the ATVA group (p=0.390). Additionally, post-thrombotic syndrome (PTS) was observed in 13.89% of the PVA group compared to 7.41% of the ATVA group (p=0.268). CDT is an effective and safe method for treating acute LEDVT. The ATVA is an effective and feasible approach for CDT with a lower incidence of complications than the PVA. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. [Soleus veins: anatomic basis and their role in the origin of deep venous lower limb thrombosis].

    Science.gov (United States)

    Sequeira, Carlos Miguel Gomes; Juliano, Yara; Novo, Neil Ferreira; Mayall, Rubens Carlos; Miranda, Fausto

    2007-01-01

    Study of the number, sectorization and termination of the soleus veins. Meticulous, stratigraphical, anatomical dissections were carried out in the posterior crural region of 100 legs of 50 fresh cadavers. Those belonging to subjects with congenital or acquired pathologies in the lower limbs were disregarded. After the skin was reflected on both sides, dissection of superficial and perforating veins, was performed. Then reflection of the subcutaneous tissue and fascia, detachment and reflection of the gastrocnemius and plantaris muscles, detachment of the tibial origin of the soleus muscle, differentiation of the soleus veins and study of morphometric parameters were carried out. The region was divided into six sectors: superior-medial, superior-lateral, medio-medial, medio-lateral, inferior-medial and inferior-lateral. Data obtained from Wilcoxon and Friedman nonparametric tests were utilized for statistical analysis. In the dissected legs 4679 soleus veins were found. The sector with the greatest number of soleus veins was the superior-lateral (1529 veins - 32.7%), followed by the mediomedial (1.256 veins - 26.8%) and the mediolateral sectors (975 veins - 20.8%). The extremities drained into communicant veins (1.207 veins - 25.8%), posterior tibial veins (964 veins - 20.6%), peroneal veins (709 veins - 15.2%) and into 32 other types (1.799 veins 38.4%). The venous drainage of the soleus muscle is carried out by a great number of soleus veins which are frequently located in the superior-lateral, mediomedial and mediolateral sectors, more often going into the posterior tibial, peroneal and communicant veins.

  18. 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)

  19. Experimental Validation of Methods for Prophylaxis against Deep Venous Thrombosis: A Review and Proposal

    Directory of Open Access Journals (Sweden)

    Paul S. Agutter

    2012-01-01

    Full Text Available The experimental procedure by which the valve cusp hypoxia (VCH hypothesis of the etiology of deep venous thrombosis (DVT was confirmed lends itself to testing of methods of prophylaxis. Similar animal experiments could end the present exclusive reliance on statistical analysis of data from large patient cohorts to evaluate prophylactic regimes. The reduction of need for such (usually retrospective analyses could enable rationally-based clinical trials of prophylactic methods to be conducted more rapidly, and the success of such trials would lead to decreased incidences of DVT-related mortality and morbidity. This paper reviews the VCH hypothesis (“VCH thesis”, following its corroboration and its implications for understanding DVT and its sequelae, and outlines the experimental protocol for testing prophylactic methods. The advantages and limitations of the protocol are briefly discussed.

  20. Quantitative ultrasound venous valve movement: early diagnosis of deep vein thrombosis

    Science.gov (United States)

    Muhd Suberi, Anis Azwani; Wan Zakaria, Wan Nurshazwani; Tomari, Razali; Ibrahim, Nabilah

    2016-07-01

    The purpose of this paper is to provide an in-depth analysis of computer aided system for the early diagnosis of Deep Vein Thrombosis (DVT). Normally, patients are diagnosed with DVT through ultrasound examination after they have a serious complication. Thus, this study proposes a new approach to reduce the risk of recurrent DVT by tracking the venous valve movement behaviour. Inspired by image processing technology, several image processing methods namely, image enhancement, segmentation and morphological have been implemented to improve the image quality for further tracking procedure. In segmentation, Otsu thresholding provides a significant result in segmenting valve structure. Subsequently, morphological dilation method is able to enhance the region shape of the valve distinctly and precisely. Lastly, image subtraction method is presented and evaluated to track the valve movement. Based on the experimental results the normal range of valve velocity lies within the range of blood flow velocity (Vb) and occasionally may result in higher values.

  1. 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.

  2. Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins.

    Science.gov (United States)

    Chi, Y-W; Woods, T C

    2014-04-01

    Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value 66 (P = 0.007), female gender (P = 0.048) and prior history of superficial thrombophlebitis (SVT) (P = 0.002) were associated with increased risk of DVT postprocedure. Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.

  3. Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome

    Directory of Open Access Journals (Sweden)

    Jiten Desai

    2018-02-01

    Full Text Available A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.

  4. A prospective, open, multicentre study to evaluate a new gelling fibre dressing containing silver in the management of venous leg ulcers.

    Science.gov (United States)

    Forlee, Martin; Rossington, Alan; Searle, Richard

    2014-08-01

    This study investigated the performance of a new gelling fibre dressing containing silver (DURAFIBER™ Ag; Smith & Nephew, Hull, UK) in moderate to highly exuding venous leg ulcers with one or more clinical signs of infection. Fourteen patients with venous leg ulceration of median ulcer duration 12·5 weeks, recruited from three centres in South Africa, received treatment with the new dressing for a maximum of 8 weeks. Multilayer compression bandaging was used for all patients, at the majority of assessments. The objectives of this study were to assess the clinical acceptability of the dressing in terms of the following characteristics: antimicrobial properties, the progress of the wound towards healing, wear time, exudate management, conformability, patient comfort, pain on application, pain on removal and dressing integrity. The new dressing was rated as clinically acceptable for all characteristics, for all 14 patients (100%). It was easy to apply and remove; in 96·8% of removals, the dressing stayed intact on removal and could be removed in one piece. Fifty per cent of the wounds healed within the 8-week study duration; between baseline and final assessment, the median percentage reduction in wound area was 98·2% and the median percentage reduction in devitalised tissue was 78%. Exudate levels and wound pain were significantly improved at final assessment compared to baseline assessment, and an increase in the number of patients with healthy peri-wound skin between baseline and final assessment was observed. A reduction in bioburden and signs of clinical infection and an improvement in quality of life were observed over the 8-week period. The average wear time was 6·4 days. This study supports the use of new dressing in the management of moderately to highly exuding venous leg ulcers with clinical signs of infection. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis.

    Science.gov (United States)

    Chandrasekaran, Sivashankar; Ariaretnam, Siva Kumar; Tsung, Jason; Dickison, David

    2009-07-01

    Both chemical and mechanical methods of prophylaxis have reduced the incidence of thromboembolic complications following total knee replacement (TKR). Only a few studies have shown that mobilization on the first post-operative day further reduces the incidence of thromboembolic phenomena. We conducted a prospective study to verify not only if early mobilization but also whether the distance mobilized on the first post-operative day after TKR reduced the incidence of thromboembolic complications. The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilization protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilization protocol changed from strict bed rest the first post-operative day to mobilization on the first post-operative day. Mobilization was defined as sitting out of bed or walking for at least 15-30 min twice a day. The distance mobilized was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post-operative day. There was a significant reduction in the incidence of thromboembolic complications in the mobilization group (seven in total) compared with the control group (16 in total) (P= 0.03). Furthermore, in the mobilization group the odds of developing a thromboemobloic complication was significantly reduced the greater the distance the patient mobilized (Chi-squared linear trend = 8.009, P= 0.0047). Early mobilization in the first 24 h after TKR is a cheap and effective way to reduce the incidence of post-operative deep venous thrombosis.

  6. Duration of wound fluid secretion from chronic venous leg ulcers is critical for interleukin-1α, interleukin-1β, interleukin-8 levels and fibroblast activation

    DEFF Research Database (Denmark)

    Zillmer, Rikke; Trøstrup, Hannah; Karlsmark, Tonny

    2011-01-01

    Wound fluid collected from chronic wounds may be used as a simple gauge of the processes taking place in the tissue. There is lack of information on the optimal conditions for wound fluid procurement. We have studied possible diurnal variations and duration of wound fluid accumulation using...... retentive hydrophobic foam on the levels of prototypic cytokines [interleukin (IL)-1α, IL-1β], a chemokine (IL-8) and proteinases [matrix metalloproteinase (MMP)-9] in 23 chronic venous leg ulcer patients. Bioactivity of 1 and 24 h wound fluids, and serum was also compared. There were no significant...

  7. Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence

    DEFF Research Database (Denmark)

    Romanelli, M.; Dini, V.; Vowden, P.

    2008-01-01

    proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface > or = area 10 cm2 and duration of > or = 6 months) showed...... therapy demonstrated in the RCT are being repeated in "real life" situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers Udgivelsesdato: 2008...

  8. Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence

    DEFF Research Database (Denmark)

    Romanelli, M.; Dini, V.; Vowden, P.

    2008-01-01

    Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell...... proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface > or = area 10 cm2 and duration of > or = 6 months) showed...

  9. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic venous leg ulcers is ulcer-age dependent

    DEFF Research Database (Denmark)

    Agren, M S; Steenfos, H H; Dabelsteen, S

    1999-01-01

    Several pathophysiologic mechanisms have been proposed to explain slow-healing leg ulcers, but little is known about the growth behavior of cells in these wounds. Platelet-derived growth factor-BB applied topically to chronic wounds has shown beneficial effects, although the effects have been less...... pronounced than would have been expected based on studies on acute wounds. The objective of this study was to compare fibroblasts in culture obtained from chronic wounds (non-healing chronic venous leg ulcers), acute wounds and normal dermis regarding growth, mitogenic response to platelet-derived growth...... from the oldest chronic wounds deviated substantially from those of acute wounds and normal dermis, and resembled in vitro aged or senescent fibroblasts. Mitogenic response of chronic wound fibroblasts to human recombinant platelet-derived growth factor-BB was also reduced with ulcer age...

  10. 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.

  11. Which frog's legs do froggies eat? The use of DNA barcoding for identification of deep frozen frog legs (Dicroglossidae, Amphibia commercialized in France

    Directory of Open Access Journals (Sweden)

    Annemarie Ohler

    2017-02-01

    Full Text Available Several millions frogs captured in the wild in Indonesia are sold for food yearly in French supermarkets, as deep frozen frog legs. They are commercialized as Rana macrodon, but up to 15 look-alike species might also be concerned by this trade. From December 2012 to May 2013, we bought 209 specimens of deep frozen frog legs, and identified them through a barcoding approach based on the 16S gene. Our results show that 206 out of the 209 specimens belong to Fejervarya cancrivora, two to Limnonectes macrodon and one to F. moodiei. Thus only 0.96 % of the frogs were correctly identified. Unless misclassification was intentional, it seems that Indonesian frog leg exporters are not able to discriminate between the species. The quasi absence of L. macrodon in our samples might be an indication of its rarity, confirming that its natural populations are declining rapidly, in agreement with its “vulnerable” status according to the IUCN Red List. Our results show that the genetic and morphological diversity of the frogs in trade is much higher than the genetic and morphological diversity measured so far by scientific studies. These results underline the need for large scale studies to assess the status of wild populations.

  12. Combination therapy of hyaluronic acid mesotherapic injections and sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency: a preliminary clinical study.

    Science.gov (United States)

    Iannitti, Tommaso; Rottigni, Valentina; Torricelli, Federica; Palmieri, Beniamino

    2014-04-01

    Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency. Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapic injections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3

  13. Ulcer-related problems and health care needs in patients with venous leg ulceration: a descriptive, cross-sectional study.

    NARCIS (Netherlands)

    Heinen, M.M.; Persoon, A.; Kerkhof, P.C.M. van de; Otero, M.; Achterberg, T. van

    2007-01-01

    BACKGROUND: Patients with leg ulceration often have long lasting and recurrent wounds. The treatment exists mainly of wound-care and compression therapy. International literature shows several indications of problems in relation to leg ulceration, but no studies were performed to give a

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Fuyou Guo

    2015-01-01

    Full Text Available Background: Deep venous thrombosis (DVT contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported. Materials and Methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3rd, 7th, and 14th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients. Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05. The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients. Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical

  16. 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.

  17. 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

  18. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    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.

  19. An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT: development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL questionnaire

    Directory of Open Access Journals (Sweden)

    Stigendal Lennart

    2004-06-01

    Full Text Available Abstract Background Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL measure, the deep venous thrombosis quality of life questionnaire (DVTQOL, for patients with recent exposition and treatment of proximal deep venous thrombosis. Methods A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years treated with warfarin (Waran® for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. Results Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising; limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93. The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. Conclusions The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored.

  20. 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.

  1. 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.

  2. Transcatheter thrombolysis via the small saphenous vein for deep venous thrombosis of lower limb

    International Nuclear Information System (INIS)

    Jiang Zhongming; Xu Qinghua

    2010-01-01

    Objective: To discuss the clinical value of transcatheter thrombolysis via the small saphenous vein for the treatment of deep venous thrombosis (DVT) of lower extremity. Methods: Angiography of the diseased lower limb was performed in 14 patients with suspected DVT of lower limb. When the diagnosis was confirmed, the catheter-directed thrombolosis via the small saphenous vein was carried out through continuous infusion of urokinase with a micro-pump. The clinical symptoms were observed and the therapeutic results were analyzed. Results: Of 14 cases with lower extremity DVT, central type DVT was seen in 8 and mixed type in 6. The total success rate of thrombolysis was 71.4%. Trunk re-canalization as well as increased collateral circulation was seen in 10 patients. Alleviation of pain, subsidence of swelling and restoring to normal labor were obtained in 12 patients. Significant subsidence of edema was achieved in the remaining 2 patients and the patients were able to do some household works. Conclusion: The catheter-directed thrombolysis via the small saphenous vein is a safe and effective treatment for lower extremity DVT. (J Intervent Radiol, 2010, 19 : 944-946)(authors)

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

    Science.gov (United States)

    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.

  4. Design of a HIFU array for the treatment of deep venous thrombosis: a simulation study

    Science.gov (United States)

    Smirnov, Petr; Hynynen, Kullervo

    2017-08-01

    Deep venous thrombosis of the iliofemoral veins is a common and morbid disease, with the recommended interventional treatment carrying a high risk of hemorrhaging and complications. High intensity focused ultrasound delivered with a single element transducer has been shown to successfully precipitate thrombolysis non-invasively in vitro and in vivo. However, in all previous studies damage to the veins or surrounding tissue has been observed. Using a simulation model of the human thigh, this study investigated whether a phased array device could overcome the large focal region limitations faced by single transducer treatment devices. Effects of the size, shape and frequency of the array on its focal region were considered. It was found that a λ/2 spaced array of 7680 elements operating at 500 kHz could consistently focus to a region fully contained within the femoral vein. Furthermore, it is possible to reduce the number of elements required by building arrays operating at lower frequencies. The results suggest that phased transducer arrays hold potential for developing a safe, non-invasive treatment of thrombolysis.

  5. Circulating tissue factor positive microparticles in patients with acute recurrent deep venous thrombosis.

    Science.gov (United States)

    Ye, Runyi; Ye, Caisheng; Huang, Yongbo; Liu, Longshan; Wang, Shenming

    2012-08-01

    Circulating tissue factor positive microparticles (MPTF) were reported in a wide range of diseases with thrombotic tendency. Though D-dimer assay had a high negative predictive value for deep venous thrombosis (DVT) recurrence, there are currently no reliable positive predictors for recurrent DVT. We therefore quantified MPTF in patients with acute recurrent DVT to determine whether MPTF levels could be used to predict recurrent DVT. Microparticles (MPs) were isolated from plasma of initial DVT patients (n=25), recurrent DVT patients (n=25) and sex- and age-matched healthy individuals (n=25), stained with annexin V, cell-specific monoclonal antibodies (MoAbs) and a MoAb directed against tissue factor (TF), and analyzed by flow cytometry. We also determined the plasma procoagulant activity with a Human TF Chromogenic Activity Assay Kit. We found total MPTF to be elevated in recurrent DVT patients versus normal individuals (P=0.001). The number of monocyte-derived MPTF in both initial and recurrent DVT was higher than in normal individuals (Pderived MPTF in recurrent DVT were significantly increased relative to other MPTF (P<0.05), although there was no difference between initial DVT patients and normal individuals. We demonstrated elevated procoagulant activity of platelet-free plasma in DVT patients relative to normal individuals, and a positive correlation with MPTF. The elevated MPTF could be a potentially predictor for DVT recurrence. Further studies are needed to validate its sensitivity and specificity. Copyright © 2011. Published by Elsevier Ltd.

  6. Deep venous thrombosis in the antenatal period in a large cohort of pregnancies from western India

    Directory of Open Access Journals (Sweden)

    Salvi Vinita

    2007-07-01

    Full Text Available Abstract Background Deep venous thrombosis (DVT is an important complication in the peripartal and postpartal period. Methods We followed up prospectively the prevalence of DVT in 34720 prenatal mothers between June 2002 and July 2006 attending the antenatal clinics of two major hospitals in Mumbai, India. Thirty two women (0.1% presented for the first time with symptomatic DVT i.e. 17 in the first trimester, 6 in the second and 9 in the third trimester of pregnancy. Nine had history of fetal loss while in the remaining twenty three there was no history of fetal loss. Results The evaluation of both acquired and heritable thrombophilia showed a conglomeration of thrombophilia in this group when compared to 100 normal pregnant women who have given birth to at least one healthy baby with no history of fetal death, DVT or other obstetrical complications. The relative risks for all the antiphospholipid antibodies (APA studied i.e lupus anticoagulant (LA, IgG/IgM antibodies for cardiolipin (ACA, β2 glycoprotein 1 (β2 GP 1 and annexin V were significantly higher in women with pregnancy associated DVT (RR 7.4 95% CI 4.3–11.3 P Conclusion We conclude that the prevalence of DVT in India is more or less similar to other reports published and both acquired and heritable thrombophilia show strong association with DVT associated with pregnancy.

  7. Reflex sympathetic dystrophy secondary to deep venous thrombosis mimicking post-thrombotic syndrome.

    Science.gov (United States)

    Duman, Iltekin; Yavuz, Ferdi; Dincer, Kemal

    2009-12-01

    The objective of this report is to represent a case of reflex sympathetic dystrophy (RSD) secondary to the upper extremity deep venous thrombosis (DVT). A 21-year-old man admitted with the complaints of pain and swelling in his right upper limb was presented. The patient had been diagnosed DVT in the right subclavian vein. The thrombosis had recovered completely with the standard treatment of DVT and doppler ultrasound had revealed normal findings at follow-up. After few months, he developed limb edema and pain considering post-thrombotic syndrome (PTS). The patient showed no response to the treatments for PTS. He was diagnosed with RSD according to the clinical findings. The bone scan confirmed the diagnosis. He responded well to the physical therapy and therapeutic exercises program. RSD and PTS are the two conditions having some common features and resembling clinical pictures. RSD also should be kept in mind in differential diagnosis of patients who developed limb pain and edema after DVT. There are some different points in the characteristics of the common symptoms obtained in both of the clinical conditions. Bone scan can help to confirm the diagnosis if RSD is suspected. Because the treatments of two conditions are different, making the differential diagnosis is crucial.

  8. 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

  9. 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)

  10. 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.)

  11. A case of cutaneous large B-cell lymphoma of the legs appearing as chronic venous ulceration

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    Marta Carlesimo

    2012-04-01

    Full Text Available We report here a case of a woman with a cutaneous large B-cell lymphoma of the legs. She had a plaque lesion, superficially ulcerated and necrotized with tumorous borders situated on the posterior side of the right leg and two red or bluish-red nodular lesions. A skin biopsy from both nodular and plaque lesion showed a diffuse infiltrate of atypical large B cells CD20+ and CD79a+, spanning epidermis, dermis and subcutaneous tissue. A therapeutic approach containing anti-CD20 monoclonal antibody (rituximab was suggested.

  12. Risk of Cerebral Venous Thrombosis in Obese Women

    NARCIS (Netherlands)

    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

  13. Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: Experimental and clinical evidence  ||FREE PAPER||

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    Marco Romanelli

    2008-06-01

    Full Text Available Marco Romanelli1, Valentina Dini1, Peter Vowden2, Magnus S Ågren31Department of Dermatology, University of Pisa, Pisa, Italy; 2Vascular Unit, Bradford Royal Infirmary, Bradford, United Kingdom; 3Department of Surgery K, Bispebjerg Hospitals, Copenhagen University Hospital, Copenhagen, DenmarkAbstract: Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT involving patients with hard-to-heal venous leg ulcers (VLUs (ie, ulcers with a surface area ≥10 cm2 and duration of ≥6 months showed that the application of amelogenin (Xelma®, Molnlycke Health Care, Gothenburg, Sweden as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.Keywords: extracellular matrix, amelogenin, venous leg ulcers, diabetic foot ulcers, pyoderma gangrenosum

  14. Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living alone.

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    Parker, C N; Finlayson, K J; Edwards, H E

    2016-11-02

    Chronic wounds are costly and affect approximately 1-2% of the population. Venous disease is responsible for about 60% of all chronic leg ulcers and these ulcers can be debilitating, with evidence of a decreased quality of life. Unfortunately, up to 30% of venous leg ulcers (VLUs) fail to heal, despite best practice treatment. This study aimed to identify risk factors associated with delayed healing in participants with VLUs and in particular, whether psychosocial factors play a part in this process. A secondary analysis was conducted of a large data set of clinical, wound healing, health, social, economic and psychological data collected in previous prospective studies of participants with VLUs. Generalised linear mixed modelling was used to identify independent predictors of failure to heal after 24 weeks. We recruited 247 participants with 318 VLUs from hospital and community settings. Findings revealed that four early predictors were independently significantly associated with failure to heal by 24 weeks. These were: participants who lived alone (OR 2.3, 95%CI [1.13-4.61], p=0.03); had less than 25% reduction in ulcer area within two weeks of treatment (OR 10.07, 95%CI [4.60-22.19], pulcer severity scores (OR 5.1, 95%CI [2.33-11.88], p=0.001); and participants who were not treated with high level compression therapy (i.e.>30 mmHg) at the time of assessment (OR 4.18, 95% CI [1.95-8.97], p=0.002). Identified risk factors offer an opportunity for clinicians to determine realistic outcomes for their patients and to guide decisions on early referral and implementation of tailored adjunctive interventions. Additionally, findings from this study suggest health professionals need to assess and address not only clinical risk factors but also social risk factors, when planning interventions to promote healing.

  15. 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.

  16. Molecular Aspects of Wound Healing and the Rise of Venous Leg Ulceration: Omics Approaches to Enhance Knowledge and Aid Diagnostic Discovery

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    Broszczak, Daniel A; Sydes, Elizabeth R; Wallace, Daniel; Parker, Tony J

    2017-01-01

    Chronic wounds, in particular venous leg ulcers (VLU), represent a substantial burden for economies, healthcare systems and societies worldwide. This burden is exacerbated by the recalcitrant nature of these wounds, despite best practice, evidence-based care, which substantially reduces the quality of life of patients. Furthermore, co-morbidities such as diabetes and cardiovascular disease within ageing populations further contribute to the increasing prevalence in developed countries. This review provides an overview of the literature concerning the cellular and molecular mechanisms of wound healing and aspects where this process fails, resulting in a chronic wound. VLU may arise from chronic venous disease, which presents with many clinical manifestations and can lead to a highly complex disease state. Efforts to comprehend this state using various omics based approaches have delivered some insight into the underlying biology of chronic wounds and revealed markers of differentiation at the genomic, transcriptomic, proteomic and metabolomic levels. Furthermore, this review outlines the array of analytical tools and approaches that have been utilised for capturing multivariate data at each of these molecular levels. Future developments in spatiotemporal analysis of wounds along with the integration of multiple omics datasets may provide much needed information on the key molecules that drive wound chronicity. Such biomarkers have the potential to be developed into clinically relevant diagnostic tools to aid in personalised wound management. PMID:28798504

  17. Relationship between deep venous thrombosis and inflammatory cytokines in postoperative patients with malignant abdominal tumors

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    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.

  18. [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.

  19. Effectiveness of digital infrared thermal imaging in detecting lower extremity deep venous thrombosis.

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    Deng, Fangge; Tang, Qing; Zeng, Guangqiao; Wu, Hua; Zhang, Nuofu; Zhong, Nanshan

    2015-05-01

    The authors aimed to determine the effectiveness of infrared thermal imaging (IRTI) as a novel, noninvasive technique in adjunctive diagnostic screening for lower limb deep venous thrombosis (DVT). The authors used an infrared thermal imaging sensor to examine the lower limbs of 64 DVT patients and 64 healthy volunteers. The DVT patients had been definitively diagnosed with either Doppler vascular compression ultrasonography or angiography. The mean area temperature (T_area) and mean linear temperature (T_line) in the region of interest were determined with infrared thermal imaging. Images were evaluated with qualitative pseudocolor analysis to verify specific color-temperature responses and with quantitative temperature analysis. Differences in T_area and T_line between the DVT limb and the nonaffected limb in each DVT patient and temperature differences (TDs) in T_area (TDarea) and T_line (TDline) between DVT patients and non-DVT volunteers were compared. Qualitative pseudocolor analysis revealed visible asymmetry between the DVT side and non-DVT side in the presentation and distribution characteristics (PDCs) of infrared thermal images. The DVT limbs had areas of abnormally high temperature, indicating the presence of DVT. Of the 64 confirmed DVT patients, 62 (96.88%) were positive by IRTI detection. Among these 62 IRTI-positive cases, 53 (82.81%) showed PDCs that agreed with the DVT regions detected by Doppler vascular compression ultrasonography or angiography. In nine patients (14.06%), IRTI PDCs did not definitively agree with the DVT regions established with other testing methods, but still correctly indicated the DVT-affected limb. There was a highly significant difference between DVT and non-DVT sides in DVT patients (P Infrared thermal imaging can be effectively used in DVT detection and adjunctive diagnostic screening because of its specific infrared PDCs and TDs values.

  20. 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.

  1. Combined use of fenestrated-type artificial dermis and topical negative pressure wound therapy for the venous leg ulcer of a rheumatoid arthritis patient.

    Science.gov (United States)

    Morimoto, Naoki; Kuro, Atsuyuki; Yamauchi, Takashi; Horiuchi, Ai; Kakudo, Natsuko; Sakamoto, Michiharu; Suzuki, Kenji; Kusumoto, Kenji

    2016-02-01

    We report a case of circumferential venous leg ulcer in a rheumatoid arthritis patient. Mesh skin grafting was performed in another hospital, but the graft failed and the patient was referred to our hospital. This ulcer was treated by the combination therapy of a fenestrated-type artificial dermis with negative pressure wound therapy (NPWT) and secondary mesh grafting using our 'grip tape technique'. NPWT was started at -100 mmHg and continued until the formation of dermis-like tissue. A section stained using haematoxylin and eosin and an anti-αSMA (α smooth muscle actin) immunohistological section of the biopsy from dermis-like tissue showed an abundant infiltration of fibroblasts and capillary formation beneath the fenestration of the silicone sheet. Threefold mesh skin grafting was subsequently performed and it was taken up completely. The fenestrated-type artificial dermis in combination with NPWT produced good results without infection in the treatment of complex wounds. In addition, our 'grip tape technique' was useful to apply polyurethane foam to the entire surface of the lower leg. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  2. [Venous leg ulcers: no improvement of wound healing with 685-nm low level laser therapy. Randomised, placebo-controlled, double-blind study].

    Science.gov (United States)

    Kokol, R; Berger, C; Haas, J; Kopera, D

    2005-06-01

    Venous leg ulcers (ulcera crurum venosa) are frequently seen in elderly patients. It has been suggested that low level laser irradiation has a biostimulative and wound healing effect; however, this has not yet been clinically verified by controlled studies. The difference in size reduction of leg ulcers with and without low level laser or placebo laser treatment was measured in 44 patients randomised into two treatment groups (685-nm low level laser and placebo laser) or a control group which served to quantify the effect of laser application. All patients received standardized wound care. The aim of the study was to compare the effectiveness of low level laser irradiation with that of a placebo "light source". The size of the ulcers was planimetrically measured at baseline (day 1), at the end of therapy (day 28) and 2 months later (day 90). The difference in wound size was evaluated. There were no statistically significant differences in reduction of wound size between the three groups, thus suggesting that low level laser light does not have any stimulatory effect on wound healing in ulcera crurum venosa.

  3. 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.

  4. Acute deep venous thrombosis of the upper extremity as demonstrated by scintigraphy with {sup 99m}Tc-apcitide

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    Dunzinger, A.; Piswanger-Soelkner, J.; Lipp, R. [Medical Univ. Graz (Austria). Div. of Nuclear Medicine; Hafner, F.; Brodmann, M. [Medical Univ. Graz (Austria). Div. of Angiology

    2008-07-01

    With an incidence of 0.7% inhabitants per year, acute deep venous thrombosis (DVT) is a common occurrence (20). Its incidence in the upper extremities, however, is not as precisely known; the literature reports that 1% to 10% of all DVT cases involve the upper limbs. Acute DVT of upper limb is mainly iatro-genic following interventions like implantation of pacemakers or central venous catheters, and is more likely to occur in obese patients or those with malignant diseases. Life-threatening pulmonary embolism (PE) may occur if acute DVT remains undetected. The presented case report demonstrates the feasibility of {sup 9}9mTc-apcitide scintigraphy for diagnosis of acute DVT of the upper limb and exclusion of PE in a single examination.

  5. Comparing study with two venous approaches of antegrade catheterization for thrombolysis in acute iliofemoral deep vein thrombosis

    International Nuclear Information System (INIS)

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

    2008-01-01

    Objective: To evaluate the clinical effectiveness of catheterization via the great saphenous vein for thrombolysis in acute iliofemoral deep vein thrombosis (IFVT). Methods: Patients with documented acute iliofemoral deep vein thrombosis were divided into two groups. Patients in group A received CDT with venous access through the ipsilateral great saphenous vein. The patients in group B received CDT via the ipsilateral popliteal vein. Clinical efficacy was evaluated by measuring the circumferences between the normal and affected limbs before and after treatment; the venous patency score, the rate of patency improvement based on venographic results; and the clinical results including the limbs edema reduction rate, the mean punctuation duration and complications; were all compared between the two groups. Results: The total effective rates between group A and group B showed no significant difference (95.2% vs 96%, P = 0.549); including the limbs edema reduction rates(86.6 ± 20.0% vs 85.7 ± 14.6%, P=0.868), likewise, the rates of venous patency improvement(57.9 ± 19.4% vs 57.7 ± 19.3%, P=0.968). The mean punctuation duration of group A was remarkable less than that of group B (7.3 minutes vs 16.7 minutes, P<0.05). The incidence of complications at the site of insertion in group A was lower than that in group B (P<0.05). Conclusions: The great saphenous vein is a new alternative access site for antegrade catheterization in catheter-directed thrombolysis for treatment of acute IFVT; more convenient and safe than popliteal venous approach. (authors)

  6. One session of strength exercise does not promote negative changes in the structure venous leg and thigh in men

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    Adenilson de Araújo Júnior

    2014-09-01

    Full Text Available The increase of the venous diameter is associated with the incompetence of the venous system of lower limb. In order to analyze the acute effects of one session of strength exercise (SE on superficial venous diameter (VD of the lower limbs (LL. Twenty-two men (22 ± 2 years old, 81.2 ± 13.4kg weight, 173.0 ± 4.0 cm height and 18.6 ± 3.3% estimated body fat performed a circuit of  three SE, with 3 sets of 6 repetitions, controlled by metronome, with a load of 85% (1-RM and 3 minutes rest. The VDs of the internal saphenous vein (ISV, in right and left LL, were measured at baseline and immediately after each set with color eco-Doppler. Data were analyzed by means of a one-way ANOVA for repeated measures. There was a significant effect of time for the right and left VSI (p= 0.001, the VDs at baseline were higher than in series for both. Furthermore, between sets, there was a significant decrease between the first and second (p= 0.009 and an increase between the second and third series (p= 0.027 for the right ISV. For the left ISV, only measured after the first and second are different (p= 0.001. There was a trend toward reduction in VD after the acute bout of strength exercise, indicating that their practice is efficient for the performance of this structure.

  7. Superficial venous disease.

    Science.gov (United States)

    Brown, Kellie R; Rossi, Peter J

    2013-08-01

    Superficial venous disease is a common clinical problem. The concerning disease states of the superficial venous system are venous reflux, varicose veins, and superficial venous thrombosis. Superficial venous reflux can be a significant contributor to chronic venous stasis wounds of the lower extremity, the treatment of which can be costly both in terms of overall health care expenditure and lost working days for affected patients. Although commonly thought of as a benign process, superficial venous thrombosis is associated with several underlying pathologic processes, including malignancy and deep venous thrombosis. Published by Elsevier Inc.

  8. Venous Ulcers

    Science.gov (United States)

    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

  9. Treatment of nocturnal leg cramps by blockade of the medial branch of the deep peroneal nerve after lumbar spine surgery

    Science.gov (United States)

    Imura, Takayuki; Inoue, Gen; Nakazawa, Toshiyuki; Miyagi, Masayuki; Saito, Wataru; Uchida, Kentaro; Namba, Takanori; Shirasawa, Eiki; Takahira, Naonobu; Takaso, Masashi

    2015-01-01

    Introduction Patients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease. Methods We evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two-thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine. Results Two weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P cramp was less in about two-thirds of patients (63.4%; n = 26) in the block group and was unchanged in one-third (31.7%; n = 13). Conclusions Blocking the medial branch of the peroneal nerve can be an effective, long-lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery. PMID:26445706

  10. Effect of pathological heterogeneity on shear wave elasticity imaging in the staging of deep venous thrombosis.

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    Xiaona Liu

    Full Text Available We aimed to observe the relationship between the pathological components of a deep venous thrombus (DVT, which was divided into three parts, and the findings on quantitative ultrasonic shear wave elastography (SWE to increase the accuracy of thrombus staging in a rabbit model.A flow stenosis-induced vein thrombosis model was used, and the thrombus was divided into three parts (head, body and tail, which were associated with corresponding observation points. Elasticity was quantified in vivo using SWE over a 2-week period. A quantitative pathologic image analysis (QPIA was performed to obtain the relative percentages of the components of the main clots.DVT maturity occurred at 2 weeks, and the elasticity of the whole thrombus and the three parts (head, body and tail showed an increasing trend, with the Young's modulus values varying from 2.36 ± 0.41 kPa to 13.24 ± 1.71 kPa; 2.01 ± 0.28 kPa to 13.29 ± 1.48 kPa; 3.27 ± 0.57 kPa to 15.91 ± 2.05 kPa; and 1.79 ± 0.36 kPa to 10.51 ± 1.61 kPa, respectively. Significant increases occurred on different days for the different parts: the head showed significant increases on days 4 and 6; the body showed significant increases on days 4 and 7; and the tail showed significant increases on days 3 and 6. The QPIA showed that the thrombus composition changed dynamically as the thrombus matured, with the fibrin and calcium salt deposition gradually increasing and the red blood cells (RBCs and platelet trabecula gradually decreasing. Significant changes were observed on days 4 and 7, which may represent the transition points for acute, sub-acute and chronic thrombi. Significant heterogeneity was observed between and within the thrombi.Variations in the thrombus components were generally consistent between the SWE and QPIA. Days 4 and 7 after thrombus induction may represent the transition points for acute, sub-acute and chronic thrombi in rabbit models. A dynamic examination of the same part of the thrombus

  11. 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.

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

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    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.

  13. Nocturnal Foraging by Red-Legged Kittiwakes, a Surface Feeding Seabird That Relies on Deep Water Prey During Reproduction.

    Directory of Open Access Journals (Sweden)

    Nobuo Kokubun

    Full Text Available Narrow foraging specialization may increase the vulnerability of marine predators to climate change. The red-legged kittiwake (Rissa brevirostris is endemic to the Bering Sea and has experienced drastic population fluctuations in recent decades, presumably due to climate-driven changes in food resources. Red-legged kittiwakes are presumed to be a nocturnal surface-foraging seabird that feed almost entirely on deep water Myctophidae fishes. However, there is little empirical evidence confirming their nocturnal foraging activity during the breeding season. This study investigated the foraging behavior of red-legged kittiwakes by combining GPS tracking, accelerometry, and dietary analyses at the world's largest breeding colony of red-legged kittiwakes on St. George I. GPS tracking of 5 individuals revealed that 82.5% of non-flight behavior (including foraging and resting occurred over the ocean basin (bottom depth >1,000 m. Acceleration data from 4 birds showed three types of behaviors during foraging trips: (1 flight, characterized by regular wing flapping, (2 resting on water, characterized by non-active behavior, and (3 foraging, when wing flapping was irregular. The proportions of both foraging and resting behaviors were higher at night (14.1 ± 7.1% and 20.8 ± 14.3% compared to those during the day (6.5 ± 3.0% and 1.7 ± 2.7%. The mean duration of foraging (2.4 ± 2.9 min was shorter than that of flight between prey patches (24.2 ± 53.1 min. Dietary analyses confirmed myctophids as the dominant prey (100% by occurrence and 98.4 ± 2.4% by wet-weight. Although the sample size was limited, these results suggest that breeding red-legged kittiwakes concentrated their foraging on myctophids available at the surface during nighttime in deep water regions. We propose that the diel patterns and ephemeral nature of their foraging activity reflected the availability of myctophids. Such foraging specialization may exacerbate the vulnerability of red-legged

  14. Efficacy of prophylactic inferior vena caval filters in prevention of pulmonary embolism in the absence of deep venous thrombosis.

    Science.gov (United States)

    Davies, Mark G; Hart, Joseph P; El-Sayed, Hosam F

    2016-01-01

    There is an increasing use of inferior vena caval filters (IVCFs) as prophylactic activity in the absence of a deep venous thrombosis (DVT) to prevent pulmonary embolism (PE) in high-risk patients. These devices are effective in preventing PE in the presence of lower extremity DVT, when anticoagulation is contraindicated or has failed. An electronic databases search of MEDLINE, PubMed, The Cochrane Library, and Google Scholar for relevant articles listed between January 2000 and December 2014 was performed. The review was confined to patients without a history of previous venous thromboembolism and no evidence of changes on venous duplex imaging suggestive of previous DVT. At present, the use of prophylactic IVCF is predominantly in the trauma, orthopedic, and bariatric surgical populations. Currently, no class I studies exist to support insertion of an IVCF in a patient without an established DVT or PE. However, there is a body of class II and class III evidence that would support the use of IVCFs in certain "high-risk" patients who do not have a documented DVT or the occurrence of a PE. Widespread use of prophylactic IVCFs is not supported by evidence and should be discouraged. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  15. In the unloaded lower leg, vibration extrudes venous blood out of the calf muscles probably by direct acceleration and without arterial vasodilation.

    Science.gov (United States)

    Zange, Jochen; Molitor, Sven; Illbruck, Agnes; Müller, Klaus; Schönau, Eckhard; Kohl-Bareis, Matthias; Rittweger, Jörn

    2014-05-01

    During vibration of the whole unloaded lower leg, effects on capillary blood content and blood oxygenation were measured in the calf muscle. The hypotheses predicted extrusion of venous blood by a tonic reflex contraction and that reactive hyperaemia could be observed after vibration. Twelve male subjects sat in front of a vibration platform with their right foot affixed to the platform. In four intervals of 3-min duration vibration was applied with a peak-to-peak displacement of 5 mm at frequencies 15 or 25 Hz, and two foot positions, respectively. Near infrared spectroscopy was used for measuring haemoglobin oxygen saturation (SmO2) and the concentration of total haemoglobin (tHb) in the medial gastrocnemius muscle. Within 30 s of vibration SmO2 increased from 55 ± 1 to 66 ± 1 % (mean ± SE). Within 1.5 min afterwards SmO2 decreased to a steady state (62 ± 1 %). During the following 3 min of recovery SmO2 slowly decreased back to base line. THb decreased within the first 30 s of vibration, remained almost constant until the end of vibration, and slowly recovered to baseline afterwards. No significant differences were found for the two vibration frequencies and the two foot positions. The relaxed and unloaded calf muscles did not respond to vibration with a remarkable reflex contraction. The acceleration by vibration apparently ejected capillary venous blood from the muscle. Subsequent recovery did not match with a reactive hyperaemia indicating that the mere mechanical stress did not cause vasodilation.

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

    Science.gov (United States)

    Chatterjee, Sasanka S.

    2012-01-01

    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. PMID:23162226

  17. 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.

  18. Deep venous drainage in great cerebral vein (vein of Galen) absence and malformations

    International Nuclear Information System (INIS)

    Lasjaunias, P.; Garcia-Monaco, R.; Rodesch, G.; Terbrugge, K.

    1991-01-01

    We report two types of venous patterns associated with great cerebral vein (vein of Galen) absence or unavailability. Developmental venous anomalies or vein of Galen arteriovenous malformations (VGAM) serve as an illustrative material. A diencephalic pattern that collects the thalamo-striate veins into the tentorial sinus is recognized in most VGAM. A telencephalic arrangement connecting the striate veins with the rostral afferents to the basal vein is less frequent. Both patterns reproduce embryonic stages preceeding the development of the great cerebral vein, thus confirming Raybaud's hypothesis that in VGAM the pouch is not the vein of Galen but the medial vein of the prosencephalon. The prognostic value of each pattern can then be appreciated and the therapeutic strategies rationalized; some unexplained complications of the venous approach for non-selected VGAM can thus be avoided. (orig.)

  19. Dutch Venous Ulcer guideline update.

    Science.gov (United States)

    Maessen-Visch, M Birgitte; de Roos, Kees-Peter

    2014-05-01

    The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa

    DEFF Research Database (Denmark)

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing

    2011-01-01

    The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected...... leg ulcers on 91 extremities, from the 1(st) of March 2005 until the 31(st) of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment...... and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P...

  1. Deep Venous Thrombosis with Pulmonary Embolism Related to IVIg Treatment: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Michael T. Flannery

    2015-01-01

    Full Text Available IVIg therapy has potentially been related to arterial and venous therapy. We performed an Ovid review focusing on IVIg and thrombotic events. While a few case reports were reviewed case series and case control studies were particularly reviewed in relation to thrombotic events. Outcomes demonstrate a correlation between underlying cardiovascular risk factors with predominately arterial events which typically occurred within 4–24 hours of infusion. While venous events occurred less commonly they were associated with traditional risk factors and occurred later, typically, 1–7 days following infusion of IVIg. Potential causation of thrombotic events was discussed.

  2. Two-dimensional phase contrast MR angiography of the venous system of lower extremities

    International Nuclear Information System (INIS)

    Hashimoto, Hiromi; Nakatsuka, Haruki; Tsubakimoto, Mitsuo

    1994-01-01

    Two-dimensional phase contrast MR angiography (MRA) was performed in 10 healthy volunteers and 14 patients in whom deep venous occlusion was clinically suspected. In all volunteers, MRA demonstrated bilateral great saphenous veins, superficial femoral veins and popliteal veins. Deep veins in the calves were visualized in only 3 of 20 legs (15%) examined, but after applying tourniquets above the knee, they were visualized in 6 of 8 legs (75%). In 5 of 8 patients whose lower extremities were swollen, deep vein occlusions were diagnosed by MRA and in 4 patients deep vein thrombosis was confirmed by computed tomography or conventional venography. In the other 3 patients whose lower extremities were swollen and in 6 patients whose lower extremities were not swollen but who had varicose veins, MRA demonstrated patency of the deep veins. It is concluded that MRA is a non-invasive useful diagnostic technique for evaluating patency of the deep venous system of the lower extremities. (author)

  3. Two-dimensional phase contrast MR angiography of the venous system of lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Hiromi; Nakatsuka, Haruki; Tsubakimoto, Mitsuo (Itami City Hospital, Hyogo (Japan)) (and others)

    1994-01-01

    Two-dimensional phase contrast MR angiography (MRA) was performed in 10 healthy volunteers and 14 patients in whom deep venous occlusion was clinically suspected. In all volunteers, MRA demonstrated bilateral great saphenous veins, superficial femoral veins and popliteal veins. Deep veins in the calves were visualized in only 3 of 20 legs (15%) examined, but after applying tourniquets above the knee, they were visualized in 6 of 8 legs (75%). In 5 of 8 patients whose lower extremities were swollen, deep vein occlusions were diagnosed by MRA and in 4 patients deep vein thrombosis was confirmed by computed tomography or conventional venography. In the other 3 patients whose lower extremities were swollen and in 6 patients whose lower extremities were not swollen but who had varicose veins, MRA demonstrated patency of the deep veins. It is concluded that MRA is a non-invasive useful diagnostic technique for evaluating patency of the deep venous system of the lower extremities. (author).

  4. Mobilização precoce na fase aguda da trombose venosa profunda de membros inferiores Early mobilization in acute stage of deep venous thrombosis of the lower limbs

    Directory of Open Access Journals (Sweden)

    Geane de Souza Penha

    2009-03-01

    quality of life, using the therapeutic strategy of early mobilization in combination with anticoagulation and compression of the leg in patients with deep venous thrombosis, without increased risk of relevant outcomes, such as pulmonary embolism and death.

  5. Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg.

    Science.gov (United States)

    Hu, Shuaiyu; Zhuo, Lifan; Zhang, Xiaoming; Yang, Shengbo

    2017-10-01

    To identify the optimal body surface puncture locations and the depths of nerve entry points (NEPs) in the deep posterior compartment muscles of the leg, 60 lower limbs of thirty adult cadavers were dissected in prone position. A curved line on the skin surface joining the lateral to the medial epicondyles of the femur was taken as a horizontal reference line (H). Another curved line joining the lateral epicondyle of the femur to the lateral malleolus was designated the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate and then subjected to spiral computed tomography scanning. The projection point of the NEP on the posterior skin surface of the leg was designated P, and the projection in the opposite direction across the transverse plane was designated P'. The intersections of P on H and L were identified as P H and P L , and their positions and the depth of the NEP on PP' were measured using the Syngo system and expressed as percentages of H, L, and PP'. The P H points of the tibial posterior, flexor hallucis longus and flexor digitorum longus muscles were located at 38.10, 46.20, and 55.21% of H, respectively. The P L points were located at 25.35, 41.30, and 45.39% of L, respectively. The depths of the NEPs were 49.11, 54.64, and 55.95% of PP', respectively. The accurate location of these NEPs should improve the efficacy and efficiency of chemical neurolysis for treating spasticity of the deep posterior compartment muscles of the leg. Clin. Anat. 30:855-860, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  6. Reduction of venous thrombosis complicating phlebography

    International Nuclear Information System (INIS)

    Bettmann, M.A.; Salzman, E.W.; Rosenthal, D.; Clagett, P.; Davies, G.; Nebesar, R.; Rabinov, K.; Ploetz, J.; Skillman, J.

    1980-01-01

    Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125 I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reuction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy

  7. Reduction of venous thrombosis complicating phlebography

    Energy Technology Data Exchange (ETDEWEB)

    Bettmann, M.A. (Peter Bent Brigham Hospital, Boston, MA); Salzman, E.W.; Rosenthal, D.; Clagett, P.; Davies, G.; Nebesar, R.; Rabinov, K.; Ploetz, J.; Skillman, J.

    1980-06-01

    Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive /sup 125/I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reuction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.

  8. Effects of intermittent pneumatic compression of the thigh on blood flow velocity in the femoral and popliteal veins: developing a new physical prophylaxis for deep vein thrombosis in patients with plaster-cast immobilization of the leg.

    Science.gov (United States)

    Nakanishi, Keisuke; Takahira, Naonobu; Sakamoto, Miki; Yamaoka-Tojo, Minako; Katagiri, Masato; Kitagawa, Jun

    2016-11-01

    Patients with plaster-cast immobilization of the lower limb have an estimated venous thromboembolism rate of 2.5 % without prophylaxis, which includes many fatal cases. However, there is no practical physical prophylaxis for deep-vein thrombosis (DVT) in these patients. The aim of this study was to examine the effects of intermittent pneumatic compression on the thigh alone (IPC to the thigh) on peak blood velocity (PBV) in the legs and to consider the possibility that IPC of the thigh could be used as physical prophylaxis for DVT in patients with plaster-cast immobilization of the lower leg. Nine healthy male volunteers and eighteen elderly males were recruited. We immobilized each subject's right lower leg and ankle with a plaster splint, and applied the ActiveCare+S.F.T.(®) (Medical Compression Systems, Inc.) device to each subject's right thigh. The PBV in the superficial femoral vein (PBVFV) and the popliteal vein (PBVPV) were measured using duplex Doppler ultrasonography. IPC to the thigh resulted in a 2.3-fold increase in PBVFV and a 3.0-fold increase in PBVPV compared with resting at supine in the elderly group. Although IPC to the thigh also increased PBVFV and PBVPV significantly in the sitting position, the change ratios of PBV in the supine and sitting positions were equal (2.6-fold increase in PBVFV and 2.9-fold increase in PBVPV). IPC to the thigh in supine and sitting positions significantly increased PBVFV and PBVPV, and could be a useful prophylaxis for DVT in patients with plaster-cast immobilization of the lower leg.

  9. [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...

  10. Predictive factors for concurrent deep-vein thrombosis and symptomatic venous thromboembolic recurrence in case of superficial venous thrombosis. The OPTIMEV study.

    Science.gov (United States)

    Galanaud, Jean-Philippe; Genty, Celine; Sevestre, Marie-Antoinette; Brisot, Dominique; Lausecker, Michel; Gillet, Jean-Luc; Rolland, Carole; Righini, Marc; Leftheriotis, Georges; Bosson, Jean-Luc; Quere, Isabelle

    2011-01-01

    Superficial venous thrombosis (SVT) prognosis is debated and its management is highly variable. It was the objective of this study to assess predictive risk factors for concurrent deep-vein thrombosis (DVT) at presentation and for three-month adverse outcome. Using data from the prospective multicentre OPTIMEV study, we analysed SVT predictive factors associated with concurrent DVT and three-month adverse outcome. Out of 788 SVT included, 227 (28.8%) exhibited a concurrent DVT at presentation. Age >75years (odds ratio [OR]=2.9 [1.5-5.9]), active cancer (OR=2.6 [1.3-5.2]), inpatient status (OR=2.3 [1.2-4.4]) and SVT on non-varicose veins (OR=1.8 [1.1-2.7]) were significantly and independently associated with an increased risk of concurrent DVT. 39.4% of SVT on non-varicose veins presented a concurrent DVT. However, varicose vein status did not influence the three-month prognosis as rates of death, symptomatic venous thromboembolic (VTE) recurrence and major bleeding were equivalent in both non-varicose and varicose SVTs (1.4% vs. 1.1%; 3.4% vs. 2.8%; 0.7% vs. 0.3%). Only male gender (OR=3.5 [1.1-11.3]) and inpatient status (OR=4.5 [1.3-15.3]) were independent predictive factors for symptomatic VTE recurrence but the number of events was low (n=15, 3.0%). Three-month numbers of deaths (n=6, 1.2%) and of major bleedings (n=2, 0.4%) were even lower, precluding any relevant interpretation. In conclusion, SVT on non-varicose veins and some classical risk factors for DVT were predictive factors for concurrent DVT at presentation. As SVT remains mostly a clinical diagnosis, these data may help selecting patients deserving an ultrasound examination or needing anticoagulation while waiting for diagnostic tests. Larger studies are needed to evaluate predictive factors for adverse outcome.

  11. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  12. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins.

    Science.gov (United States)

    Milio, Glauco; Siragusa, Sergio; Minà, Chiara; Amato, Corrado; Corrado, Egle; Grimaudo, Stefania; Novo, Salvatore

    2008-01-01

    Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition with a low importance, but this approach has changed in recent years, when several studies demonstrated spreading to deep veins occurring from 7.3 to 44%, with high prevalence of pulmonary embolism. To evaluate the prevalence of genetic risk factors for VTE in patients suffering from SVT on both normal and varicose vein, and to understand their role on spreading to deep veins, we studied 107 patients with SVT, without other risk factors. Ultrasound examination was performed, and the presence of FV Leiden, Prothrombin G20210A mutation, and MTHFR C677T mutation was researched. In the patients where SVT occurred in normal veins, the presence of FV Leiden was 26.3% of the non-spreading and 60% of the spreading to deep veins SVT; Prothrombin mutation was found in 7.9% of the former case and in 20% of the latter; MTHFR C677T mutation was found respectively in 23.7% and 40%. In the patients with SVT on varicose veins, the presence of these factors was less evident (6.7%, 4.4% and 6.7% respectively), but their prevalence was considerably higher (35.7%, 7.4% and 21.4% respectively) in SVT spreading to deep veins than in non-spreading. Our data demonstrate the high prevalence of these mutations, especially FV Leiden and associations, in patients with SVT on normal veins and their role in the progression to deep vein system.

  13. Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers

    Science.gov (United States)

    Bilyayeva, Olga O; Neshta, Viacheslav V; Golub, Alexander A; Sams-Dodd, Frank

    2017-08-01

    The purpose of this study was to determine the wound healing effects of Acapsil, a white, odorless powder based on micropore particle technology (MPPT) (Willingsford Ltd, Southampton, UK) by comparing it to Gentaxane (Gentaksan, Borshchagovsky CCP, Kyiv, Ukraine) (polydimethylsiloxane powder with gentamicin antibiotic) and Ioddicerin (Farmak, Kyiv, Ukraine) (iodine with dimethyl sulfoxide [DMSO]). The study included 266 patients with primarily trophic ulcers caused by pancreatic diabetes and venous insufficiency of the lower extremities, carbuncles, phlegmons, infected third- or fourth-degree heat burns, and infiltrations of postoperative wounds. The products were applied once daily to the wound until it was clean (ie, free from necrosis, pus, and fibrinogenous thickenings). The number of days (mean ± standard deviation) to a clean wound was 3.0 ± 0.9 for MPPT (n = 88) compared with 7.0 ± 1.2 and 8.0 ± 1.1 for Gentaxane (n = 90) and iodine/DMSO (n = 88), respectively. Thus, MPPT reduced the time to reach a clean wound by 57% and 62%, respectively. Products were used once daily until a clean wound was reached, which also reflects the number of applications. Days to onset of granulation for MPPT, Gentaxane, and iodine/DMSO were 4.5 ± 0.8, 9.2 ± 1.4, and 10.3 ± 1.5 days, respectively; and days to onset of epithelialization were 7.8 ± 1.1, 14.1 ± 1.9, and 16.4 ± 2.7 days, respectively. Subgroup analysis of patients with diabetic foot and venous leg ulcers found that each of these demonstrated the same pattern of healing as the overall study. The number of hospitalization days was 14.6 ± 5.6 for MPPT, 21.0 ± 10.7 for Gentaxane, and 24.0 ± 7.9 for iodine/DMSO. Compared with Gentaxane, patients receiving MPPT had a 31% reduction in hospitalization duration and a 39% reduction compared with iodine/DMSO. These findings demonstrate that MPPT represents a valuable new approach to wound care.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. 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

  17. 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...... with 19 population controls (n = 3,420). Information on hospitalizations for stroke, PE, and DVT was obtained from the Danish National Hospital Register. The occurrence of vascular events in the GPA cohort was compared with that in the control group by calculation of incidence rate ratios (IRRs). RESULTS......: The median duration of followup was 7.2 years (interquartile range 3.1-11.7 years) in the GPA cohort. Within the first 2 years following the diagnosis of vasculitis, the incidences of PE and DVT were substantially increased among the patients (IRR 25.7 [95% confidence interval (95% CI) 6.9-96] for PE and IRR...

  18. 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

    Directory of Open Access Journals (Sweden)

    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.

  19. Flexor accessorius longus: A rare variation of the deep extrinsic digital flexors of the leg and its phylogenetic significance

    Directory of Open Access Journals (Sweden)

    Jaijesh P

    2006-01-01

    Full Text Available Anomalies of the calf muscles are rare. One such anomalous muscle, known as the Muscle Flexor accessorius longus (also named accessorius ad accessorium, accessorius secondus, accessory flexor digitorum longus or pronator pedis is of morphological significance. When present, this originates in the deep fascia of the tibia or fibula and inserts in the foot either into the flexor digitorum accessorius or into the tendons of the flexor digitorum longus. In this report we present a discussion of the morphological significance and phylogenetic history of one such muscle observed. In this case report we describe an anomalous calf muscle which extends from the popliteal region, runs along the posterior compartment of the leg, reaches the sole and is inserted to the flexor digitorum longus muscle. This kind of muscle variations are considered to be the higher origin of the flexor digitorum accessorius muscle of the sole. Here we discuss the phylogenetic history of this muscle as this muscle variant is present in some primitive mammals, absent in apes and in this particular case appeared as one of the muscles of the flexor compartment of the leg.

  20. Predictors for the development of post-thrombotic syndrome in patients with primary lower limb deep venous thrombosis: A case-control study.

    Science.gov (United States)

    Siddiqui, Nadeem A; Sophie, Ziad; Zafar, Farhan; Soares, Delvene; Naz, Iram

    2017-02-01

    Introduction Post-thrombotic syndrome is a common and debilitating sequelae of lower limb deep venous thrombosis. Very little awareness is present about the risk factors and about the diagnosis, prevention, and treatment of this condition. Objective The objective of this study is to identify the predictors of post-thrombotic syndrome after lower limb deep venous thrombosis. Materials and methods A case-control study was conducted on all adult patients who were admitted with lower limb deep venous thrombosis at our institution from January 2005 to June 2012. These patients were scheduled for a research clinic visit, which included informed consent, data collection, and physical examination. Patients found to have post-thrombotic syndrome served as cases and those without post-thrombotic syndrome served as controls. Villalta scoring system was used to diagnose the post-thrombotic syndrome and then to assess the severity of the condition in both the groups. Cox regression risk factor analysis was performed to identify the predictors of post-thrombotic syndrome. Results Out of the 125 patients examined, 49 were found to have post-thrombotic syndrome. Risk factors found to be significant were body mass index of more than 35 kg/m 2 ( n = 13, p = 0.003), history of immobilization ( n = 19, p = 0.003), one or more hypercoagable disorders ( n = 32, p = 0.02), iliofemoral deep venous thrombosis ( n = 18, p = 0.001), complete obstruction on ultrasound ( n = 26, p = 0.016), unstable range of international normalized ratio ( n = 23, p = 0.041) and non-compliance for the use of compressions stockings ( n = 14, p = 0.001). On multivariate analysis, one or more hypercoagable disorder, iliofemoral deep venous thrombosis, and non-compliance to the use of compression stockings were found to be independent risk factors for the development of post-thrombotic syndrome. Conclusion One or more hypercoagable disorders, iliofemoral

  1. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism

    DEFF Research Database (Denmark)

    Suadicani, Poul; Hannerz, Harald; Bach, Elsa

    2012-01-01

    There is mounting evidence that prolonged cramped sitting in connection with long-lasting air travel increases the risk of deep vein thrombosis of the legs and pulmonary embolism, i.e. venous thromboembolism (VTE). Prolonged cramped sitting may occur even in various jobs unrelated to air travel...

  2. Arteriovenous Fistula Complicated by Popliteal Venous Access for Endovascular Thrombolytic Therapy of Deep Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Sung Su; Kim, Jeong Ho; Park, Chul Hi; Hwang, Hee Young; Kim, Hyung SiK [Gacheon University Gil Medical Center, Gacheon (Korea, Republic of); Jeon, Young Sun; Kim, Won Hong [Inha University College of Medicine, Incheon (Korea, Republic of)

    2008-10-15

    We report a case of an iatrogenic arteriovenous fistula complicated by catheter- directed thrombolytic therapy in a patient with acute deep vein thrombosis of a lower extremity. To the best of our knowledge, this is the first report of an arteriovenous fistula between the sural artery and popliteal vein in that situation. As the vessels have a close anatomical relationship, the arteriovenous fistula seems to be a potential complication after endovascular thrombolytic therapy of acute deep vein thrombosis.

  3. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)], E-mail: lucasalvolini@alice.it; Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Via G. Merliani 31, 80127 Naples (Italy); Giuseppetti, Gian Marco; Giovagnoni, Andrea [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)

    2008-03-15

    Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE 'one-stop-shop' diagnosis in everyday clinical practice can be ascertained.

  4. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

    International Nuclear Information System (INIS)

    Salvolini, Luca; Scaglione, Mariano; Giuseppetti, Gian Marco; Giovagnoni, Andrea

    2008-01-01

    Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE 'one-stop-shop' diagnosis in everyday clinical practice can be ascertained

  5. The clinical importance of air plethysmography in the assessment of chronic venous disease

    Directory of Open Access Journals (Sweden)

    Nei Rodrigues Alves Dezotti

    Full Text Available Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

  6. 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.

  7. Safety and feasibility of a diagnostic algorithm combining clinical probability, D-dimer and ultrasonography in suspected upper extremity deep vein thrombosis: : A prospective management study

    NARCIS (Netherlands)

    Kleinjan, A.; Di Nisio, M.; Beyer-Westendorf, J.; Cosmi, B.; Camporese, G.; Ghirarduzzi, A.; Kamphuisen, P.W.; Otten, H.M.; Porreca, E.; Büller, H.R.

    2013-01-01

    Background: Traditionally, the focus of the diagnosis of venous thromboembolism (VTE) is on deep vein thrombosis (DVT) of the leg and pulmonary embolism. Until recently, upper extremity DVT (UEDVT) was regarded as an uncommon presentation of VTE; however, the more widespread use of central venous

  8. A prospective study of Rivaroxaban for central venous catheter associated upper extremity deep vein thrombosis in cancer patients (Catheter 2).

    Science.gov (United States)

    Davies, G A; Lazo-Langner, A; Gandara, E; Rodger, M; Tagalakis, V; Louzada, M; Corpuz, R; Kovacs, M J

    2018-02-01

    Patients with cancer are at increased risk of thrombosis, particularly those with central venous catheter (CVC) placement, which may predispose to the development of upper extremity deep vein thrombosis (UEDVT). Standard treatment includes low molecular weight heparin (LMWH) or LMWH bridged to warfarin. The direct oral anticoagulants (DOACs) have become standard of care for uncomplicated venous thromboembolism (VTE), but research in patients with cancer is ongoing. To assess rivaroxaban monotherapy in patients with cancer who develop UEDVT due to CVC for preservation of line function, and safety outcomes of VTE recurrence, bleeding risk and death. Patients ≥18years of age with active malignancy and symptomatic proximal UEDVT with or without pulmonary embolism (PE), associated with a CVC, were eligible. Treatment included rivaroxaban 15mg oral twice daily for 3weeks, followed by 20mg oral daily for 9weeks. Patients were followed clinically for 12weeks to assess for line function, recurrent VTE and bleeding. Seventy patients (47 women) were included, with mean age 54.1years. The most common malignancy was breast cancer (41%). Preservation of line function was 100% at 12weeks. The risk of recurrent VTE at 12weeks was 1.43%, with one episode of fatal PE. 9 patients (12.9%) experienced 11 total bleeding episodes. Rivaroxaban showed promise in treating CVC-UEDVT in cancer patients, resulting in preserved line function. However, bleeding rates and a fatal pulmonary embolism on treatment are concerning safety outcomes necessitating further study before rivaroxaban can be recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. 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.

  10. The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study.

    Science.gov (United States)

    Aviña-Zubieta, J Antonio; Vostretsova, Kateryna; De Vera, Mary A; Sayre, Eric C; Choi, Hyon K

    2015-10-01

    To estimate the future risk and time trends of newly diagnosed venous thromboembolism (VTE) in individuals with incident systemic lupus erythematosus (SLE) in the general population. Using a population-based database that includes all residents of British Columbia, Canada we conducted a study cohort of all patients with incident SLE and up to 10 age-, sex-, and entry-time-matched individuals from the general population. We compared incidence rates of pulmonary embolism (PE), deep venous thrombosis (DVT), and VTE between the two groups according to SLE disease duration. We calculated hazards ratios (HR), adjusting for confounders. Among 4863 individuals with SLE (86% female; mean age, 48.9 years), the incidence rates (IRs) of PE, DVT, and VTE were 2.58, 3.33, and 5.32 per 1000 person-years, respectively, whereas the corresponding rates in the comparison cohort were 0.67, 0.57, and 1.11 per 1000 person-years. Compared with non-SLE individuals, the multivariable HRs among SLE patients were 3.04 (95% CI: 2.08-4.45), 4.46 (95% CI: 3.11-6.41), and 3.55 (95% CI: 2.69-4.69), respectively. The age-, sex-, and entry-time-matched HRs for PE, DVT, and VTE were highest during the first year after SLE diagnosis [13.57 (95% CI: 7.66-24.02), 11.13 (95% CI: 6.55-18.90), and 12.89 (95% CI: 8.56-19.41), respectively]. These findings provide population-based evidence that patients with SLE have a substantially increased risk of VTE, especially in the first year after SLE diagnosis. Awareness and increased vigilance of this potentially fatal, but preventable, complication is recommended. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Roy Wesley Jones

    2017-02-01

    Full Text Available Objective: We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. Methods: A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Results: Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Conclusion: Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

  12. [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

  13. 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

  14. 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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Sun; Lee, Jee Eun; Hwang, Ji Young; Shim, Sung Shine; Yoo, Jeong Hyun; Suh, Jeong Soo; Park, Jae Young [College of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2006-11-15

    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.

  15. Thrombophilia in Klinefelter Syndrome With Deep Venous Thrombosis, Pulmonary Embolism, and Mesenteric Artery Thrombosis on Testosterone Therapy: A Pilot Study.

    Science.gov (United States)

    Glueck, Charles J; Jetty, Vybhav; Goldenberg, Naila; Shah, Parth; Wang, Ping

    2017-11-01

    We compared thrombophilia and hypofibrinolysis in 6 men with Klinefelter syndrome (KS), without previously known familial thrombophilia, who had sustained deep venous thrombosis (DVT)-pulmonary emboli (PE) or mesenteric artery thrombosis on testosterone replacement therapy (TRT). After the diagnosis of KS, TRT had been started in the 6 men at ages 11, 12, 13, 13, 19, and 48 years. After starting TRT, DVT-PE or mesenteric artery thrombosis was developed in 6 months, 1, 11, 11, 12, and 49 years. Of the 6 men, 4 had high (>150%) factor VIII (177%, 192%, 263%, and 293%), 3 had high (>150%) factor XI (165%, 181%, and 193%), 1 was heterozygous for the factor V Leiden mutation, and 1 was heterozygous for the G20210A prothrombin gene mutation. None of the 6 men had a precipitating event before their DVT-PE. We speculate that the previously known increased rate of DVT-PE and other thrombi in KS reflects an interaction between prothrombotic, long-term TRT with previously undiagnosed familial thrombophilia. Thrombophilia screening in men with KS before starting TRT would identify a cohort at increased risk for subsequent DVT-PE, providing an optimally informed estimate of the risk/benefit ratio of TRT.

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

    International Nuclear Information System (INIS)

    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)

  17. Parametric study on the behavior of an innovative subsurface tension leg platform in ultra-deep water

    Science.gov (United States)

    Zhen, Xing-wei; Huang, Yi

    2017-10-01

    This study focuses on a new technology of Subsurface Tension Leg Platform (STLP), which utilizes the shallowwater rated well completion equipment and technology for the development of large oil and gas fields in ultra-deep water (UDW). Thus, the STLP concept offers attractive advantages over conventional field development concepts. STLP is basically a pre-installed Subsurface Sea-star Platform (SSP), which supports rigid risers and shallow-water rated well completion equipment. The paper details the results of the parametric study on the behavior of STLP at a water depth of 3000 m. At first, a general description of the STLP configuration and working principle is introduced. Then, the numerical models for the global analysis of the STLP in waves and current are presented. After that, extensive parametric studies are carried out with regarding to SSP/tethers system analysis, global dynamic analysis and riser interference analysis. Critical points are addressed on the mooring pattern and riser arrangement under the influence of ocean current, to ensure that the requirements on SSP stability and riser interference are well satisfied. Finally, conclusions and discussions are made. The results indicate that STLP is a competitive well and riser solution in up to 3000 m water depth for offshore petroleum production.

  18. Venous Sampling

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Venous sampling Venous sampling is a diagnostic procedure that uses ... the limitations of venous sampling? What is venous sampling? Venous sampling is a diagnostic procedure that involves ...

  19. Catheter-Directed Thrombolysis with a Continuous Infusion of Low-Dose Urokinase for Non-Acute Deep Venous Thrombosis of the Lower Extremity

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Binbin; Zhang, Jingyong; Wu, Xuejun; Han, Zonglin; Zhou, Hua; Dong, Dianning; Jin, Xing [Shandong Provincial Hospital, Shandong University, Ji' nan (China)

    2011-02-15

    We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and posttreatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in fi ve iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs: complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During followup (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion: 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower

  20. [Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

    Science.gov (United States)

    Capillas Pérez, R; Cabré Aguilar, V; Gil Colomé, A M; Gaitano García, A; Torra i Bou, J E

    2000-01-01

    The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18

  1. New biomarkers and imaging approaches for the diagnosis of deep venous thrombosis.

    Science.gov (United States)

    Schaefer, Jordan K; Jacobs, Benjamin; Wakefield, Thomas W; Sood, Suman L

    2017-05-01

    Symptoms suggestive of deep vein thrombosis (DVT) are extremely common in clinical practice, but unfortunately nonspecific. In both ambulatory and inpatient settings, clinicians are often tasked with evaluating these concerns. Here, we review the most recent advances in biomarkers and imaging to diagnose lower extremity DVT. The modified Wells score remains the most supported clinical decision rule for risk stratifying patients. In uncomplicated patients, the D-dimer can be utilized with risk stratification to reasonably exclude lower extremity DVT in some patients. Although numerous biomarkers have been explored, soluble P-selectin has the most promise as a novel marker for DVT. Imaging will be required for many patients and ultrasound is the primary modality. Nuclear medicine techniques are under development, and computed tomography (CT) and magnetic resonance venography are reasonable alternatives in select patients. D-dimer is the only clinically applied biomarker for DVT diagnosis, with soluble P-selectin a promising novel biomarker. Recent studies have identified several other potential biomarkers. Ultrasound remains the imaging modality of choice, but CT, MRI, or nuclear medicine tests can be considered in select scenarios.

  2. A single-arm trial indirect comparison investigation: a proof-of-concept method to predict venous leg ulcer healing time for a new acellular synthetic matrix matched to standard care control.

    Science.gov (United States)

    Shannon, Ronald; Nelson, Andrea

    2017-08-01

    To compare data on time to healing from two separate cohorts: one treated with a new acellular synthetic matrix plus standard care (SC) and one matched from four large UK pragmatic, randomised controlled trials [venous leg ulcer (VLU) evidence network]. We introduce a new proof-of-concept strategy to a VLU clinical evidence network, propensity score matching and sensitivity analysis to predict the feasibility of the new acellular synthetic matrix plus SC for success in future randomised, controlled clinical trials. Prospective data on chronic VLUs from a safety and effectiveness study on an acellular synthetic matrix conducted in one wound centre in the UK (17 patients) and three wound centres in Australia (36 patients) were compared retrospectively to propensity score-matched data from patients with comparable leg ulcer disease aetiology, age, baseline ulcer area, ulcer duration, multi-layer compression bandaging and majority of care completed in specialist wound centres (average of 1 visit per week), with the outcome measures at comparable follow-up periods from patients enrolled in four prospective, multicentre, pragmatic, randomised studies of venous ulcers in the UK (the comparison group; VLU evidence network). Analysis using Kaplan-Meier survival curves showed a mean healing time of 73·1 days for ASM plus SC (ASM) treated ulcers in comparison with 83·5 days for comparison group ulcers treated with SC alone (Log rank test, χ 2 5·779, P = 0·016) within 12 weeks. Sensitivity analysis indicates that an unobserved covariate would have to change the odds of healing for SC by a factor of 1·1 to impact the baseline results. Results from this study predict a significant effect on healing time when using a new ASM as an adjunct to SC in the treatment of non-healing venous ulcers in the UK, but results are sensitive to unobserved covariates that may be important in healing time comparison. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  3. CT Venography for Deep Vein Thrombosis Using a Low Tube Voltage (100 kVp) Setting Could Increase Venous Enhancement and Reduce the Amount of Administered Iodine

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eun-Suk; Chung, Jae-Joon; Kim, Sungjun; Kim, Joo Hee; Yu, Jeong-Sik; Yoon, Choon-Sik [Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 135-720 (Korea, Republic of)

    2013-07-01

    To investigate the validity of the 100 kVp setting in CT venography (CTV) in the diagnosis of deep vein thrombosis (DVT), and to evaluate the feasibility of reducing the amount of administered iodine in this setting. After receiving the contrast medium (CM) of 2.0 mL/kg, 88 patients underwent CTV of the pelvis and lower extremities by using one of four protocols: Group A, 120 kVp setting and 370 mgI/mL CM; group B, 120 kVp and 300 mgI/mL; group C, 100 kVp and 370 mgI/mL; group D, 100 kVp and 300 mgI/mL. The groups were evaluated for venous attenuation, vein-to-muscle contrast-to-noise ratio (CNR{sub VEIN}), DVT-to-vein contrast-to-noise ratio (CNR{sub DVT}), and subjective degree of venous enhancement and image quality. Venous attenuation and CNR{sub VEIN} were significantly higher in group C (144.3 Hounsfield unit [HU] and 11.9), but there was no significant difference between group A (118.0 HU and 8.2) and D (122.4 HU and 7.9). The attenuation value of DVT was not significantly different among the four groups, and group C had a higher absolute CNR{sub DVT} than the other groups. The overall diagnostic image quality and venous enhancement were significantly higher in group C, but there was no difference between groups A and D. The 100 kVp setting in CTV substantially help improve venous enhancement and CNR{sub VEIN}. Furthermore, it enables to reduce the amount of administered iodine while maintaining venous attenuation, as compared with the 120 kVp setting.

  4. A cost-effectiveness analysis of a hydration response technology dressing in the treatment of venous leg ulcers in the UK.

    Science.gov (United States)

    Walzer, Stefan; Dröschel, Daniel; Vollmer, Lutz; Atkin, Leanne; Ousey, Karen

    2018-03-02

    Venous leg ulcers (VLUs) cause significant pain and suffering for patients. Additionally, they place considerable financial and service burden on the National Health Service (NHS). A large proportion of VLUs do not heal within the standard time frame of 16-24 weeks, resulting in static wounds which commonly have issues with increasing exudate production. As the NHS continues to face times of austerity, services need to find solutions to be able to reduce costs and release nursing time while maintaining standards of care. Cutimed Sorbion Sachet S, a hydration response technology dressing (HRTD), is a treatment option for the management of patients with a VLU. The objective of this study was to provide an update of the health economic analysis of HRTD in comparison with relevant comparators in the UK with current cost data. HRTD was compared against four different dressings, Zetuvit Plus (a super absorbent polymer dressing SAP), DryMax extra (a superabsorbent dressing, SADM), KerraMax Care (superabsorbent dressing, SAKM) and Eclypse (superabsorbent dressing, SAE) from a cost-effectiveness perspective. Clinical data were derived from literature and expert opinion. Cost input was utilised based on publicly available data and literature. The average patient in the model is assumed to be 65 years with a diagnosed VLU. It is assumed that patients in the different treatment arms have the same background mortality, hence the endpoint mortality is not included in the model. The analysis is based on a deterministic Markov model derived from Harding et al. with weekly cycles. The following assumptions are made: first, all patients start in a static health state with a non-healed but non-progressing VLU. It is assumed in the model that patients wounds can transition to a deteriorating state or one where a wound is improving or could progress. Additionally, VLUs could be healed from a progressed wound (i.e. improved wound), or they could develop into a severe wound with

  5. D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis.

    Science.gov (United States)

    Sartori, Michelangelo; Migliaccio, Ludovica; Favaretto, Elisabetta; Cini, Michela; Legnani, Cristina; Palareti, Gualtiero; Cosmi, Benilde

    2015-04-01

    D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT). To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT. We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: ≤500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism. We enrolled 239 patients (F: 63.6%; mean±SD age: 58.3±16.8). At the initial diagnostic work-up, DVT was detected in 24 (10%) patients while SVT in 35 (14.6%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92% (95%CI: 73-99%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 98% (95%CI: 93-100%), whereas for SVT they were 77% (95%CI: 59-89%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 93% (95%CI: 86-97%). D-dimer has a negative predictive value ≥93% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Venogram - leg

    Science.gov (United States)

    Phlebogram - leg; Venography - leg; Angiogram - leg ... into a vein in the foot of the leg being looked at. An intravenous (IV) line is ... vein. A tourniquet may be placed on your leg so the dye flows into the deeper veins. ...

  7. Short-Term Catheter-Directed Thrombolysis with Low-Dose Urokinase Followed by Aspiration Thrombectomy for Treatment of Symptomatic Lower Extremity Deep Venous Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Se Hee; Lim, Nam Yeul; Song, Jang Hyeon [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kim, Jae Kyu; Lim, Jae Hoon [Dept. of Radiology, Hospital, Ulsan University School of Medicine, Gweangju (Korea, Republic of); Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of)

    2011-10-15

    To evaluate the venous patency in patients treated by catheter-directed thrombolysis with low-dose urokinase (UK) for symptomatic lower extremity deep venous thrombosis (DVT). Eighty-nine consecutive patients (46 women and 43 men; mean age, 58.1 years), treated by catheter-directed thrombolysis with low-dose UK were included in this study. Immediate venous patency was evaluated in terms of technical success (successful restoration of antegrade in-line flow in the treated vein with residual stenosis rate of less than 30%) and clinical success (significant reduction of clinical symptoms before hospital discharge). Late venous patency was evaluated in terms of primary patency rate and clinical success. Immediate technical success was achieved in all patients and immediate clinical success in 80 (90%) patients. There was no major systemic bleeding complication. The primary patency rate at 6 months and 12 months was 84% and 79%, respectively. Fifty-six (63%) patients were asymptomatic after a median clinical follow-up of 18 months, eleven (12%) patients improved moderately, seven (8%) patients remained unchanged, and fifteen (17%) patients had no clinical follow-up. Short-term catheter-directed thrombolysis with low-dose UK can be an effective, safe method to manage DVT of the lower extremities.

  8. Catheter-Directed Thrombolysis vs. Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: Cost-Effectiveness Analysis.

    Science.gov (United States)

    Mahmoud, O; Vikatmaa, P; Räsänen, J; Peltola, E; Sihvo, E; Vikatmaa, L; Lappalainen, K; Venermo, M

    2018-03-06

    We compared the immediate and one-year results as well as total hospital costs between catheter-directed thrombolysis (CDT) and pharmacomechanical thrombolysis (PMT) in the treatment of symptomatic upper extremity deep venous thrombosis (UEDVT). From 2006 to 2013, 55 patients with UEDVT were treated with either CDT or PMT at Helsinki University Hospital. Of them, 43 underwent thoracoscopic rib resection later in order to relieve phlebography-confirmed vein compression. This patient cohort was prospectively followed up with repeated phlebographies. CDT was performed to 24 patients and 19 had PMT with a Trellis™ device. Clinical evaluation and vein patency assessment were performed with either phlebography or ultrasound one year after the thrombolysis. Primary outcomes were immediate technical success, one-year vein patency, and costs of the initial treatment. The immediate overall technical success rate, defined as recanalization of the occluded vein and removal of the fresh thrombus, was 91.7% in the CDT group, and 100% in the PMT group (n.s.). The median thrombolytic time was significantly longer in CDT patients than PMT patients (21.1 hours vs. 0.33 hours, P<0.00001). There were no procedure-related complications. The one-year primary assisted patency rate was similar in both groups (91.7% and 94.7%, respectively). There were no recurrences of clinical DVT. The hospital costs for the acute period were significantly lower in the PMT group than the CDT group (medians 11,476 € and 5,975 € in the in the CDT and PMT group, respectively (P<0.00001)). The clinical results of the treatment of UEDVT with CDT or PMT were similar. However, PMT required shorter hospital stay and less intensive surveillance, leading to lower total costs. Copyright © 2018. Published by Elsevier Inc.

  9. Real clinical practice of catheter therapy for deep venous thrombosis: periprocedural and 6-month outcomes from the EDO registry.

    Science.gov (United States)

    Mizuno, Atsushi; Anzai, Hitoshi; Utsunomiya, Makoto; Yajima, Junji; Ohta, Hiroshi; Ando, Hiroshi; Umemoto, Tomoyuki; Higashitani, Michiaki; Ozaki, Shunsuke; Sakamoto, Hiroshi; Nakao, Masashi; Yuzawa, Yasufumi; Kaneko, Hidehiro; Nakamura, Masato

    2015-07-01

    A recent national study in Japan indicated that 5.8 % of deep venous thrombosis (DVT) patients were treated using endovascular procedures, 83 % of which included catheter-directed thrombolysis (CDT). However, the details of these endovascular procedures and their outcomes have not yet been fully evaluated. Using DVT data from the EDO registry (EnDOvascular treatment registry) database, a total of 35 symptomatic iliac or femoral DVT patients who received endovascular treatment (54.3 % male, age 64.7 ± 15.1) were analyzed. The dominant patient risks were being bedridden (22.9 %) and May-Thurner syndrome (25.7 %). Approximately 77.1 % of patients were treated using an antegrade approach, and CDT and other endovascular procedures were performed in 82.9 and 57.1 % of patients, respectively. A periprocedural inferior vena cava (IVC) filter was used in 94.1 % of patients, which remained implanted in 37.1 and 20.0 % of patients after discharge and 6 months after hospitalization, respectively. After 6 months of treatment, 2.9 % of patients experienced a recurrence of DVT and 5.7 % suffered revascularization, but no patient had a recurrence of pulmonary embolism. Subjective symptoms improved in 80.0 % of patients, while 2.9 % of patients felt worse at 6 months after treatment. Postthrombotic syndrome-related symptoms were observed in seven patients (19.4 %), and edema was most frequently observed (71.4 %). The details of CDT procedures, such as approach site and the removal of the IVC filter, varied among hospitals. Despite improved symptoms, further procedural standardization and data collection should be conducted to reduce complications and improve outcomes.

  10. {sup 99m}Tc-apcitide scintigraphy in patients with clinically suspected deep venous thrombosis and pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Dunzinger, Andreas; Piswanger-Soelkner, Jutta-Claudia; Lipp, Rainer W. [Medical University of Graz, Division of Nuclear Medicine, Department of Internal Medicine, Graz (Austria); Hafner, Franz; Brodmann, Marianne [Medical University of Graz, Divison of Angiology, Department of Internal Medicine, Graz (Austria); Schaffler, Gottfried [Medical University of Graz, Department of Radiology, Graz (Austria)

    2008-11-15

    Detection of acute deep venous thrombosis (DVT) in patients presenting with clinical symptoms suggesting DVT and pulmonary embolism (PE) with {sup 99m}Tc-apcitide, a synthetic polypeptide, binding to glycoprotein IIb/IIIa receptors expressed on activated platelets is the objective of the study. Nineteen patients (11 males, eight females) received within 24h after admission to the hospital a mean of 841MBq (range 667 to 1,080) {sup 99m}Tc-apcitide i.v. followed by planar recordings 10, 60, and 120min after injection. Images were compared to the results of compression ultrasonography and/or phlebography. Patients with clinically suspected PE underwent spiral computed tomography or lung perfusion scans. {sup 99m}Tc-apcitide scintigraphy showed acute clot formation in 14 out of 16 patients where the other imaging modalities suggested DVT. Positive scintigraphic results were seen up to 17days after the onset of clinical symptoms. In three out of three patients without any proof of DVT, {sup 99m}Tc-apcitide scintigraphy was truly negative. Glycoprotein receptor imaging showed only one segmental PE in six patients with imaging-proven subsegmental (N = 3) or segmental PE (N = 3). {sup 99m}Tc-apcitide scintigraphy may be an easy and promising tool for the detection of acute clot formation in patients with DVT up to 17days after the onset of clinical symptoms with a sensitivity of 87% and a specificity of 100%. However, it failed to demonstrate PE in 83% of examined patients with proven PE. (orig.)

  11. 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.

  12. Venous thrombosis - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100168.htm Venous thrombosis - series—Normal anatomy To use the sharing features ... Editorial team. Related MedlinePlus Health Topics Deep Vein Thrombosis A.D.A.M., Inc. is accredited by ...

  13. Klinefelter Syndrome With Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Narendra G

    1999-01-01

    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  14. Plasminogen activator inhibitor-1 4G/5G genotype and residual venous occlusion following acute unprovoked deep vein thrombosis of the lower limb: A prospective cohort study.

    Science.gov (United States)

    Giurgea, Georgiana-Aura; Brunner-Ziegler, Sophie; Jilma, Bernd; Sunder-Plassmann, Raute; Koppensteiner, Renate; Gremmel, Thomas

    2017-05-01

    A recent study suggested that the plasminogen activator inhibitor (PAI)-1 4G/5G genotype may play a role in the resolution of deep vein thrombosis (DVT) after surgery. In the present study, we investigated the association between PAI-1 4G/5G genotype and the persistence of venous occlusion after acute idiopathic DVT of the lower limb. The PAI-1 4G/5G genotype was determined by real-Time PCR in 43 patients with unprovoked DVT of the lower limb. Residual venous occlusion was assessed by duplex sonography 1, 3, 6, 12 and 24months after the acute event. The PAI-1 Activity was determined by ELISA. Ten patients (23%) were homozygous for 4G (4G/4G), 27 patients (63%) were heterozygous 4G/5G and 6 patients (14%) were homozygous for 5G (5G/5G). Residual venous occlusion (RVO) was found in 77%, 65%, 58%, 56% and 37% of the overall study population, at 1, 3, 6, 12 and 24months after acute DVT, respectively. The presence of residual venous occlusion at 1, 3, 6, 12 and 24months after acute unprovoked DVT did not differ significantly between genotypes, but age was associated with RVO. Plasma levels of PAI-1 activity correlated with body mass index but was not associated with genotypes in our study. The PAI-1 4G/5G genotype was not a relevant predictor of persistent residual venous occlusion after idiopathic DVT, which however was associated with age. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. [Duplexsonography investigation in patients with venous ulcer].

    Science.gov (United States)

    Jeanneret-Gris, Christina

    2011-03-01

    Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended.

  16. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  17. Incidence of ipsilateral postoperative deep venous thrombosis in the amputated lower extremity of patients with peripheral obstructive arterial disease.

    Science.gov (United States)

    Matielo, Marcelo Fernando; Presti, Calógero; Casella, Ivan Benaduce; Netto, Baptista Muraco; Puech-Leão, Pedro

    2008-12-01

    Patients undergoing amputation of the lower limb due to peripheral arterial disease (PAD) are at risk of developing deep venous thrombosis (DVT). Few studies in the research literature report the incidence of DVT during the early postoperative period or the risk factors for the development of DVT in the amputation stump. This prospective study evaluated the incidence of DVT during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD and its relation to comorbidities and death. Between September 2004 and March 2006, 56 patients (29 men), with a mean age of 67.25 years, underwent 62 amputations, comprising 36 below knee amputations (BKA) and 26 above knee amputations (AKA). Echo-Doppler scanning was performed preoperatively and on postoperative days 7 and 31 (approximately). All patients received acetylsalicylic acid (100 mg daily) preoperatively and postoperatively, but none received prophylactic anticoagulation. DVT occurred in 25.8% of extremities with amputations (10 AKA and 6 BKA). The cumulative incidence in the 35-day postoperative period was 28% (Kaplan-Meier). There was a significant difference (P = .04) in the incidence of DVT between AKA (37.5%) and BKA (21.2%). Age >or=70 years (48.9% vs 16.8%, P = .021) was also a risk factor for DVT in the univariate analysis. Of the 16 cases, 14 (87.5%) were diagnosed during outpatient care. The time to discharge after amputation was averaged 6.11 days in-hospital stay (range, 1-56 days). One symptomatic nonfatal pulmonary embolism occurred in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. The multivariate analysis showed no association between risk factors and the occurrence of DVT in the amputated extremity. DVT ipsilateral to the amputation did not influence the mortality rate (9.7%). The incidence of DVT in the early postoperative period (or=70 years and for AKA. Patients with PAD who have recently undergone

  18. Iliac Vein Compression as Risk Factor for Left- versus Right-Sided Deep Venous Thrombosis: Case-Control Study

    Science.gov (United States)

    Eng, John; Carmi, Lemore; McGrane, Siobhan; Ahmed, Muneeb; Sharrett, A. Richey; Streiff, Michael; Coresh, Josef; Powe, Neil; Hong, Kelvin

    2012-01-01

    Purpose: To determine if compression of the left common iliac vein (LCIV) by the right common iliac artery is associated with left-sided deep venous thrombosis (DVT). Materials and Methods: This institutional review board–approved case-control study was performed in a cohort of 230 consecutive patients (94 men, 136 women; mean age, 57.5 years; range, 10–94 years) at one institution who had undergone contrast material–enhanced computed tomography of the pelvis prior to a diagnosis of unilateral DVT. Demographic data and information on risk factors were collected. Two board-certified radiologists determined iliac vein compression by using quantitative measures of percentage compression {[1 minus (LCIV diameter at point of maximal compression/distal right common iliac vein diameter)] times 100%}, as well as qualitative measures (none, mild, moderate, severe), with estimates of measurement variability. Logistic regression analysis was performed (independent variable, left vs right DVT; dependent variable, iliac vein compression). Cutpoints of relevant compression were evaluated by using splines. Means (with 95% confidence intervals [CIs]) and odds ratios (ORs) (and 95% CIs) of left DVT per 1% increase in percentage compression were calculated. Results: Patients with right DVT were more likely than those with left DVT to have a history of pulmonary embolism. Overall, in all study patients, mean percentage compression was 36.6%, 66 (29.7%) of 222 had greater than 50% compression, and 16 (7.2%) had greater than 70% compression. At most levels of compression, increasing compression was not associated with left DVT (adjusted ORs, 1.00, 0.99, 1.02) but above 70%, LCIV compression may be associated with left DVT (adjusted ORs, 3.03, 0.91, 10.15). Conclusion: Increasing levels of percentage compression were not associated with left-sided DVT up to 70%; however, greater than 70% compression may be associated with left DVT. ©RSNA, 2012 Supplemental material: http

  19. Analysis of Risk Factors for Lower-limb Deep Venous Thrombosis in Old Patients after Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jian Kang

    2015-01-01

    Full Text Available Background: Deep venous thrombosis (DVT is a common complication of arthroplasty in old patients. We analyzed risk factors for lower-limb DVT after arthroplasty in patients aged over 70 years to determine controllable risk factors. Methods: This was a retrospective study of 1,025 patients aged >70 years treated with knee arthroplasty at our hospital between January 2009 and December 2013. Of 1,025 patients, 175 had postoperative lower-limb DVT. We compared medical history, body mass index (BMI, ambulatory blood pressure, preoperative and postoperative fasting blood glucose (FBG, preoperative blood total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, and preoperative homocysteine (Hcy between thrombus and non-thrombus groups. B-mode ultrasonography was used to detect lower-limb DVT before the operation and 7 days after the operation in all patients. Logistic regression analysis was used to determine risk factors for DVT. Results: Incidence of diabetes (P = 0.014, BMI (P = 0.003, preoperative FBG (P = 0.004, postoperative FBG (P = 0.012, and preoperative Hcy (P < 0.001 were significantly higher in the thrombus group. A significantly greater proportion of patients in the non-thrombus group had early postoperative activity (P < 0.001 and used a foot pump (P < 0.001. Operative duration was significantly longer in the thrombus group (P = 0.012. Within the thrombus group, significantly more patients had bilateral than unilateral knee arthroplasty (P < 0.01. Multivariate logistic analysis revealed BMI, preoperative Hcy, postoperative FBG, long operative duration, bilateral knee arthroplasty, and time to the activity after the operation to be predictive factors of DVT. At 6-month follow-up of the thrombus group, 4.7% of patients had pulmonary embolism and 18.8% had recurrent DVT; there were no deaths. Conclusions: Obesity, inactivity after operation, elevated preoperative Hcy and postoperative FBG, long operative duration, and

  20. Clinical evaluation of the efficacy and safety of a medical device in various forms containing Triticum vulgare for the treatment of venous leg ulcers – a randomized pilot study

    Directory of Open Access Journals (Sweden)

    Romanelli M

    2015-05-01

    Full Text Available Marco Romanelli,1 Michela Macchia,1 Salvatore Panduri,1 Battistino Paggi,1 Giorgio Saponati,2 Valentina Dini1 1Wound Healing Research Unit, Dermatology Division, Department of Clinical and Experimental Medicine, University of Pisa, 2ISPharm srl, Lucca, Italy Abstract: This study was carried out to assess the efficacy and tolerability of the topical application of an aqueous extract of Triticum vulgare (TV in different vehicles (cream, impregnated gauzes, foam, hydrogel, and dressing gel for the treatment of venous lower leg ulcers. Fifty patients were randomized to receive one of the five investigational vehicles. Treatment was performed up to complete healing or to a maximum of 29 days. The wound size reduction from baseline was the primary efficacy variable, which was measured by means of a noninvasive laser scanner instrument for wound assessment. In all groups, apart from the foam group, a similar trend toward the reduction of the surface area was observed. The cream showed the greatest effect on the mean reduction of the lesion size. At last visit, six ulcers were healed: two in the cream group, three in the gauze group, and one in the dressing gel group. In the patients treated with the cream, the gauzes, the hydrogel, and the dressing gel, the reduction of lesion size was 40%–50%; the reduction was smaller in the foam group. No impact in terms of age on the healing process was found. The Total Symptoms Score decreased in all groups during the study; a greater efficacy in terms of signs/symptoms was observed in the patients treated with the gauzes. In the dressing gel group, one patient had an infection of the wound after 3 weeks of treatment and 2 of colonization, leading to a systemic antibiotic treatment. The events were judged as nonrelated to the device used. On the basis of the results, it could be argued that the medical device may be useful in the treatment of chronic venous ulcers. Keywords: venous leg ulcers, Triticum vulgare

  1. Clinical patterns of venous diseases and diagnostic demands on radiology

    International Nuclear Information System (INIS)

    Wienert, V.

    1988-01-01

    The author deals with the clinical signs and treatment of the valvular incompetence of the venae saphenae in varicosis of the lower extremities, varicosis or insufficiency of the venae perforantes (an insufficiency of the deep venous system, manifested by an insufficiency of the valvular system of the vena femoralis and venae saphenae but not representing a post-thrombotic syndrome), phlebothrombosis and postthrombosis. Routine phlebography for diagnosing a number of venous diseases has become redundant especially by the use of noninvasive methods such as Doppler ultrasound and light reflection rheography. However, if there is a suspicion of a deep thrombosis in the leg, phlebography is imperative. Dermatological phlebography specialists would like the radiologists to supply them with phlebographic criteria for the disease pattern of the insufficiency of the venae perforantes, vena femoralis and venae saphenae as mentioned above. Whether Duplex scanning can replace phlebography in the long run remains to be seen. (orig.) [de

  2. The use of indium-111 labeled platelet scanning for the detection of asymptomatic deep venous thrombosis in a high risk population

    Energy Technology Data Exchange (ETDEWEB)

    Siegel, R.S.; Rae, J.L.; Ryan, N.L.; Edwards, C.; Fortune, W.P.; Lewis, R.J.; Reba, R.C. (George Washington Univ. Medical Center, Washington, DC (USA))

    1989-11-01

    Five hundred indium-111 labeled platelet imaging studies (387 donor and 113 autologous) were performed postoperatively in 473 patients who had undergone total hip replacement, total knee replacement, or internal fixation of a hip fracture to detect occult deep venous thrombosis. All patients had been anticoagulated prophylactically with aspirin, warfarin sodium (Coumadin), or dextran. Thirty-four possible cases of proximal deep venous thrombosis were identified in 28 asymptomatic patients. To verify the scan results, 31 venograms were performed in 25 patients (three refused). In 21 of 31 cases, totally occlusive thrombi were detected; in 5 cases, partially occlusive thrombi were detected; in 5 cases, no thrombus was seen. No patient who had a negative scan nor any patient who had a verified positive scan (and received appropriate heparin therapy) subsequently developed symptoms or signs of pulmonary embolism. One hundred forty-one indium study patients also underwent Doppler ultrasonography/impedance plethysmography (Doppler/IPG) as a comparative non-invasive technique. In 137 cases, the results of the indium study and Doppler/IPG studies were congruent. The indium study had no false negative results that were detected by Doppler/IPG. No patient had any clinically evident toxicity. These results suggest that indium-111 labeled platelet scanning is a safe, noninvasive means for identifying DVT in high risk patients.

  3. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study.

    Science.gov (United States)

    Kleinjan, Ankie; Di Nisio, Marcello; Beyer-Westendorf, Jan; Camporese, Giuseppe; Cosmi, Benilde; Ghirarduzzi, Angelo; Kamphuisen, Pieter W; Otten, Hans-Martin; Porreca, Ettore; Aggarwal, Anita; Brodmann, Marianne; Guglielmi, Maria Domenica; Iotti, Matteo; Kaasjager, Karin; Kamvissi, Virginia; Lerede, Teresa; Marschang, Peter; Meijer, Karina; Palareti, Gualtiero; Rickles, Frederick R; Righini, Marc; Rutjes, Anne W S; Tonello, Chiara; Verhamme, Peter; Werth, Sebastian; van Wissen, Sanne; Büller, Harry R

    2014-04-01

    Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, d-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). To assess the safety and feasibility of a new diagnostic algorithm in patients with clinically suspected UEDVT. Diagnostic management study. (ClinicalTrials.gov: NCT01324037) SETTING: 16 hospitals in Europe and the United States. 406 inpatients and outpatients with suspected UEDVT. The algorithm consisted of the sequential application of a clinical decision score, d-dimer testing, and ultrasonography. Patients were first categorized as likely or unlikely to have UEDVT; in those with an unlikely score and normal d-dimer levels, UEDVT was excluded. All other patients had (repeated) compression ultrasonography. The primary outcome was the 3-month incidence of symptomatic UEDVT and pulmonary embolism in patients with a normal diagnostic work-up. The algorithm was feasible and completed in 390 of the 406 patients (96%). In 87 patients (21%), an unlikely score combined with normal d-dimer levels excluded UEDVT. Superficial venous thrombosis and UEDVT were diagnosed in 54 (13%) and 103 (25%) patients, respectively. All 249 patients with a normal diagnostic work-up, including those with protocol violations (n = 16), were followed for 3 months. One patient developed UEDVT during follow-up, for an overall failure rate of 0.4% (95% CI, 0.0% to 2.2%). This study was not powered to show the safety of the substrategies. d-Dimer testing was done locally. The combination of a clinical decision score, d-dimer testing, and ultrasonography can safely and effectively exclude UEDVT. If confirmed by other studies, this algorithm has potential as a standard approach to suspected UEDVT. None.

  4. High resolution unenhanced computed tomography in patients with swollen legs.

    Science.gov (United States)

    Monnin-Delhom, E D; Gallix, B P; Achard, C; Bruel, J M; Janbon, C

    2002-09-01

    To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.

  5. Combined magnetic resonance imaging of deep venous thrombosis and pulmonary arteries after a single injection of a blood pool contrast agent

    Energy Technology Data Exchange (ETDEWEB)

    Hansch, Andreas; Neumann, Steffi; Baltzer, Pascal; Waginger, Matthias; Kaiser, Werner A.; Mentzel, Hans-Joachim [Friedrich-Schiller-University Jena, Institute of Diagnostic and Interventional Radiology, Jena (Germany); Betge, Stefan; Poehlmann, Gunther [Friedrich-Schiller-University Jena, Department of Internal Medicine I, Jena (Germany); Pfeil, Alexander; Wolf, Gunter [Friedrich-Schiller-University Jena, Department of Internal Medicine III, Jena (Germany); Boettcher, Joachim [SRH Klinikum Gera, Institute of Diagnostic and Interventional Radiology, Gera (Germany)

    2011-02-15

    Agreement rate between magnetic resonance imaging (MRI) and Doppler ultrasound (DUS) for the detection of deep vein thrombosis (DVT) in the lower extremities was attempted by using the intravascular MRI contrast agent gadofosveset trisodium. The potential of this method to detect pulmonary embolism (PE) was also evaluated. Forty-three consecutive inpatients with ultrasound-confirmed DVT but no clinical signs of PE were prospectively enrolled in this feasibility study. MRI was performed after a single injection of gadofosveset trisodium. The pulmonary arteries were imaged using a 3D Fast Low Angle Shot (FLASH) gradient recalled echo sequence. Additionally, pulmonary arteries, abdominal veins, pelvic and leg veins were imaged using a fat-suppressed 3D gradient echo Volume Interpolated Breath-hold Examination (VIBE FS). Gadofosveset trisodium-enhanced MRI detected more thrombi in the pelvic region, upper leg and lower leg than the initial DUS. In addition, PE was detected in 16 of the 43 DVT patients (37%). This study shows the feasibility of a combined protocol for the MRI diagnosis of DVT and PE using gadofosveset trisodium. This procedure is not only more sensitive in detecting DVT compared to standard DUS, but is also able to detect PE in asymptomatic patients. (orig.)

  6. Editor's Choice - Mid-term Outcomes of Endovenous Laser Ablation in Patients with Active and Healed Venous Ulcers: A Follow-up Study.

    Science.gov (United States)

    Sinabulya, H; Östmyren, R; Blomgren, L

    2017-05-01

    The aim of this study was to assess the mid-term ulcer recurrence rate in patients with healed or active venous ulcers treated with endovenous laser ablation (EVLA) for incompetent superficial axial veins and to search for possible risk factors for non-healing and recurrence. Consecutive patients treated with EVLA because of a healed or active venous ulcer between 2006 and 2013 were identified in the medical records and quality registry and invited to follow-up, including clinical history, study examination, Duplex ultrasound scanning, ankle brachial pressure, photoplethysmography, venous clinical severity score (VCSS), and health related quality of life (HRQoL) measured with EQ5D. Of 228 patients, 170 (195 legs) fulfilled the inclusion criteria. Twenty patients were interviewed by phone, 27 were unreachable and 11 were excluded. Univariate and multivariate regression analyses were performed to identify possible risk factors for recurrence. The mean follow-up time was 41 months (range 14-89 months). The average age was 66.6 years (range 36-87 years). All 86 legs operated on for an active ulcer had this ulcer healed sometime between the operation and the study examination, but thereafter it recurred in 14 patients (16%). In 109 legs operated on for a healed ulcer, the ulcer recurred in 17 legs (16%). Complications such as permanent sensory loss were seen in 16 legs (8%) and deep venous thrombosis in two legs (1%). Thirty legs (15%) were re-treated for superficial venous incompetence (SVI). Reduced ankle mobility was a risk factor for recurrence in both univariate and multivariate analysis (p=.048). These midterm results demonstrate that endovenous laser ablation of SVI in patients with healed or active venous ulcers achieves good healing and low ulcer recurrence rates, with a low rate of complications and an acceptable re-intervention rate. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  7. A new topographic method for localising the venous angle of the deep cerebral veins on the lateral phlebographic phase

    International Nuclear Information System (INIS)

    Klaus, E.; Nekula, J.; Waberzinek, G.

    1978-01-01

    A simple topographic method has been developed for the localisation of the venous angle on the lateral cerebral phlebogram. The principle depends on an angular measurement and an estimation of proportions which are statistically independant of each other. The method was tested on 103 phlebograms of adult patients with supratentorial spaceoccupying lesions. It was compared with conventional measurements; a number of advantages were found for using our method and its accuracy is as good as the other, most precise, methods. (orig.) [de

  8. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study

    DEFF Research Database (Denmark)

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing

    2011-01-01

    The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected...... leg ulcers on 91 extremities, from the 1(st) of March 2005 until the 31(st) of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment...... and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P...

  9. Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels.

    Science.gov (United States)

    Yamamoto, Takumi; Yamamoto, Nana; Hayashi, Akitatsu; Koshima, Isao

    2017-02-01

    Lymphatic supermicrosurgery or supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming popular for the treatment of compression-refractory upper extremity lymphedema (UEL) with its effectiveness and minimally invasiveness. In conventional LVA, superficial lymphatic vessels are used for anastomosis, but its treatment efficacy would be minimum when superficial lymphatic vessels are severely sclerotic. Theoretically, deep lymphatic vessels can be used for LVA, but no clinical case has been reported regarding deep lymphatic vessel-to-venous anastomosis (D-LVA). We report a breast cancer-related UEL case treated with D-LVA, in which a less-sclerotic deep lymphatic vessel was useful for anastomosis but superficial lymphatic vessels were not due to severe sclerosis. A 62-year-old female suffered from an 18-year history of compression-refractory right UEL after right breast cancer treatments, and underwent LVA under local infiltration anesthesia. Because superficial lymphatic vessels found in surgical fields were all severely sclerotic, a deep lymphatic vessel was dissected at the cubital fossa. A 0.50-mm deep lymphatic vessel running along the brachial artery was supermicrosurgically anastomosed to a nearby 0.40-mm vein. At postoperative 12 months, her right UEL index decreased from 134 to 118, and she could reduce compression frequency from every day to 1-2 days per week to maintain the reduced lymphedematous volume. D-LVA may be a useful option for the treatment of compression-refractory UEL, when superficial lymphatic vessels are severely sclerotic. © 2015 Wiley Periodicals, Inc. Microsurgery 37:156-159, 2017. © 2015 Wiley Periodicals, Inc.

  10. Avaliação das limitações de úlcera venosa em membros inferiores Evaluation of limitations of venous ulcers in legs

    Directory of Open Access Journals (Sweden)

    Célia Regina Lopes

    2013-03-01

    Full Text Available CONTEXTO: A insuficiência venosa crônica tem um impacto socioeconômico considerável nos países ocidentais devido à alta prevalência, custo das investigações e tratamento e à perda de dias trabalhados. O questionário de qualidade de vida Short Form Health Survey (SF-36, bem como a análise da ativação muscular e mobilidade da articulação tibiotársica, é um instrumento utilizado para a sua mensuração. OBJETIVO: Avaliar as limitações osteomusculares e as alterações na qualidade de vida em portadores de úlcera venosa em membros inferiores. MÉTODOS: Foram estudados dez pacientes com úlceras classificadas com Classificação de Doença Venosa Crônica (CEAP: Clinica, Eliologia, Anatomia e Fisiopatologia 6, que responderam ao questionário SF36 e à escala analógica de dor e realizaram a goniometria, força muscular e eletromiografia. RESULTADOS: A idade média do grupo estudado foi 67,4 (±11,7, sendo 70% dos casos do sexo feminino. Não houve correlação significativa entre dor amplitude do movimento (ADM, força muscular, eletromiografia (EMG e o tamanho da lesão. Entretanto, houve correlação entre o perfil psicológico do SF-36 e o domínio de atividades motoras, bem como do perfil psicológico com as atividades sociais e percepção de si mesmo. Também houve diferença significativa na avaliação eletromiográfica dos músculos estudados. CONCLUSÃO: A presença de úlcera venosa em membros inferiores pode gerar limitações e alterações na qualidade de vida destes indivíduos. O aspecto psicossocial demonstrou-se preponderante sobre o aspecto motor, aumentando as restrições nas atividades de vida diária.BACKGROUND: : The chronic venous insufficiency has a considerable socioeconomic impact in western countries because of high prevalence, treatment and research cost, and loss of days worked. The health survey questionnaire Short Form Health Survey (SF36, as well as the analysis of muscle activation and mobility

  11. Urinary hemosiderin: role in evaluation of chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    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.

  12. D-dimer is not elevated in asymptomatic high altitude climbers after descent to 5340 m: the Mount Everest Deep Venous Thrombosis Study (Ev-DVT).

    Science.gov (United States)

    Zafren, Ken; Feldman, Joanne; Becker, Robert J; Williams, Sarah R; Weiss, Eric A; Deloughery, Tom

    2011-01-01

    We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340 m (17,500 ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

  13. 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 Tornby; Frøkjaer, Jens Brøndum; Hagedorn Nielsen, Tina Sandie

    2008-01-01

    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......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...... clinical pre-test probability (PTP) can be safely used to rule out the tentative diagnosis of DVT in cancer patients. However, the accuracy in colorectal cancer patients is uncertain. This study assessed the diagnostic accuracy of a quantitative D-dimer assay in combination with the PTP score in ruling out...

  14. 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

  15. 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.

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

    Science.gov (United States)

    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

  17. [Homocysteine levels and polymorphisms of MTHFR and CBS genes in Colombian patients with superficial and deep venous thrombosis].

    Science.gov (United States)

    Ayala, Claudia; García, Reggie; Cruz, Edith; Prieto, Karol; Bermúdez, Marta

    2010-01-01

    Thrombosis develops when the hemostatic system is incorrectly activated due to the unbalance between procoagulant, anticoagulant and fibrinolytic mechanisms allowing the formation of a clot within a blood vessel. The risk factors of this pathology can be acquired or can be genetic. To analyze in a Colombian population with diagnosis of venous thrombosis, lipid profile, glucose and homocystein levels, to calculate the alleles and genotypic frequencies of polymorphisms c.699 C>T, c.1080 C>T, c.844ins68 of the cystathionine ß synthase and the c.677 C>T of the methylenetetrahydrofolate reductase (MTHFR) genes. Thirty three patients and their controls were studied. The biochemical test was carried out by colorimetric methods and immunoassay. In this survey we used the restriction fragments longitude polymorphism (RLFP) technique to identify the polymorphisms mentioned. The association study was performed through the chi square test. We confirmed that gene alterations increase risk for pathology; we found statistically significant differences in the group with hypercholesterolemia in presence of the polymorphism c.699 C>T in the CBS gene, showing a protective effect in the individuals carrying this genetic variation. Likewise, we found a statistical trend for an eventual protective effect of the CBS c.844ins68 polymorphism to venous thrombotic disease. There were not any statistically significant differences in homocystein levels between cases and controls; nevertheless, the variability in the plasma concentrations was greater in the group of cases.

  18. Postthrombotic or non-postthrombotic severe venous insufficiency: impact of removal of superficial venous reflux with or without subcutaneous fasciotomy.

    Science.gov (United States)

    Christenson, Jan T

    2007-08-01

    Severe chronic venous insufficiency is often associated with therapy-resistant or recurrent venous leg ulcers, either as a result of deep vein thrombosis (DVT)- (postthrombotic syndrome [PTS]) or superficial venous insufficiency (SVI). Frequently present dermatoliposclerosis affects the skin as well as the subcutaneous and subfascial structures, which may impact tissue pressures and compromise skin perfusion. This study was undertaken to measure tissue pressures in PTS and SVI limbs and to evaluate the impact of removal of superficial venous reflux with or without concomitant subcutaneous fasciotomy. In eight patients with recurrent, therapy-resistant venous leg ulcers, due to PTS (11 limbs, 12 ulcers) and 14 patients with severe SVI (14 limbs, 14 ulcers), subcutaneous fasciotomy was performed in addition to removal of superficial reflux. They were compared with eight patients with PTS (11 limbs, 11 ulcers) and 10 patients with SVI (13 limbs, 13 ulcers) who did not have fasciotomy in addition to removal of their superficial venous reflux. Intramuscular (i.m.) and subcutaneous (s.c.) tissue pressures and transcutaneous oxygen tension (TcPO(2)) were measured prior to, immediately after, and 3 months following the surgical intervention. Healing of ulcer (spontaneous or by skin grafting) at 3 months was also observed. There were no statistical differences between the groups regarding gender and age distribution or ulcer age at the time of surgery. All patients had in addition to surgery compression stockings class II (30 mm Hg). The i.m. tissue pressure was higher in patients with PTS compared with SVI patients, while s.c. tissue pressure and TcPO(2) did not differ between the groups. When fasciotomy was performed, i.m. and s.c. tissue pressures decreased and TcPO(2) increased significantly. Without fasciotomy, only s.c. tissue pressure decreased first at 3 months postoperatively. In the SVI-group, i.m tissue pressure was significantly decreased at 3 months in the

  19. 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.

  20. 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.

  1. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Clinical overview of venous thromboembolism

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) is the result of a venous blood clot formation which may manifest itself as deep vein thrombosis. (DVT) or pulmonary embolism (PE).1,2 DVT and PE are part of the same syndrome. However, important distinguishing factors in terms of epidemiology, diagnosis and treatment exist between.

  4. Deep venous thrombosis caused by congenital inferior vena cava agenesis and heterozygous factor V Leiden mutation – a case report

    Science.gov (United States)

    Vasco, Pablo Guisado; López, Angel Ruedas; Piñeiro, María Laiño; Rivera, José Ignacio Gallego

    2009-01-01

    The unusual clinical presentation, importance of imaging techniques and role of low molecular weight heparin are described for an initial treatment of thrombosis in inferior vena cava agenesis associated with heterozygous factor V Leiden. The patient, a 36-year-old woman, presented to the emergency room with sudden onset of back pain, swelling of the legs and thighs, and claudication while walking. Abdominal ultrasonography was immediately ordered. Anomalies in vascular blood flow were detected. Computed tomography was performed, and initially showed a complete absence of the infrarenal segment of inferior vena cava caudally to the origin of both renal veins. Treatment with enoxaparin (1 mg/kg twice per day) was started. The patient was discharged and returned to her activities of daily living two weeks after admission. This vascular abnormality is mostly incidentally diagnosed in adults and only a few cases are described as being associated with thrombophilia. PMID:22477517

  5. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  6. [Developmental venous anomaly (DVA)].

    Science.gov (United States)

    Zimmer, A; Hagen, T; Ahlhelm, F; Viera, J; Reith, W; Schulte-Altedorneburg, G

    2007-10-01

    As congenital anatomic variants of venous drainage, developmental venous anomalies (DVA) represent up to 60% of all cerebral vascular malformations. The prior term "venous angioma" is a misnomer implicating an abnormal vascular structure with an increased bleeding risk. They are often found incidentally and are hardly ever symptomatic. Their morphologic characteristics are dilated vessels in the white matter, which converge on a greater collector vein, forming the typical caput medusae. They drain into the superficial or deep venous system. The frequent association with other, potentially bleeding-prone vascular malformations is clinically relevant, in particular cavernous angioma, which might require therapeutic action. Therefore, coincident vascular lesions need to be actively sought by appropriate additional imaging techniques.

  7. Risk Factors for Cerebral Venous Thrombosis

    NARCIS (Netherlands)

    Silvis, Suzanne M.; Middeldorp, Saskia; Zuurbier, Susanna M.; Cannegieter, Suzanne C.; Coutinho, Jonathan M.

    2016-01-01

    Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often

  8. 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)

  9. 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)

  10. 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.

  11. 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.

  12. Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis: A prospective observational study of two centers.

    Science.gov (United States)

    Shackford, Steven R; Cipolle, Mark D; Badiee, Jayraan; Mosby, Danielle L; Knudson, M Margaret; Lewis, Paul R; McDonald, Victoria S; Olson, Erik J; Thompson, Kimberly A; Van Gent, Jan-Michael; Zander, Ashley L

    2016-05-01

    Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in trauma. Controversy exists regarding the use of lower extremity duplex ultrasound screening and surveillance (LEDUS). Advocates cite earlier diagnosis and treatment of deep venous thrombosis (DVT) to prevent clot propagation and pulmonary embolism (PE). Opponents argue that LEDUS identifies more DVT (surveillance bias) but does not reduce the incidence of PE. We sought to determine the magnitude of surveillance bias associated with LEDUS and test the hypothesis that LEDUS does not decrease the incidence of PE after injury. We compared data from two Level 1 trauma centers: Scripps Mercy Hospital, which used serial LEDUS, and Christiana Care Health System, which used LEDUS only for symptomatic patients. Beginning in 2013, both centers prospectively collected data on demographics, injury severity, and VTE risk for patients admitted for more than 48 hours. Both centers used mechanical and pharmacologic prophylaxis based on VTE risk assessment. Scripps Mercy treated 772 patients and Christiana Care treated 454 patients with similar injury severity and VTE risk. The incidence of PE was 0.4% at both centers. The odds of a DVT diagnosis were 5.3 times higher (odds ratio, 5.3; 95% confidence interval, 2.5-12.9; p < 0.0001) for patients admitted to Scripps Mercy than for patients admitted to Christiana Care. Of the 80 patients who developed DVT, PE, or both, 99% received prophylaxis before the event. Among those who received pharmacologic prophylaxis, the VTE rates between the two centers were not statistically significantly different (Scripps Mercy, 11% vs. Christiana Care, 3%; p = 0.06). The odds of a diagnosis of DVT are increased significantly when a program of LEDUS is used in trauma patients. Neither pharmacologic prophylaxis nor mechanical prophylaxis is completely effective in preventing VTE in trauma patients. VTE should not be considered a "never event" in this cohort. Prognostic

  13. The Diagnostic Value of 3-Dimensional Sampling Perfection With Application Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) MRI in Evaluating Lower Extremity Deep Venous Thrombus.

    Science.gov (United States)

    Wu, Gang; Xie, Ruyi; Zhang, Xiaoli; Morelli, John; Yan, Xu; Zhu, Xiaolei; Li, Xiaoming

    2017-12-01

    The aim of this study was to evaluate the diagnostic performance of noncontrast magnetic resonance imaging utilizing sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) in detecting deep venous thrombus (DVT) of the lower extremity and evaluating clot burden. This prospective study was approved by the institutional review board. Ninety-four consecutive patients (42 men, 52 women; age range, 14-87 years; average age, 52.7 years) suspected of lower extremity DVT underwent ultrasound (US) and SPACE. The venous visualization score for SPACE was determined by 2 radiologists independently according to a 4-point scale (1-4, poor to excellent). The sensitivity and specificity of SPACE in detecting DVT were calculated based on segment, limb, and patient, with US serving as the reference standard. The clot burden for each segment was scored (0-3, patent to entire segment occlusion). The clot burden score obtained with SPACE was compared with US using a Wilcoxon test based on region, limb, and patient. Interobserver agreement in assessing DVT (absent, nonocclusive, or occlusive) with SPACE was determined by calculating Cohen kappa coefficients. The mean venous visualization score for SPACE was 3.82 ± 0.50 for reader 1 and 3.81 ± 0.50 for reader 2. For reader 1, sensitivity/specificity values of SPACE in detecting DVT were 96.53%/99.90% (segment), 95.24%/99.04% (limb), and 95.89%/95.24% (patient). For reader 2, corresponding values were 97.20%/99.90%, 96.39%/99.05%, and 97.22%/95.45%. The clot burden assessed with SPACE was not significantly different from US (P > 0.05 for region, limb, patient). Interobserver agreement of SPACE in assessing thrombosis was excellent (kappa = 0.894 ± 0.014). Non-contrast-enhanced 3-dimensional SPACE magnetic resonance imaging is highly accurate in detecting lower extremity DVT and reliable in the evaluation of clot burden. SPACE could serve as an important alternative for patients in whom US

  14. Safety and feasibility of a diagnostic algorithm combining clinical probability, D-dimer and ultrasonography in suspected upper extremity deep vein thrombosis: : A prospective management study

    NARCIS (Netherlands)

    Kleinjan, Ankie; Di Nisio, Marcello; Beyer-Westendorf, Jan; Cosmi, Benilde; Camporese, Giuseppe; Ghirarduzzi, Angelo; Kamphuisen, Pieter W.; Otten, Hans-Martin; Porreca, Ettore; Büller, Harry R.

    2012-01-01

    Introduction: Traditionally, the focus of VTE diagnostic is on deep vein thrombosis (DVT) of the leg and pulmonary embolism. Until recently, upper extremity DVT (UEDVT) was regarded as an uncommon and relatively benign presentation of venous thromboembolism; however, the more widespread use of

  15. Venous giant post-thrombotic chronic ulcer: successful treatment with Bosentan.

    Science.gov (United States)

    Solís, J V; Portero, J L; Ribé, L

    2011-06-01

    To report a case of a refractory post-thrombotic chronic venous ulcer managed with an off-label treatment. We present the case of an 82-year-old woman with a previous medical history of severe hypertension and a deep vein thrombosis three years before. A refractory giant chronic venous ulcer in her left leg was treated with Bosentan. The appearance of the ulcer improved in the first 45 days, worsened after an unintended stop of the treatment and was almost resolved after 90 days of treatment. Ulcer-associated pain improved very quickly and so, in only one week, opioid treatment was stopped. Bosentan treatment was well tolerated, with only mild and manageable side effects. Treatment with Bosentan has been successful in the treatment of this case of refractory chronic venous ulcer.

  16. 125I-labeled fibrinogen scanning. Use in the diagnosis of venous thrombosis

    International Nuclear Information System (INIS)

    Hirsh, J.; Gallus, A.S.

    1975-01-01

    Venous thrombosis is often asymptomatic in patients in whom major pulmonary embolism develops. When used expectantly, iodine-125-labeled fibrinogen scanning is a very sensitive method for detecting subclinical leg vein thrombi. Fibrinogen scanning is less useful for the diagnosis of established venous thrombosis, but is valuable for detecting extension of venographically diagnosed calf vein thrombosis. The technique is safe if fibrinogen is obtained from carefully screened donors. The limitations of the method include its inability to distinguish between superficial and deep venous thrombi, and its sensitivity to fibrin in hematoma and inflammatory exudates. Though the results agree closely with those of phlebography, scanning seems less reliable for detecting femoral vein than calf vein thrombi and is insensitive to thrombi above the inguinal ligament. Screening for these major thrombi may be improved by combining fibrinogen scanning with impedance plethysmography or ultrasonic examination. (U.S.)

  17. Deep vein thrombosis and/or pulmonary embolism concurrent with superficial vein thrombosis of the legs: cross-sectional single center study of prevalence and risk factors.

    Science.gov (United States)

    Hirmerova, J; Seidlerova, J; Subrt, I

    2013-08-01

    The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the patients with superficial vein thrombosis (SVT) of the legs and to find factors significantly and independently associated with coincident DVT/PE. In the setting of a tertiary referral hospital, patients with SVT, attending vascular clinic, underwent physical examination, laboratory testing and leg vein ultrasound (in the case of clinically suspected PE also perfusion/ventilation lung scan or/and helical CT pulmonary angiography). In statistical analysis, we used unpaired t-test, non-parametric Wilcoxon rank sum test, stepwise logistic regression and multivariable logistic regression model. We examined 138 patients (age 61.4 ± 13.9 years, 36.2% men), with ST mostly on varicose veins (89.9%). The prevalence of concurrent DVT/PE was 34.1%. Neither the clinical manifestation nor SVT localization differed significantly between the group with isolated SVT and that with coincident DVT/PE. Of all the assessed patients characteristics (age and sex, BMI, history of SVT, DVT or PE, hypercoagulable states, cardiovascular risk factors) only two factors were significantly and independently associated with the presence of concurrent DVT/PE. Log BMI was significantly higher in the patients with isolated SVT. Factor V Leiden (FVL) was proved as an independent risk factor for concomitant DVT/PE with odds ratio 2,531 (95% CI 1,064-6,016). The prevalence of concurrent DVT/PE in patients with SVT, referred to hospital vascular clinic was 34.1%. Lower BMI (log BMI, respectively) and the presence of FVL were significantly and independently associated with concurrent DVT/PE. Our results should be further investigated in a larger prospective study.

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

    OpenAIRE

    Wankhade, Vaishali; Singh, Rajesh; Sadhwani, Venus; Kodate, Purnima; Disawal, Amit

    2014-01-01

    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 ven...

  19. The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy

    Science.gov (United States)

    Wollina, Uwe; Heinig, Birgit; Stelzner, Christian; Hansel, Gesina; Schönlebe, Jacqueline; Tchernev, Georgi; Lotti, Torello

    2018-01-01

    BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. CASE REPORT: To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain. CONCLUSION: Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend. PMID:29483986

  20. A case-control study of risk factors of chronic venous ulceration in patients with varicose veins.

    Science.gov (United States)

    Abelyan, Gohar; Abrahamyan, Lusine; Yenokyan, Gayane

    2018-02-01

    Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013-2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95-56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08-1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23-10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18-8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08-0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while

  1. Lower-limb venous thrombosis

    African Journals Online (AJOL)

    muscle strains, tears, or twisting injuries to the leg. • other causes of lower-limb swelling such as cardiac, hepatic and renal pathologies. • lymphoedema. • chronic venous hypertension and its complications. • popliteal (Baker's) cysts. • cellulitis. • other knee pathologies. The objective methods of making a diagnosis of DVT ...

  2. Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case

    Directory of Open Access Journals (Sweden)

    Kaukab Maqbool Hassan

    2013-01-01

    Full Text Available A 45-year-old man presented with global headache, vomiting and abnormal behavior after cross-country run at high altitude. There was no seizure, loss of consciousness, fever or head injury. He was conscious, abulic and uncooperative with normal vitals. There was no focal neurological deficit. Non contrast computed tomography scan of head was normal. Magnetic resonance imaging of brain showed venous infarct in bilateral thalami, left basal ganglia and periventricular white matter. Magnetic resonance venography revealed thrombosis involving internal cerebral veins, septal veins, thalamostriate veins, vein of Galen and proximal portion of straight sinus. His condition steadily improved on low molecular weight heparin bridged with oral anticoagulation for one year. At two months, serum homocysteine was 31.51 μmol/l (5.46-16.2 μmol/l and protein S was 49.00% (77-143.00%. He received methylcobalamin, pyridoxine and folic acid. After 16 months, he was asymptomatic with partially recanalized deep cerebral veins and serum homocysteine falling to 16.50 μmol/l (5.46-16.2 μmol/l.

  3. Integrated TLWP-FPSO (Tension Leg Wellhead Platform-Floating Production, Storage and Offloading Vessel) solution for deep water field development offshore Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Neil; Heidari, Homayoun; Large, Sean [SBM Atlantia, Houston, TX (United States)

    2008-07-01

    A development strategy for some deep water fields offshore Brazil consists of a TLWP (Tension-Leg Wellhead Platform) connected by a fluid transfer line to a nearby FPSO. The TLWP provides dry tree riser support, drilling capability, manifolding, test separation, and multiphase pumping, while all other functions including full processing, accommodations, gas compression, power generation, water and chemical injection, storage and offloading, and gas export are provided by the FPSO. In one such scenario, the TLWP and FPSO could be connected using SBM's GAP mid-water fluid transfer line technology, with SBM Atlantia's FourStar{sup TM} hull concept for the TLWP. The FourStar{sup TM} is designed to be quayside- or float over-integrable, thus eliminating the need for a heavy lift installation vessel; while being structurally and hydrodynamically superior to other TLP alternatives. This paper presents a description of the technical development of the FourStar{sup TM} TLP and an overview of the GAP technology, and discusses the characteristics of an integrated TLWP-GAP-FPSO field development solution for a typical application offshore Brazil (author)

  4. Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound-based study in children 12 years of age or younger.

    Science.gov (United States)

    Scherer, Andrea G; White, Ian K; Shaikh, Kashif A; Smith, Jodi L; Ackerman, Laurie L; Fulkerson, Daniel H

    2017-07-01

    OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery. METHODS A total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year. RESULTS There was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol. CONCLUSIONS In this

  5. [Venous ulcer].

    Science.gov (United States)

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms.

  6. [Quality of care and safety indicators in anticoagulated patients with non-valvular auricular fibrillation and deep venous thromboembolic disease].

    Science.gov (United States)

    Ignacio, E; Mira, J J; Campos, F J; López de Sá, E; Lorenzo, A; Caballero, F

    2018-03-19

    To identify and prioritise indicators to assess the quality of care and safety of patients with non-valvular auricular fibrillation (NVAF) and deep vein thrombosis (DVT) treated with anticoagulants. Using the consensus conference technique, a group of professionals and clinical experts, the determining factors of the NVAF and DVT care process were identified, in order to define the quality and safety criteria. A proposal was made for indicators of quality and safety that were prioritised, taking into account a series of pre-established attributes. The selected indicators were classified into indicators of context, safety, action, and outcomes of the intervention in the patient. A set of 114 health care and safety quality indicators were identified, of which 35 were prioritised: 15 for NVAF and 20 for DVT. About half (49%) of the indicators (40% for NVAF and 55% for DVT) applied to patient safety, and 26% (33% for NVAF and 20% for DVT) to the outcomes of interventions in the patient. The present work presents a set of agreed indicators by a group of expert professionals that can contribute to the improvement of the quality of care of patients with NVAF and DVT treated with anticoagulants. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial.

    Science.gov (United States)

    O'Brien, Jane; Finlayson, Kathleen; Kerr, Graham; Edwards, Helen

    2017-02-01

    Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the

  8. Trombose venosa profunda e sua relação com trombofilias e neoplasias: estudo retrospectivo Deep venous thrombosis and its relationship with thrombophilias and malignancies: retrospective study

    Directory of Open Access Journals (Sweden)

    Ana Vieira Baptista

    2012-09-01

    Full Text Available Objectivos: Avaliação dos resultados obtidos através dos protocolos instituídos no Serviço para despiste de trombofilias e/ou neoplasias em doentes internados ao longo de 5 anos com o diagnóstico de trombose venosa profunda (TVP. Material e métodos: Estudo retrospectivo, através da consulta dos processos hospitalares, de todos os doentes com idade igual ou inferior a 50 anos internados no Serviço entre 01 de Janeiro de 2006 e 31 de Dezembro de 2010 com esse diagnóstico, e análise dos resultados obtidos nos protocolos. Resultados: De um total de 89 doentes, 64 (71,9% eram do sexo feminino e 25 (28,1% do masculino, sendo a média de idades de 33,3 ±10,0 anos. 14,6% dos doentes já haviam tido, pelo menos, um episódio prévio de TVP e 78,7% apresentavam, pelo menos, um factor de risco. Em 65 doentes (73,0% foi aplicado o protocolo de despiste de trombofilias e de neoplasias, tendo sido detectadas trombofilias congénitas em 41 doentes (63,1%, dois casos de síndrome dos anticorpos anti-fosfolipídicos (SAF, um caso de gamapatia monoclonal, um de neoplasia do pulmão e um de cordoma do sacro. 49 dos doentes que realizaram os protocolos (75,4% foram orientados para a Consulta de Hematologia, sendo que em 40 deles (81,6% foi sugerido manter a anticoagulação oral por um período superior a 12 meses. Conclusões: Dada a elevada prevalência de polimorfismos genéticos que conferem risco trombótico acrescido e os não raros casos de SAF e de neoplasias ocultas presentes nesta população de doentes, considera-se que, apesar dos elevados custos, se deverá continuar a fazer o despiste deste tipo de patologias.Objectives: Evaluation of the results obtained with the application of specific protocols established in the Department for screening for thrombophilia and malignancy in patients hospitalized during a period of five years with the diagnosis of deep venous thrombosis (DVT. Material and methods: A retrospective study was performed

  9. Normal venous anatomy and physiology of the lower extremity.

    Science.gov (United States)

    Notowitz, L B

    1993-06-01

    Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

  10. Epidemiology of recurrent venous thrombosis

    Science.gov (United States)

    Ribeiro, D.D.; Lijfering, W.M.; Barreto, S.M.; Rosendaal, F.R.; Rezende, S.M.

    2011-01-01

    Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed. PMID:22183247

  11. 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)

  12. [Etiological diagnosis of leg ulcers].

    Science.gov (United States)

    Debure, Clélia

    2010-09-20

    Etiological diagnosis of leg ulcers must be the first step of treatment, even if we know that veinous disease is often present. We can build a clinical decisional diagram, which helps us to understand and not forget the other causes of chronic wounds and choose some basic examination, like ultrasound and histological findings. This diagnosis helps to choose the right treatment in order to cure even the oldest venous ulcers. Educational programs should be improved to prevent recurrence.

  13. Leg Swelling

    Science.gov (United States)

    ... ed. New York, N.Y.: The McGraw Hill Companies; 2016. http://www.accessmedicine.com. Accessed Dec. 31, ... http://www.mayoclinic.org/symptoms/leg-swelling/basics/definition/SYM-20050910 . Mayo Clinic Footer Legal Conditions and ...

  14. Venous thromboses

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, A.; Tosch, U.; Rath, M.

    1985-02-01

    The suspicion of the presence of venous thrombosis is supported by Doppler-sonography. The crucial diagnostic procedure, however, is the conventional x-ray-phlebography. The digital subtraction phlebography adds to the conventional technique in the pelvic and thoracic area if parts of the skeleton or soft tissue are overlapping. The radionuclid-phlebography will be applied in contrast medium incompatibility or in suspicion of pulmonary embolism. Factors of increased prevalence of venous thrombosis can be confirmed by CT or sonography.

  15. Leg ulcers due to hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D

    2006-01-01

    Full Text Available Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.

  16. Venous thromboembolism: The intricacies

    Directory of Open Access Journals (Sweden)

    Dutta T

    2009-01-01

    Full Text Available Venous thromboembolism (VTE has been a subject of great interest of late. Since Rudolph Virchow described the famous Virchow′s triad in 1856, there have been rapid strides in the understanding of the pathogenesis and factors responsible for it. Discovery of various thrombophilic factors, both primary and acquired, in the last 40 years has revolutionized prognostication and management of this potentially life-threatening condition due to its associated complication of pulmonary thromboembolism. Detailed genetic mapping and linkage analyses have been underlining the fact that VTE is a multifactorial disorder and a complex one. There are many gene-gene and gene-environment interactions that alter and magnify the clinical picture in this disorder. Point in case is pregnancy, where the risk of VTE is 100-150 times increased in the presence of Factor V Leiden, prothrombin mutation (Prothrombin 20210A and antithrombin deficiency. Risk of VTE associated with long-haul air flight has now been well recognized. Thrombotic events associated with antiphospholipid syndrome (APS are 70% venous and 30% arterial. Deep venous thrombosis and pulmonary embolism are the most common venous events, though unusual cases of catastrophes due to central vein thrombosis like renal vein thrombosis and Budd-Chiari syndrome (catastrophic APS may occur.

  17. 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.

  18. Genetic risk factors of venous thrombosis

    NARCIS (Netherlands)

    Franco, R. F.; Reitsma, P. H.

    2001-01-01

    Venous thrombosis, whose main clinical presentations include deep vein thrombosis and pulmonary embolism, represents a major health problem worldwide. Numerous conditions are known to predispose to venous thrombosis and these conditions are commonly referred to as risk indicators or risk factors.

  19. Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study.

    Science.gov (United States)

    Lee, Amanda J; Robertson, Lindsay A; Boghossian, Sheila M; Allan, Paul L; Ruckley, C Vaughan; Fowkes, F Gerald R; Evans, Christine J

    2015-01-01

    The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression. The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI. Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system

  20. Venous thromboembolism after fibula fracture: a patient's perspective.

    Science.gov (United States)

    Harvey, Carol V; Runner, Megan

    2011-01-01

    Venous Thromboembolism (VTE) is a significant healthcare issue in the United States. This article presents information on the scope of the problem of VTE through a case study demonstrating the physical and psychosocial experiences of a 24-year-old woman with a fibula fracture treated in a short leg cast who developed a deep vein thrombosis that went on to become a pulmonary embolism. The patient experience is evaluated and supported by literature review in terms of risk factors as well as diagnostic, prophylaxis, medical treatment, and nursing implications. Analysis of a patient experience with VTE is valuable to add to the nursing body of knowledge for improvement of evidence-based practice.

  1. Systematic review of topic treatment for venous ulcers

    OpenAIRE

    Borges, Eline Lima; Caliri, Maria Helena Larcher; Haas, Vanderlei José

    2007-01-01

    Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. Evidence-based professional practice generates effective results for patients and services. This research aimed to carry out a systematic review to assess the most effective method to improve venous return and the best topic treatment for these ulcers. Studies were collected in eight databases, using the following descriptors: leg ulcer, venous ulcer and similar terms. T...

  2. Broken Leg

    Science.gov (United States)

    ... the leg, which can result in a fracture. Stress fractures outside of sport situations are more common in people who have: ... shoes. Choose the appropriate shoe for your favorite sports or activities. And ... can prevent stress fractures. Rotate running with swimming or biking. If ...

  3. 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

  4. 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 venous ulcers of secondary etiology (P 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 (Ad), and all ulcers showed reflux without obstruction (Pr). Venous ulcers were more prevalent among low-income patients, especially chronic

  5. Night Leg Cramps

    Science.gov (United States)

    Symptoms Night leg cramps By Mayo Clinic Staff Night leg cramps, also called nocturnal leg cramps, are painful, involuntary contractions or spasms of muscles in your legs, usually occurring when you're in bed. Night ...

  6. Diagnosis of stenosis within the popliteal–femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty

    Science.gov (United States)

    Dabbs, Emma; Sheikh, Alina; Beckett, David; Whiteley, Mark S

    2017-01-01

    This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal–femoral segment. An interventional radiologist performed venoplasty to this popliteal–femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal–femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention. PMID:29147566

  7. Diagnosis of stenosis within the popliteal-femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty.

    Science.gov (United States)

    Dabbs, Emma; Sheikh, Alina; Beckett, David; Whiteley, Mark S

    2017-01-01

    This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal-femoral segment. An interventional radiologist performed venoplasty to this popliteal-femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal-femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.

  8. [Swollen leg with blisters].

    Science.gov (United States)

    Rafeiner, Ph; Templeton, A J; Vonesch, H J

    2005-10-05

    We report the case of a 84-year-old woman suffering from strong pain in her right leg initially resembling thrombosis of deep veins. Eight hours after admission a superficial blister developed at the calf with following hemorrhagic aspect and spontanous eruption of clear yellowish fluid. Later on a new blister appeared at the thigh. The patient died 33 hours after admission of streptococcal toxic shock syndrome. The latter was based on a necrotizing fasciitis. Streptoccus pyogenes (group A) could be cultivated from the blood and fluid of the blister. We discuss the clinical presentation of necrotizing fasciitis with "pain out of proportion" as characteristic complaint and the appropriate management.

  9. 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

  10. Deep venous thrombosis with suspected pulmonary embolism: simultaneous evaluation using combined CT venography and pulmonary CT angiography; Trombose venosa profunda e suspeita de tromboembolismo pulmonar: avaliacao simultanea por meio de angiotomografia pulmonar e venotomografia combinadas

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Laura de Moraes [Universidade Federal, Rio de Janeiro (UFRJ), RJ (Brazil)]. E-mail: lauramgomes@terra.com.br; Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil); Rodrigues, Rosana Souza [Hospital Copa D' Or, Rio de Janeiro, RJ (Brazil)

    2006-01-15

    Objective: To evaluate the occurrence and the correlation between pulmonary embolism (PE) and deep venous thrombosis (DVT) using a single CT angiography protocol. Materials and methods: This was a prospective study performed at Hospital Copa D'Or, Rio de Janeiro, Brazil from July 2003 to June 2004. We analyzed 116 CT angiography examinations of patients with clinical suspicion of PE. After an interval of approximately three minutes, venous phase images from the diaphragm to the knees were acquired without additional contrast injection in order to determine the presence of DVT. Results: From the 116 patients studied, 23 (19.8%) had PE, 24 (20.7%) had DVT, 15 (12.9%) had both PE and DVT and 9 (7.8%) had DVT alone. Among the 23 cases of PE, 15 (65.2%) had concomitant DVT whereas 8 (34.8%) had only PE. Among the 24 cases of DVT, 15 (62.5%) had associated PE and 9 (37.5%) had DVT alone. Conclusion: The results showed a strong relationship between PE and DVT, as well as the importance of investigating DVT in cases with suspected PE and the benefits of performing indirect CT venography after pulmonary CT angiography as a single examination alternative method for simultaneous investigation of PE and DVT. (author)

  11. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials

    NARCIS (Netherlands)

    Cherpanath, Thomas G. V.; Hirsch, Alexander; Geerts, Bart F.; Lagrand, Wim K.; Leeflang, Mariska M.; Schultz, Marcus J.; Groeneveld, A. B. Johan

    2016-01-01

    Passive leg raising creates a reversible increase in venous return allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings potentially affecting the diagnostic performance of passive leg raising. Therefore we performed a

  12. Four Thrombotic Events Over 5 Years, Two Pulmonary Emboli and Two Deep Venous Thrombosis, When Testosterone-HCG Therapy Was Continued Despite Concurrent Anticoagulation in a 55-Year-Old Man With Lupus Anticoagulant.

    Science.gov (United States)

    Glueck, Charles J; Lee, Kevin; Prince, Marloe; Jetty, Vybhav; Shah, Parth; Wang, Ping

    2016-01-01

    When exogenous testosterone or treatments to elevate testosterone (human chorionic gonadotropin [HCG] or Clomid) are prescribed for men who have antecedent thrombophilia, deep venous thrombosis and pulmonary embolism often occur and may recur despite adequate anticoagulation if testosterone therapy is continued. A 55-year-old white male was referred to us because of 4 thrombotic events, 3 despite adequate anticoagulation over a 5-year period. We assessed interactions between thrombophilia, exogenous testosterone therapy, and recurrent thrombosis. In 2009, despite low-normal serum testosterone 334 ng/dL (lower normal limit [LNL] 300 ng/dL), he was given testosterone (TT) cypionate (50 mg/week) and human chorionic gonadotropin (HCG; 500 units/week) for presumed hypogonadism. Ten months later, with supranormal serum T (1385 ng/dL, upper normal limit [UNL] 827 ng/dL) and estradiol (E2) 45 pg/mL (UNL 41 pg/mL), he had a pulmonary embolus (PE) and was then anticoagulated for 2 years (enoxaparin, then warfarin). Four years later, on TT-HCG, he had his first deep venous thrombosis (DVT). TT was stopped and HCG continued; he was anticoagulated (enoxaparin, then warfarin, then apixaban, then fondaparinux). One year after his first DVT, on HCG, still on fondaparinux, he had a second DVT (5/315), was anticoagulated (enoxaparin + warfarin), with a Greenfield filter placed, but 8 days later had a second PE. Thrombophilia testing revealed the lupus anticoagulant. After stopping HCG, and maintained on warfarin, he has been free of further DVT-PE for 9 months. When DVT-PE occur on TT or HCG, in the presence of thrombophilia, TT-HCG should be stopped, lest DVT-PE reoccur despite concurrent anticoagulation.

  13. Low-dose warfarin coupled with lower leg compression is effective prophylaxis against thromboembolic disease after hip arthroplasty.

    Science.gov (United States)

    Bern, Murray; Deshmukh, Rahul V; Nelson, Russell; Bierbaum, Benjamin; Sevier, Nancy; Howie, Noreen; Losina, Elena; Katz, Jeffrey N

    2007-08-01

    Consecutive patients having elective total hip arthroplasty were prescribed 1 mg of warfarin for 7 days preceding surgery, variable doses while in hospital (target international normalized ratio, 1.5-2.0), and discharged to rehabilitation center or home taking 1 mg daily until 4-week to 6-week follow-up visit. Lower leg pneumatic compression was used postoperatively and elastic compression stockings after discharge. Hospital and clinic charts plus auxiliary sources were reviewed for evidence of thromboembolic diseases (TED). Of 1003 consecutive patients studied, 3 (0.3%, 95% CI 0.0-0.6%) had symptomatic TED, including 2 with deep venous thrombosis and 1 with nonfatal pulmonary embolus. Follow-up rate was 99.1%. Complications from warfarin were minimal. Very-low-dose warfarin coupled with lower leg compression is effective prophylaxis against TED after elective hip arthroplasty when prescribed as described.

  14. Deep vein thrombosis after ischemic stroke: rationale for a therapeutic trial

    Energy Technology Data Exchange (ETDEWEB)

    Bornstein, N.M.; Norris, J.W.

    1988-11-01

    Deep venous thrombosis (DVT) in the legs occurs in 23% to 75% of patients with acute ischemic stroke, and pulmonary embolism accounts for about 5% of deaths. New heparinoid substances, lacking the hazards of more established anticoagulants, raise the question of DVT prophylaxis for these patients. Two hundred fifty consecutive acute ischemic stroke patients were evaluated for the presence of DVT of the legs in a feasibility study for a trial of low-molecular-weight heparin prophylaxis. Forty-nine patients were found suitable for the study, of whom 11 (22.5%) developed DVT. All patients underwent clinical examination, I-125 fibrinogen leg scanning, and impedance plethysmography. Five patients were sufficiently alert and without serious neurologic deficits to justify DVT prophylaxis. Recent advances in noninvasive diagnostic techniques to detect DVT early and the development of relatively safe heparinoid compounds increase the need for a prophylactic study in patients with ischemic stroke.

  15. Deep vein thrombosis after ischemic stroke: rationale for a therapeutic trial

    International Nuclear Information System (INIS)

    Bornstein, N.M.; Norris, J.W.

    1988-01-01

    Deep venous thrombosis (DVT) in the legs occurs in 23% to 75% of patients with acute ischemic stroke, and pulmonary embolism accounts for about 5% of deaths. New heparinoid substances, lacking the hazards of more established anticoagulants, raise the question of DVT prophylaxis for these patients. Two hundred fifty consecutive acute ischemic stroke patients were evaluated for the presence of DVT of the legs in a feasibility study for a trial of low-molecular-weight heparin prophylaxis. Forty-nine patients were found suitable for the study, of whom 11 (22.5%) developed DVT. All patients underwent clinical examination, I-125 fibrinogen leg scanning, and impedance plethysmography. Five patients were sufficiently alert and without serious neurologic deficits to justify DVT prophylaxis. Recent advances in noninvasive diagnostic techniques to detect DVT early and the development of relatively safe heparinoid compounds increase the need for a prophylactic study in patients with ischemic stroke

  16. Contemporary diagnosis of venous malformation

    Directory of Open Access Journals (Sweden)

    Lee BB

    2013-11-01

    coagulopathy status. Localized intravascular coagulopathy may cause serious thrombohemorrhagic events, including deep venous thrombosis and pulmonary embolism.Keywords: venous malformation, extratruncular lesions, truncal lesions, noninvasive tests, less invasive tests, localized intravascular coagulopathy

  17. Tuberculosis and Venous Thromboembolism: a case series.

    Science.gov (United States)

    Goncalves, Ivone M; Alves, Daniela Costa; Carvalho, Aurora; do Ceu Brito, Maria; Calvario, Fernando; Duarte, Raquel

    2009-12-16

    Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.

  18. Leg Injuries and Disorders

    Science.gov (United States)

    Your legs are made up of bones, blood vessels, muscles, and other connective tissue. They are important for motion ... falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint ...

  19. Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis

    NARCIS (Netherlands)

    Tick, L.W.; Doggen, Catharina Jacoba Maria; Rosendaal, F.R.; Faber, W.R.; Bousema, M.T.; Mackaay, A.J.C.; van Balen, P.; Kramer, H.H.

    2010-01-01

    Background: Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) affecting a large number of patients. Because of its potential debilitating effects, identification of patients at high risk for the development of this syndrome is relevant, and only a few predictors

  20. Peripheral artery disease - legs

    Science.gov (United States)

    Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of ...

  1. Venous Thromboembolism in Adolescents

    Directory of Open Access Journals (Sweden)

    Aneta Samková

    2012-01-01

    Full Text Available The incidence of venous thromboembolism (VTE during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%, 2 boys (11.1%. In 9 patients (50% thrombosis of the lower limb deep veins was diagnosed, six patients (33.3% suffered from symptomatic pulmonary embolism (PE and 3 patients (16.7% from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%. The most frequent acquired risk factor was oral contraception (OC in 12 out of 16 girls (75%. All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6% patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50% in patients with distal lower limb thrombosis, but very high (100% in patients with PE.

  2. A prospective, multi-centre, randomised, open label, parallel, comparative study to evaluate effects of AQUACEL(®) Ag and Urgotul(®) Silver dressing on healing of chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Harding, Keith; Gottrup, Finn; Jawień, Arkadiusz

    2011-01-01

    This study compared wound healing efficacy of two silver dressings, AQUACEL(®) Ag and Urgotul(®) Silver, against venous ulcers at risk of infection, over 8 weeks of treatment. The primary objective was to show non inferiority of AQUACEL(®) Ag to Urgotul(®) Silver. Patients (281) were randomised......, safety events and ulcer healing were compared. After 8 weeks of treatment, the AQUACEL(®) Ag group had a relative wound size reduction (49·65% ± 52·53%) compared with the Urgotul(®) Silver group (42·81% ± 60·0%). The non inferiority of the AQUACEL(®) Ag group to the Urgotul(®) Silver group...... was established based on the difference between them (6·84% ± 56·3%, 95% confidence interval -6·56 to 20·2) and the pre-defined non inferiority margin (-15%). Composite wound healing analysis showed that the AQUACEL(®) Ag group had statistically higher percentage of subjects with better wound progression (66...

  3. Fragment E1 labeled with I-123 in the detection of venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Knight, L.C.; Maurer, A.H.; Robbins, P.S.; Malmud, L.S.; Budzynski, A.Z.

    1985-08-01

    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.

  4. 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

  5. Profilaxia medicamentosa da trombose venosa profunda em pacientes submetidos à cirurgia do trauma em um hospital universitário Drug prophylaxis of deep venous thrombosis in patients submitted to trauma surgery in a university hospital

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Engelhorn

    2012-06-01

    consequence of deep vein thrombosis, represents a major cause of the morbidity and mortality in postoperative state, and it could be avoided with adequate prophylaxis. OBJECTIVE: To evaluate the use of chemoprophylaxis for deep vein thrombosis, in patients undergoing emergency trauma surgery in a teaching hospital. METHODS: A cross-sectional analytic study was conducted with 153 patients admitted to Cajuru University Hospital, in Curitiba, Paraná, in a two-month period. Records of patients who required surgery due to trauma were prospectively analyzed. The study included those classified as high and medium risk for deep vein thrombosis. Then, it was identified whether or not the drug prophylaxis was used. A statistical analysis was descriptively performed. RESULTS: Of the 153 patients included, 99 (64.7% were classified as high risk for deep vein thrombosis and 54 (35.3% as medium risk. Of the total, 144 (94% did not receive prophylaxis and nine (6% did. On those who received prophylaxis, only four patients received the adequate. CONCLUSIONS: Prophylaxis of venous thrombosis disease is not performed routinely in patients of medium and high risk of developing deep vein thrombosis, who underwent trauma surgery. And, when performed, it is often inappropriate.

  6. Thick legs - not always lipedema.

    Science.gov (United States)

    Reich-Schupke, Stefanie; Altmeyer, Peter; Stücker, Markus

    2013-03-01

    Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed. © The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  7. A Novel Stretch Sensor to Measure Venous Hemodynamics

    Directory of Open Access Journals (Sweden)

    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.

  8. An unusual cause of hydrocephalus: aqueductal developmental venous anomaly

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  9. Results of phase III clinical trial of 99mTc-labelled recombinant tissue plasminogen activator in the detection of deep venous thrombosis

    International Nuclear Information System (INIS)

    Butler, S.P.; 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 79 patients suspected of DVT. A kit formulation has been devised in which 99 mTc is labelled to rt- PA where the plasminogen binding site has been permanently inhibited but the fibrin binding site remained active. Kit preparation 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. Mean thrombus age was 5.4 days. 58% patients were receiving intravenous heparin. Mean time interval between contrast venography and scanning was 20 hours. For the purpose of analysis, the leg was divided into proximal and distal segments for both the scintigraphic study and the contrast venography. Of the 14 thrombosed proximal segments, 13 had positive scans; in the 53 non-thrombosed proximal segments, 49 had negative scans. Thus in proximal vein thrombosis, scanning had a sensitivity of 93% and a specificity of 92%. Of the 36 thrombosed calf vein segments, 31 had positive scans; in the 30 non-thrombosed calf segments, 28 had negative scans. Thus in calf vein thrombosis, scanning has a sensitivity of 86% and a specificity of 93%. Scintigraphic scanning with this new radiopharmaceutical permits accurate detection of thrombus in both proximal and calf veins. The technique detects both fresh and aged thrombi and is unaffected by heparin administration. Further work in different patient groups will need to be performed to define its clinical usefulness

  10. [Abdominoscrotal hydrocele with leg edema in a 4-month-old boy].

    Science.gov (United States)

    Faure, A; Bouali, O; Chaumoitre, K; Louka, B; Alessandrini, P; Merrot, T

    2009-10-01

    We present a case of a 4-month-old boy with a right abdominoscrotal hydrocele associated to a compression of the femoral triangle, causing an unilateral leg edema. Abdominoscrotal ultrasound revealed a fluid collection with abdominal and scrotal components, communicating through the deep inguinal ring. Sagittal views of magnetic resonance imaging (MRI) showed a dumbbell-shaped hydrocele and the angio-MRI venous sequences confirmed the compression of the right iliac vessels. Curative treatment was surgical through an inguinal approach and consisted in high ligation of the processus vaginalis and hydrocelectomy. Abdominoscrotal hydrocele is an uncommon pathology, which rarely occurs in pediatric population. This diagnosis should be discussed when a cystic abdominal mass is associated to an ipsilateral scrotal hydrocele. The abdominal component of the hydrocele can result in compression of adjacent structures (iliac vessels, ureter). Surgical treatment is recommended. Epididymal and testicular abnormalities are frequently described, as in our observation, and the effects on the future fertility are unknown.

  11. Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of acute pulmonary embolism and lower extremity deep venous thrombosis: A novel one-stop endovascular strategy.

    Science.gov (United States)

    Liu, Bing; Liu, MingYuan; Yan, LiHong; Yan, JunWei; Wu, Jiang; Jiao, XueFei; Guo, MingJin

    2018-02-01

    Objective This study was performed to evaluate the efficacy and feasibility of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in patients with acute pulmonary embolism (APE) and lower extremity deep venous thrombosis (LEDVT). Methods In total, 20 consecutive patients with APE and LEDVT were prospectively selected for PMT combined with CDT. Mechanical thrombus fragmentation and aspiration using a pigtail rotation catheter followed by CDT was performed in each patient. Details regarding the patients' clinical presentation and outcome, pulmonary status parameters (pulmonary arterial pressure, partial pressure of oxygen in arterial blood, Miller score, thigh and calf circumference, and shock index), and lower extremity parameters (thrombus-lysis grade and Villalta scale score) were recorded. Results All 20 patients' clinical manifestations significantly improved. Both the clinical success rate and technical success rate were 100%. No major adverse events occurred during hospitalization. Four patients developed iliac vein compression syndrome and underwent stent implantation in the iliac vein. No pulmonary embolism recurred within 16.5±6.8 months of follow-up. Conclusions The combination of PMT and CDT is a safe and effective treatment for APE and LEDVT with good short- and intermediate-term clinical outcomes.

  12. The hyperaemic response to passive leg movement is dependent on nitric oxide

    DEFF Research Database (Denmark)

    Mortensen, Stefan Peter; Askew, Christopher D; Walker, Meegan

    2012-01-01

    interstitial space. Inhibition of NO synthesis lowered the vasodilatory response to passive leg movement by ~90%. The increase in leg blood flow was lower in elderly subjects compared to young subjects and leg blood flow did not increase when passive leg movement was performed by elderly with peripheral artery...... disease. The results suggest that the hyperaemia induced by passive leg movement is NO dependent. The hyperaemic response to passive leg movement and to ACh was also assessed in elderly subjects and patients with peripheral artery disease.......Key points Passive leg movement is associated with a ~3-fold increase in blood flow to the leg, but the underlying mechanisms remain unknown. Passive leg movement increased venous levels of metabolites of nitric oxide (NO) in young subjects, whereas they remained unaltered in the muscle...

  13. Mesenteric venous thrombosis

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001157.htm Mesenteric venous thrombosis To use the sharing features on this page, please enable JavaScript. Mesenteric venous thrombosis (MVT) is a blood clot in one or ...

  14. Glucose-induced thermogenesis in splanchnic and leg tissues in man

    DEFF Research Database (Denmark)

    Simonsen, L; Ryge, C; Bülow, J

    1995-01-01

    and lactate were taken from an artery, a hepatic vein and a femoral vein. Blood flow in the splanchnic region was measured by constant infusion of Indocyanine Green. Leg blood flow was measured by venous occlusion strain-gauge plethysmography. Oxygen uptake and carbon dioxide output in the splanchnic and leg...

  15. Metabolic and mechanical involvement of arms and legs in simulated double pole skiing

    DEFF Research Database (Denmark)

    Rud, B; Secher, N H; Nilsson, J

    2014-01-01

    We evaluated arm and leg work rate and metabolism during double pole ergometer skiing. Thermodilution arm and leg blood flow was determined together with the arterial to venous difference for oxygen, while the work rate was assessed in eight male recreational skiers [24 (SD 7) years]. When work r...

  16. 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.)

  17. Epidemiology, etiology, and treatment of chronic leg ulcer ...

    African Journals Online (AJOL)

    smoking, obesity, and diabetes. The treatment of venous ulcer is expensive, leading to large economic burden on health services in many countries. The aim of this communication is to determine the incidence, etiology, and presentation of chronic leg ulcer. It is also to evaluate the various modalities of treatment used in a ...

  18. Clinical overview of venous thromboembolism | Schellack | South ...

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a ...

  19. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    However, the high level of thromboprophylaxis practice appears doubtful because only a few of these physicians carry out VTE risk assessment for their patients as well as follow clinical guidelines on VTE thromboprophylaxis. Key words: Venous thromboembolism, deep vein thrombosis, pulmonary embolism, risk factor, ...

  20. The diagnostic accuracy of magnetic resonance venography in the detection of deep venous thrombosis: a systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Abdalla, G.; Fawzi Matuk, R.; Venugopal, V.; Verde, F.; Magnuson, T.H.; Schweitzer, M.A.; Steele, K.E.

    2015-01-01

    Aim: To search the literature for further evidence for the use of magnetic resonance venography (MRV) in the detection of suspected DVT and to re-evaluate the accuracy of MRV in the detection of suspected deep vein thrombosis (DVT). Materials and methods: PubMed, EMBASE, Scopus, Cochrane, and Web of Science were searched. Study quality and the risk of bias were evaluated using the QUADAS 2. A random effects meta-analysis including subgroup and sensitivity analyses were performed. Results: The search resulted in 23 observational studies all from academic centres. Sixteen articles were included in the meta-analysis. The summary estimates for MRV as a diagnostic non-invasive tool revealed a sensitivity of 93% (95% confidence interval [CI]: 89% to 95%) and specificity of 96% (95% CI: 94% to 97%). The heterogeneity of the studies was high. Inconsistency (I2) for sensitivity and specificity was 80.7% and 77.9%, respectively. Conclusion: Further studies investigating the use of MRV in the detection of suspected DVT did not offer further evidence to support the replacement of ultrasound with MRV as the first-line investigation. However, MRV may offer an alternative tool in the detection/diagnosis of DVT for whom ultrasound is inadequate or not feasible (such as in the obese patient). -- Highlights: •We aimed to search the literature for evidence for the use of MRV in the detection of suspected DVT. •We questioned the use of MRV in special populations like the obese where contrast venography may not be feasible or safe. •MRV may not replace ultrasound as the first-line modality for DVT detection. •Consider MRV use in special populations like the obese where other diagnostic tools are not feasible. •Studies to compare MRV vs. ultrasound as a screening tool for DVT in the obese should be considered

  1. Leg lengthening - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100127.htm Leg lengthening - series—Indications To use the sharing features ... with lengthening procedures are the bones of the leg, the tibia and the femur. Surgical treatment may ...

  2. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features ... Overview The arteries which supply blood to the leg originate from the aorta and iliac vessels. Review ...

  3. Leg lengthening and shortening

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002965.htm Leg lengthening and shortening To use the sharing features on this page, please enable JavaScript. Leg lengthening and shortening are types of surgery to ...

  4. Efectividad del tratamiento de las úlceras venosas con vendaje compresivo multicapa asociado a protección de la piel perilesional con Cavilon® (película barrera no irritante Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film in the treatment of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    N. Serra

    2010-09-01

    Full Text Available Introducción: el adecuado tratamiento de las úlceras de extremidad inferior de etiología venosa es fundamental para mejorar la calidad de vida de los pacientes. El uso de terapia compresiva con vendaje multicapa es el tratamiento que mejores resultados presenta. En la práctica, se utiliza en combinación con unos adecuados cuidados locales de la herida y de la piel perilesional. El objetivo del estudio fue evaluar la efectividad clínica de un vendaje multicapa de compresión y el impacto de la utilización de la película barrera Cavilon® en úlceras vasculares de origen venoso. Metodología: ensayo clínico controlado, aleatorizado, abierto, multicéntrico y pragmático en España. Todos los pacientes incluidos fueron tratados con terapia de compresión con el mismo vendaje multicapa y asignados aleatoriamente al grupo de intervención, tratados con la PBNI Cavilon®, o al grupo control. Se realizaron un máximo de 13 visitas de estudio separadas entre ellas por una semana. El estudio fue evaluado y aprobado por los comités éticos de investigación clínica (CEIC de los siete centros participantes. Resultados: participaron 98 pacientes en el estudio (49 en el grupo intervención y 49 como control. Tras cuatro semanas, el grupo intervención presentó una reducción media (DE del tamaño de úlcera superior al grupo control (56,7% (30,3 vs. 45,5% (47,4; p = 0,087. A las 12 semanas de tratamiento, las diferencias observadas fueron estadísticamente significativas (83,4% (31,1 vs. 71,6% (44,1; p = 0,046. El 69,4% de los pacientes del grupo intervención redujo el área de úlcera en > 50% en las cuatro primeras semanas de tratamiento, respecto al 46,9% de los pacientes del grupo control (p Aim: appropriate treatment of venous leg ulcers is essential to improve the quality of life of patients. Compression therapy using multilayer bandages show to the best clinical results. In practice, it is used in combination with a suitable local care of

  5. Veias soleares: bases anatômicas e seu papel na origem da trombose venosa profunda em membro inferior Soleus veins: anatomic basis and their role in the origin of deep venous lower limb thrombosis

    Directory of Open Access Journals (Sweden)

    Carlos Miguel Gomes Sequeira

    2007-08-01

    and perforating veins, was performed. Then reflection of the subcutaneous tissue and fascia, detachment and reflection of the gastrocnemius and plantaris muscles, detachment of the tibial origin of the soleus muscle, differentiation of the soleus veins and study of morphometric parameters were carried out. The region was divided into six sectors: superior-medial, superior-lateral, medio-medial, medio-lateral, inferior-medial and inferior-lateral. Data obtained from Wilcoxon and Friedman nonparametric tests were utilized for statistical analysis. RESULTS: In the dissected legs 4679 soleus veins were found. The sector with the greatest number of soleus veins was the superior-lateral (1529 veins - 32.7%, followed by the mediomedial (1.256 veins - 26.8% and the mediolateral sectors (975 veins - 20.8%. The extremities drained into communicant veins (1.207 veins - 25.8%, posterior tibial veins (964 veins - 20.6%, peroneal veins (709 veins - 15.2% and into 32 other types (1.799 veins 38.4%. CONCLUSION: The venous drainage of the soleus muscle is carried out by a great number of soleus veins which are frequently located in the superior-lateral, mediomedial and mediolateral sectors, more often going into the posterior tibial, peroneal and communicant veins.

  6. Factors associated with poor healing and recurrence of venous ulceration.

    Science.gov (United States)

    Labropoulos, Nicos; Wang, Eric D; Lanier, Steven T; Khan, Sami U

    2012-01-01

    Plastic surgeons are often approached for wound management and closure of chronic venous ulcers that fail to heal despite multimodal management. The authors present a retrospective analysis of a large series of venous ulcers to determine factors predicting nonhealing and recurrence. Consecutive patients with chronic venous ulcers (≥ 2-cm diameter) were examined for the presence of superficial, perforating, or deep venous disease, including reflux and/or obstruction. Treatment included compression, venous ligation, stripping, thermal ablation, sclerotherapy, and local wound care. Ulcers refractory to 6 months of treatment were defined as nonhealing ulcers. Data were analyzed for differences in baseline patient and ulcer characteristics and clinical course of nonhealing ulcers. Data were compared using Wilcoxon rank sum, chi-square, and Fisher's exact tests using Sigma Stat and SPSS, with α set at p ulcers in 127 patients. Factors associated with ulcer nonhealing included advanced age, increased body mass index, history of deep venous thrombosis, noncompliance with compression therapy, and large ulcer area. One hundred thirty-one of the ulcers (85.6 percent) healed within 6 months and 147 (96 percent) of the ulcers ultimately healed without the need for operative plastic surgical intervention. A thorough understanding of risks and expected clinical course is required for assessment of the nonhealing venous ulcer. The authors recommend identification and correction of underlying venous abnormality and a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function before operative plastic surgical intervention should be considered. Risk, III.

  7. Primary chronic venous insufficiency of the lower extremities: preoperative color duplex Doppler ultrasound study; Insuficiencia venosa cronica primaria de los miembros inferiores. Valoracion prequirurgica con ecografia Doppler duplex color

    Energy Technology Data Exchange (ETDEWEB)

    Selfa, S.; Diago, T.; Ricart, M.; Chulia, R.; Martin, F. [Hospital Lluis Xativa. Valencia (Spain)

    2000-07-01

    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)

  8. [The 455th case: swollen leg, jaundice and mental disturbance].

    Science.gov (United States)

    Dong, R; Weng, L; Guo, T; Zhu, T N; Zhao, J L; Wu, Q J; Zeng, X F

    2017-04-01

    A 17-year-old young man with a history of swollen leg and intermittent jaundice was presented to Peking Union Medical College Hospital with acute fever and mental disturbance. He developed deep venous thrombosis, acute myocardial infarction and plantar skin necrosis during the past four years, and was presented with an acute episode of fever, thrombocytopenia, acute kidney injury, acute myocardial infarction, mental disturbance, and obstructive jaundice. Laboratory tests showed schistocytes on peripheral blood smear.High titer of antiphospholipid antibodies was detected.Strikingly, the activity of a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS13)was significantly decreased without the production of inhibitors. Images indicated stenosis of the common bile duct, common hepatic duct, and cystic duct, which caused dilation of bile ducts and the gall bladder. Corticosteroids and anticoagulation therapy were effective at first, but the disease relapsedonce the corticosteroids tapered down. Plasma exchange was administrated for 17 times, which was effective temporarily during this episode. Methylprednisolone pulse therapy, intravenous immunoglobulin, rituximab, anticoagulation therapy, and bile drainage, were all tried but still could not control the disease. The patient's family agreed to withdraw treatment after he developed septic shock.

  9. Complement C3 and High Risk of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Nørgaard, Ina; Nielsen, Sune Fallgaard; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS: We...... included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003-2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals...... were lost to follow-up. RESULTS: Complement C3 concentrations were approximately normally distributed, with a mean value of 1.13 g/L (interquartile range 0.98-1.26; SD 0.21). The cumulative incidence of venous thromboembolism was higher with progressively higher tertiles of complement C3 (log...

  10. Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril Comparative study between rivaroxaban and enoxaparin in deep venous thromboembolism prophylaxis in patients submitted to total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Pedro Silva Kanan

    2008-08-01

    profunda e tromboembolismo pulmonar.OBJECTIVE: To compare the effectiveness and safety of rivaroxaban to those of enoxaparin for the prophylaxis of deep venous thrombosis (DVT after total hip arthroplasty. METHODS: From September 2006 to April 2007, at the Orthopedics and Traumatology Clinic of the Hospital Complex of the Santa Casa of Porto Alegre, State of Rio Grande do Sul, a randomized, double-blind clinical trial was carried out in which 67 patients were selected (n = 67, all of them submitted to total hip arthroplasty (ATQ. Of these patients, two were excluded for lack of adherence to the prophylaxis proposed after hospital release (n = 65. One of the groups was given subcutaneous 40 mg enoxaparin 6 hours to 8 hours before surgery, and after surgery a placebo pill was added, for once a day oral intake, during the first 32 to 36 days. The other group was given oral 10 mg rivaroxaban, once a day, during the first 32 to 36 post-operative days. In order to have the double-blind feature of the study, a subcutaneous placebo injection was given 6 hours to 8 hours before surgery and on the 32 to 36 days following surgery. The main outcome aimed at was the effectiveness in preventing DVT, which was evaluated by bilateral venography carried out between days 32 and 36 after surgery, or through documented symptoms of deep venous thrombosis or pulmonary thromboembolism (PTE. The secondary outcome studied was administration safety, that was evaluated through major bleeding or liver toxicity. RESULTS: Rivaroxaban and enoxaparin showed similar results (the differences were not statistically significant when compared for the reduction of DVT incidence till the 36th post-operative day. There was no difference in blood loss and liver toxicity when the drugs were compared. CONCLUSION: In patients submitted to total hip arthroplasty, rivaroxaban showed as effective and safe as enoxaparin to prevent deep venous thrombosis and pulmonary thromboembolism.

  11. Foot, leg, and ankle swelling

    Science.gov (United States)

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  12. The restless legs syndrome (Ekbom's syndrome)

    African Journals Online (AJOL)

    1983-04-30

    Apr 30, 1983 ... same distribution as the paraesthesiae; and (v) anxiety, tension or mild depression. Paraesthesiae or creeping sensations are usually confined to the calves. They are extremely unpleasant and deep-seated in muscles or bones rather than in the skin, mostly affecting the legs between the knee and ankle.

  13. VenUS II : a randomised controlled trial of larval therapy in the management of leg ulcers

    OpenAIRE

    Dumville, J. C.; Worthy, G.; Soares, M. O.; Bland, J. M.; Cullum, N.; Dowson, C.; Iglesias, C.; McCaughan, D.; Mitchell, J. L.; Nelson, E. A.; Torgerson, D. J.

    2009-01-01

    Objectives: To compare the clinical effectiveness and cost-effectiveness of larval therapy with a standard debridement technique (hydrogel). Design: A pragmatic, three-arm, randomised controlled trial with an economic evaluation. Setting: Community nursing services, community leg ulcer clinics and hospital outpatient leg ulcer clinics. A range of urban and rural settings. Participants: Patients with venous or mixed venous/arterial ulcers (minimum ankle brachial pressure index of 0.6) where a ...

  14. Omics profiles in chronic venous ulcer wound fluid: innovative applications for translational medicine.

    Science.gov (United States)

    Mannello, Ferdinando; Ligi, Daniela; Canale, Matteo; Raffetto, Joseph D

    2014-07-01

    Chronic venous disease represents a healthcare problem due to high prevalence and recurrence rates. Studies on chronic venous ulcer wound fluid (CVUWF) have demonstrated increased inflammation and proteolysis which can cause tissue destruction and delayed healing. This review discusses: nearly all known metabolites discovered in the past 25 years in CVUWF studies; the omics approaches characterizing the microenvironment of human venous leg ulcers; and the use of biocompounds as prognostic biomarkers and as possible targets for therapeutic approaches. A biomarker is a biological compound that can be functional or non-functional, specific or non-specific in the diagnosis/prognosis to a disease state and may be quantified to determine progression or regression of disease. Omics studies in CVUWF provide the impetus for future identification of biomarkers within the intricate network in chronic venous disease and set the basis for determining the appropriate combination of molecules that are expressed with the healing status of venous leg ulcers.

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

    Science.gov (United States)

    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.

  16. Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle.

    Science.gov (United States)

    Liu, K; Chen, L E; Seaber, A V; Johnson, G W; Urbaniak, J R

    1999-01-01

    Intermittent pneumatic compression has been established as a method of clinically preventing deep vein thrombosis, but the mechanism has not been documented. This study observed the effects of intermittent pneumatic compression of legs on the microcirculation of distant skeletal muscle. The cremaster muscles of 80 male rats were exposed, a specially designed intermittent pneumatic-compression device was applied to both legs for 60 minutes, and the microcirculation of the muscles was assessed by measurement of the vessel diameter in three categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed significant vasodilation in arterial and venous vessels during the application of intermittent pneumatic compression, which disappeared after termination of the compression. The vasodilation reached a maximum 30 minutes after initiation of the compression and could be completely blocked by an inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine (10 micromol/min). A 120-minute infusion of NG-monomethyl-L-arginine, beginning coincident with 60 minutes of intermittent pneumatic compression, resulted in a significant decrease in arterial diameter that remained at almost the same level after termination of the compression. The magnitude of the decrease in diameter in the group treated with intermittent pneumatic compression and NG-monomethyl-L-arginine was comparable with that in the group treated with NG-monomethyl-L-arginine alone. The results imply that the production of nitric oxide is involved in the positive influence of intermittent pneumatic compression on circulation. It is postulated that the rapid increase in venous velocity induced by intermittent pneumatic compression produces strong shear stress on the vascular endothelium, which stimulates an increased release of nitric oxide and thereby causes systemic vasodilation.

  17. The Incidence of Giacomini Vein and Its Association with Lower Extremity venous Insufficiency: An Ultrasonographic Study

    International Nuclear Information System (INIS)

    Park, Soon Chan; Kwon, Se Hwan; Oh, Joo Hyeong; Ryu, Kyung Nam; Ahn, Hyung Joon; Park, Ho Chul

    2009-01-01

    We wanted to evaluate the incidence of Giacomini vein and its association with lower extremity venous insufficiency by performing US. From September 2006 to July 2007, 173 patients (58 males and 115 females, mean age: 52.7 years, age range: 22-72 years) who had been diagnosed with unilateral/bilateral varicose veins or telangiectasias were evaluated with duplex Doppler ultrasonography. The presence of Giacomini vein, superficial/deep vein reflux, the anatomical sites of the venous reflux and the abnormal perforating veins was investigated in 346 legs. Giacomini veins were found in 33 limbs (9.5%) of 21 patients (12.1%). Bilateral Giacomini veins were found in 12 patients. Of the 33 limbs that had Giacomini veins, 20 limbs had great saphenous vein (GSV) reflux and 4 limbs had small saphenous vein (SSV) reflux. The patients with Giacomini veins were classified into two groups according to the presence of Giacomini vein. There was no significant difference of the GSV reflux (p = 0.155), the SSV reflux (p = 0.760) and the mean velocity of the GSV reflux or the SSV reflux (p = 0.685, p = 0.431, respectively) between the two groups. Our results indicated that Giacomini vein is not associated with either GSV or SSV reflux, and this is contrary to conventional belief

  18. Impact of optimal anticoagulation therapy on chronic venous ulcer healing in thrombophilic patients with post-thrombotic syndrome.

    Science.gov (United States)

    Hinojosa, C A; Olivares-Cruz, S; Laparra-Escareno, H; Sanchez-Castro, S; Tamayo-Garcia, B; Anaya-Ayala, J E

    2016-12-02

    Post-thrombotic syndrome (PTS) is the long-term sequelae of deep venous thrombosis (DVT). PTS clinical manifestations include chronic leg pain, oedema, lipodermatosclerosis and ulcers. The objective of this study is to determine in patients with documented history of thrombophilias and DVT whether the number of previous thrombotic events and optimal anticoagulation therapy are associated with the time to venous ulcer healing following the start of compression therapy. Retrospective analysis performed in thrombophilic patients under the age of 50 years old with chronic venous ulcers secondary to DVT at the wound clinic in the National Institute of Medical Sciences and Nutrition 'Salvador Zubirán ' in Mexico City. Variables such as the number or episodes of thrombotic events, type of hypercoagulable disorder, optimal anticoagulation therapy with Warfarin monitored by therapeutic International Normalised Ratio (INR) (2-3) and compliance to compression therapy were examined. Patients that underwent superficial or perforator vein interruption or endovascular recanalisation of deep veins were excluded from the study. From a database of 29 patients with chronic venous ulcers followed in our clinic from January 1992 to September 2012, only 13 patients (61% female) met the inclusion criteria. Mean age±standard deviation (SD) was 32±12 years old. Of these, seven (54%) patients with suboptimal INR presented with an average of two previous thrombotic events and the remaining six (46%) patients with optimal INR only one event (p=0.28), the mean time to the clinical manifestation of a venous ulcer after the first episode of DVT was 39 months (range: 12-72) for patients with suboptimal INR and 82 months (range: 12-216) for those with optimal anticoagulation therapy (p=0.11). During the mean follow-up period of 52 months, all patients in optimal anticoagulation healed their ulcer; their mean time for wound healing was 44 months (range: 4-102). In the suboptimal INR group, only

  19. Venous thrombosis and coagulation parameters in patients with pure venous malformations

    NARCIS (Netherlands)

    van Es, J.; Kappelhof, N. A.; Douma, R. A.; Meijers, J. C. M.; Gerdes, V. E. A.; van der Horst, C. M. A. M.

    2017-01-01

    Venous malformations (VMs) are ubiquitous, low-flow vascular anomalies known to be occasionally painful due to thrombotic episodes within the lesion. The prevalence of superficial or deep vein thrombosis is unclear. A cross-sectional study among outpatients aged ≥ 12 years with pure VMs was

  20. Venous Leg Ulcers: Effectiveness of new compression therapy/moist ...

    African Journals Online (AJOL)

    It is surprising that fundamental scientific knowledge is given so little attention in daily practice, even in highly developed countries such as Germany, ... without interruption or the use of antibiotics, thanks to the microbe-binding wound dressing. The compression stocking system was greatly appreciated by patients and ...

  1. Animal Model of Acute Deep Vein Thrombosis

    International Nuclear Information System (INIS)

    Roy, Sumit; Laerum, Frode; Brosstad, Frank; Kvernebo, Knut; Sakariassen, Kjell S.

    1998-01-01

    Purpose: To develop an animal model of acute deep vein thrombosis (DVT). Methods: In part I of the study nine juvenile domestic pigs were used. Each external iliac vein was transluminally occluded with a balloon catheter. Thrombin was infused through a microcatheter in one leg according to one of the following protocols: (1) intraarterial (IA): 1250 U at 25 U/min in the common femoral artery (n= 3); (2) intravenous (IV): 5000 U in the popliteal vein at 500 U/min (n= 3), or at 100 U/min (n= 3). Saline was administered in the opposite leg. After the animals were killed, the mass of thrombus in the iliofemoral veins was measured. The pudendoepiploic (PEV), profunda femoris (PF), and popliteal veins (PV) were examined. Thrombosis in the tributaries of the superficial femoral vein (SFVt) was graded according to a three-point scale (0, +, ++). In part II of the study IV administration was further investigated in nine pigs using the following three regimens with 1000 U at 25 U/min serving as the control: (1) 1000 U at 100 U/min, (2) 250 U at 25 U/min, (3) 250 U at 6.25 U/min. Results: All animals survived. In part I median thrombus mass in the test limbs was 1.40 g as compared with 0.25 g in the controls (p= 0.01). PEV, PFV and PV were thrombosed in all limbs infused with thrombin. IV infusion was more effective in inducing thrombosis in both the parent veins (mass 1.32-1.78 g) and SVFt (++ in 4 of 6 legs), as compared with IA infusion (mass 0.0-1.16 g; SFVt ++ in 1 of 3 legs). In part II thrombus mass in axial veins ranged from 1.23 to 2.86 g, and showed no relationship with the dose of thrombin or the rate of infusion. Tributary thrombosis was less extensive with 250 U at 25 U/min than with the other regimens. Conclusion: Slow distal intravenous thrombin infusion in the hind legs of pigs combined with proximal venous occlusion induces thrombosis in the leg veins that closely resembles clinical DVT in distribution

  2. 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

  3. Superficial and deep vein thrombosis associated with congenital absence of the infrahepatic inferior vena cava in a young male patient.

    Science.gov (United States)

    O'Connor, Donal B; O'Brien, Noel; Khani, Tahir; Sheehan, Stephen

    2011-07-01

    Congenital absence of the inferior vena cava (AIVC) is a rare vascular anomaly that may be associated with deep vein thrombosis (DVT). It is underreported and may be present in up to 5% of young patients with DVT. We report a unique case of simultaneous thrombosis of both superficial and deep veins in a patient with AIVC. A 20-year-old man presented with a 2-week history of a swollen, painful, left lower limb. On examination, the left leg and thigh were found to be swollen and varicosities were present along the lower abdominal wall. Ultrasound showed extensive superficial and deep venous thrombosis of the entire left lower limb. Computed tomography venogram revealed an infrahepatic AIVC with lower limb drainage through enlarged intrathoracic continuations of the azygous and hemiazygous veins. The patient was put on oral anticoagulant therapy and was well at 6-month follow-up. The hypothesis for DVT in patients with AIVC is that venous drainage of the lower limbs is inadequate, leading to venous stasis and thrombosis. All young patients presenting with idiopathic DVT should be investigated for inferior vena cava anomalies with computed tomography if ultrasound does not visualize the inferior vena cava. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  4. Dynamic Leg Exercise Improves Tolerance to Lower Body Negative Pressure

    Science.gov (United States)

    Watenpaugh, D. E.; Ballard, R. E.; Stout, M. S.; Murthy, G.; Whalen, R. T.; Hargens, A. R.

    1994-01-01

    These results clearly demonstrate that dynamic leg exercise against the footward force produced by LBNP substantially improves tolerance to LBNP, and that even cyclic ankle flexion without load bearing also increases tolerance. This exercise-induced increase of tolerance was actually an underestimate, because subjects who completed the tolerance test while exercising could have continued for longer periods. Exercise probably increases LBNP tolerance by multiple mechanisms. Tolerance was increased in part by skeletal muscle pumping venous blood from the legs. Rosenhamer and Linnarsson and Rosenhamer also deduced this for subjects cycling during centrifugation, although no measurements of leg volume were made in those studies: they found that male subjects cycling at 98 W could endure 3 Gz centrifugation longer than when they remained relaxed during centrifugation. Skeletal muscle pumping helps maintain cardiac filling pressure by opposing gravity-, centrifugation-, or LBNP-induced accumulation of blood and extravascular fluid in the legs.

  5. [Physiotherapy potentials improve the calf muscle pump function in chronic venous insufficiency].

    Science.gov (United States)

    Dymarek, Robert; Ptaszkowski, Kuba; Słupska, Lucyna; Rajfur, Joanna; Pasternok, Małgorzata; Taradaj, Jakub; Halski, Tomasz

    2014-01-01

    Mechanism of the calf muscle pump plays a major role in venous blood return from peripheral parts of blood vessels of lower extremities. It enables a smooth venous blood movement from the deep venous system segment located below in a direction to the segment lying above which effectively prevents a distal blood stasis and veno-lymphatic edema of lower limbs. Calf muscle pump dysfunction together with disorders in the construction of blood vessels walls and with endurance weakness of valves, leads to venous hypertension and contributes to the development of venous insufficiency. The aim of this paper is to demonstrate the theoretical basis including venous return physiology and the mechanism of lower limbs venous--muscle pump as well as provide practical application of physiotherapy methods to support the properfunction of presented calf muscle pump. Examples in the field of physical medicine, compression therapy and kinesiotherapy for improving the efficiency of lower extremity muscles, providing a physiological venous return.

  6. Chronic venous disorders

    African Journals Online (AJOL)

    engage in social and occupational activities, reduce QoL, and impose financial constraints. CVD has a significant financial ... 'heaviness or aching' aggravated by prolonged standing and relieved by elevation. Additionally, chronic .... of image acquisition based on venous filling. Abnormalities in venous flow are depicted.

  7. The effect of ankle range of motion on venous ulcer healing rates.

    Science.gov (United States)

    Yim, Elizabeth; Richmond, Nicholas A; Baquerizo, Katherine; Van Driessche, Freya; Slade, Herbert B; Pieper, Barbara; Kirsner, Robert S

    2014-01-01

    Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes. © 2014 by the Wound Healing Society.

  8. Dynamically Stable Legged Locomotion.

    Science.gov (United States)

    1983-01-27

    balanced itself in 31) using a tabular ctontrol sclwnme. With only thUiee actuated degrees it used a shuffling gait to balance that reminds one of Charlie ... Chaplin . * The present study explores the control of a physical one-legged hopping machine. The objective of using a machine with only one leg was to

  9. Lyden-af-Leg

    DEFF Research Database (Denmark)

    Toft, Herdis

    Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform.......Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform....

  10. Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2014-12-01

    Full Text Available Objective:Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT. Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV for these diagnoses is under investigation.Methods:Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed.Results:A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035 (Fisher's exact test. There was a positive relationship between clinical classification (CEAP and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011.Conclusion:Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI.

  11. Venous muscle pump function during pregnancy. Assessment by ambulatory strain-gauge plethysmography

    DEFF Research Database (Denmark)

    Struckmann, J R; Meiland, H; Bagi, P

    1990-01-01

    The venous muscle pump function was quantitatively assessed through pregnancy weeks 16, 30, 38 and 3 months (week 53) following delivery, in 24 pregnant women who completed a normal pregnancy. A statistically significant increase was found in the mean venous reflux (P less than 0.01), which...... was restored to initial values postpartum. Expelled calf volume remained stable throughout pregnancy but increased following delivery. Venous outflow from the legs was significantly reduced in the third trimester. Subjective symptoms of venous insufficiency increased through pregnancy, but, these symptoms had...... virtually disappeared post partum, corresponding to the muscle pump normalization. No statistical correlation was found between venous muscle pump values and changes in hormone concentrations of estradiol, estriol and progesterone. It is suggested that venous insufficiency development in pregnancy is caused...

  12. Deep Vein Thrombosis

    African Journals Online (AJOL)

    OWNER

    ABSTRACT. 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 ...

  13. Assessment of nursing problems for patients after leg vein varicose surgery

    OpenAIRE

    Ardavičiūtė, Aneta

    2016-01-01

    Patients, who suffer from chronic venous blood flow deficiency, feel pain, discomfort, fatigue and other symptoms that disturb the quality of life, emotional wellbeing, and it is a common reason for incapacity and disability. Surgical treatment of venous deficiency includes not only the patient, but also nursing staff. It requires considering post-operative symptoms and needs of the patient. Keywords: leg veins, surgery, nursing, patient, nurse. The aim of research work: to determine and asse...

  14. [The contribution of Doppler echography in the diagnostic and therapeutic plan in chronic venous insufficiency surgery].

    Science.gov (United States)

    Perrin, M

    1993-01-01

    Indications for duplex scan in venous surgery. Vascular surgeons are led to request Duplex Scan examination of patients with chronic venous insufficiency in a number of circumstances: A) To obtain information supporting the diagnosis and treatment plan: Chronic venous insufficiency may be due to isolated superficial venous insufficiency or (and) deep venous insufficiency (post-thrombotic syndrome, primary deep valvular insufficiency, congenital malformation). In practice, Duplex Scan examination of the deep venous system is indicated whenever the patient's history is suggestive of deep venous thrombosis or the clinical status is stage 2 or 3 (Ad Hoc Committee classification). In patients with reflux in the popliteal fossa, Duplex Scan is helpful because physical examination and Doppler cannot correctly differentiate short saphenous insufficiency, gastrocnemius insufficiency and reflux in the popliteal-tibial axis, especially as these physiopathologic mechanisms may be associated. In patients with atypical varices, Duplex Scan can demonstrate: Absence of reflux in the greater saphenous vein-femoral vein termination or the short saphenous vein-popliteal vein termination. Varices in the lateral or posterior thigh. In patients with varicose vein thrombosis, Duplex Scan can reveal: The extent of any association with deep venous system. The extent of superficial venous thrombosis. When the results of varicose vein surgery are unsatisfactory, Duplex Scan can determine whether a redo surgery is justified: Persistence of a major leak between the deep and superficial venous system usually prompts redo surgery. Less often, recurrence is due to primary deep valvular insufficiency, in which case valvuloplasty may be indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Venous ulcer review

    Science.gov (United States)

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  16. Venous ulcer review

    OpenAIRE

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Paul Bevis, Jonothan Earnshaw Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, UKDate of preparation: 3 February 2011Conflict of interest: None declared.Clinical question: What is the best treatment for venous ulcers?Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recu...

  17. 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

  18. RESTLESS LEGS SYNDROME

    Directory of Open Access Journals (Sweden)

    Dmitriy Valer'evich Artem'ev

    2009-01-01

    Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

  19. Restless legs syndrome.

    Science.gov (United States)

    Venkateshiah, Saiprakash B; Ioachimescu, Octavian C

    2015-07-01

    Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine. Published by Elsevier Inc.

  20. Compression for preventing recurrence of venous ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Bell-Syer, Sally E M

    2014-09-09

    Up to 1% of adults will have a leg ulcer at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing/repairing the veins, or by applying compression bandages/stockings to reduce the pressure in the veins.The majority of venous ulcers heal with compression bandages, however ulcers frequently recur. Clinical guidelines therefore recommend that people continue to wear compression, usually in the form of hosiery (tights, stockings, socks) after their ulcer heals, to prevent recurrence. To assess the effects of compression (socks, stockings, tights, bandages) in preventing the recurrence of venous ulcers. If compression does prevent ulceration compared with no compression, then to identify whether there is evidence to recommend particular levels of compression (high, medium or low, for example), types of compression, or brands of compression to prevent ulcer recurrence after healing. For this second update we searched The Cochrane Wounds Group Specialised Register (searched 4 September 2014) which includes the results of regular searches of MEDLINE, EMBASE and CINAHL; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). Randomised controlled trials (RCTs)evaluating compression bandages or hosiery for preventing the recurrence of venous ulcers. Two review authors undertook data extraction and risk of bias assessment independently. Four trials (979 participants) were eligible for inclusion in this review. One trial in patients with recently healed venous ulcers (n = 153) compared recurrence rates with and without compression and found that compression significantly reduced ulcer recurrence at six months (Risk ratio (RR) 0.46, 95% CI 0.27 to 0.76).Two trials compared high-compression hosiery (equivalent to UK class 3) with

  1. Total superficial vein reflux eradication in the treatment of venous ulcer.

    Science.gov (United States)

    Kanchanabat, Burapa; Stapanavatr, Waigoon; Kanchanasuttiruk, Pong

    2015-05-01

    Total superficial vein reflux eradication in the treatment of venous ulcer. Our initial experience with groin-knee vein stripping resulted in recurrent or unhealed venous ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active venous ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active venous ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous ulcer could be satisfactory treated by the total removal of the peri-ulcer reflux.

  2. Urinary hemosiderin: role in evaluation of chronic venous insufficiency

    OpenAIRE

    Ashish Lal Shrestha; Indrani Sen; Edwin Stephen; Prabhu Premkumar; Sunil Agarwal; Sukesh Chandran

    2012-01-01

    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 du...

  3. [Plastic surgery treatment of chronic venous ulcera cruris].

    Science.gov (United States)

    Wechselberger, G; Aefel, L; Schwabegger, A; Papp, C

    1995-03-01

    Due to basic differences between the conservative and surgical approaches to the treatment of chronic venous leg ulcer, there are still a large variety of different therapeutic strategies applied today. Satisfactory results in the treatment of this kind of recurrent ulcers can only be achieved by a combination of plastic and vascular surgical techniques. Our surgical procedure is illustrated by 30 cases treated between 1990 and 1993.

  4. [Mixed leg ulcers].

    Science.gov (United States)

    Willenberg, Torsten

    2011-03-01

    Coexisting peripheral arterial disease is not uncommon (15 - 21 %) in patients with ulcera cruris primarily based on a venous etiology. Patient's history, clinical examination and detection of ABI as well as duplex scan will establish diagnosis of mixed arterial-venous ulcera. Clinical significance of coexisting arterial disease is often difficult to define and should be evaluated by a vascular specialist. The concept of treatment of mixed ulcers should always include the arterial component. Frequently peripheral arterial perfusion and healing can be improved by minimal invasive, endovascular revascularization. Compression therapy is the corner stone in treatment of venous disease and should be complemented by contemporary two piece graduated compression systems if ulcera are present. According to circumstances ablation of varicose veins must be considered.

  5. Obesity and lower limb venous disease - The epidemic of phlebesity.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Singhal, Rishi; Smith, Neil; Bradbury, Andrew W

    2017-05-01

    Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately

  6. 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

  7. Venous Thromboembolism (VTE)

    Science.gov (United States)

    ... have typical symptoms, so diagnosis is difficult. A big mis- conception is that there should be something visible with DVT. Most DVTs are associated with leg pain or mild swelling only, and the perception ...

  8. Venous Thromboembolism Incidence After Craniofacial Surgery.

    Science.gov (United States)

    Omesiete, Wilson I; Walker, James A; Yu, Jack C

    2018-05-01

    Current protocols for venous thromboembolism (VTE) prophylaxis after craniofacial surgery (CFS) vary widely with substantial disagreements in both indications and managements. An evidence-based approach to this issue requires the following: the incidence of postoperative VTE, comorbidities associated with coagulopathy, risk reduction after VTE prophylaxis, and complications attributable to prophylaxis. This study addresses the first two. Retrospective cross-sectional study. Discharge data from 64,170 patients undergoing CFS between 2008 and 2013 extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were analyzed. The outcome measures extracted were: deep venous thrombosis, pulmonary embolism, demographic data, common comorbidities, length of stay, total cost, and discharge outcome. Diagnoses of deep venous thrombosis or pulmonary embolism, collectively classified as VTE, were observed in 355 (0.55%) of 64,170 patients discharged after CFS. Other surgeries exhibited a VTE rate of 1.17%. Men exhibited nearly double the incidence of VTE relative to women (0.69% compared with 0.37% respectively, P use did not exhibit any significant association (odds ratio, 0.94; P = 0.679). Afflicted patients experienced 4.60 times longer hospital stays averaging 23.8 days (95% confidence interval, 21.4-26.2; P use of VTE chemoprophylaxis is appropriate.

  9. Changes in lipid metabolism and extension of venous thromboembolism.

    Science.gov (United States)

    Belaj, Klara; Hackl, Gerald; Rief, Peter; Eller, Philipp; Brodmann, Marianne; Gary, Thomas

    2014-01-01

    Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common diseases with a vast number of acquired and congenital risk factors. Disorders of the lipid metabolism are not established risk factors for venous thromboembolism (VTE) so far. However, in recent literature, associations between VTE and the metabolic syndrome, especially with elevated lipid parameters, have been described. The aim of our study was to investigate the association between the extension of VTE and changes in the lipid profile. We included 178 VTE patients in our study; 59 patients had isolated PE, 39 patients had isolated DVT of the leg and 80 patients had both (DVT and PE). Concerning PE, we distinguished between massive and submassive PE. We evaluated plasma lipids and lipoproteins in PE and DVT patients as well as in massive and submassive PE patients. PE patients had higher levels of plasma triglycerides [median (interquartile range): 162 (109-254) vs. 136.5 (96.5-162) mg/dl, p = 0.047] and lower levels of high-density lipoprotein cholesterol (HDL-C; 52.1 ± 17.2 vs. 63.9 ± 22.7 mg/dl, p = 0.004) than DVT patients. Furthermore, PE patients were significantly older than DVT patients (59.6 ± 16.9 vs. 52.2 ± 15.5 years, p = 0.02). We were not able to find differences in lipid parameters in patients with massive PE compared to those with submassive PE. However, patients with massive PE were more obese than patients with submassive PE (body mass index 29.1 ± 4.6 vs. 26.9 ± 4.9, p = 0.012). Lipid parameters and lipoproteins differ between DVT and PE patients. PE patients had higher triglyceride and lower HDL-C levels compared with DVT patients. © 2014 S. Karger AG, Basel.

  10. Apixaban or Dalteparin in Reducing Blood Clots in Patients With Cancer Related Venous Thromboembolism

    Science.gov (United States)

    2017-12-28

    Cerebral Vein Thrombosis; Deep Vein Thrombosis; Gonadal Thrombosis; Hepatic Thrombosis; Malignant Neoplasm; Mesenteric Thrombosis; Metastatic Malignant Neoplasm; Portal Vein Thrombosis; Pulmonary Embolism; Renal Vein Thrombosis; Splenic Thrombosis; Venous Thromboembolism

  11. 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

  12. Evaluation of quality of life and photoplethysmography in patients with chronic venous insufficiency treated with foam sclerotherapy

    Directory of Open Access Journals (Sweden)

    Felipe Coelho Neto

    2015-06-01

    Full Text Available BACKGROUND: Ultrasound-guided foam sclerotherapy plays a major role in treatment of chronic venous insufficiency, providing clinical and hemodynamic improvement to patients undergoing treatment.OBJECTIVES: To examine the relationships between venous refilling time and impact of venous disease on quality of life and between changes in venous refilling time and improvement of symptoms after ultrasound-guided foam sclerotherapy for chronic venous insufficiency.METHODS: Thirty-two patients classified as C4, C5 or C6 answered a questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy.RESULTS: Statistically significant improvements were observed in quality of life scores and in venous filling time and in the following symptoms: aching, heavy legs, restless legs, swelling, burning sensations, and throbbing (p<0.0001. A similar improvement was also seen in the work and social domains of quality of life (p<0.0001.CONCLUSIONS: As confirmed by questionnaire scores and venous refilling times, ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels and low rates of major complications.

  13. Cardiovascular and Interventional Radiological Society of Europe Commentary on the Treatment of Chronic Cerebrospinal Venous Insufficiency

    International Nuclear Information System (INIS)

    Reekers, J. A.; Lee, M. J.; Belli, A. M.; Barkhof, F.

    2011-01-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS). The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the “venous hemodynamic insufficiency severity score” (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called “liberation treatment,” and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists

  14. Phleboscintigraphic detection of incompetent perforating veins to guide the surgical treatment of venous stasis ulceration

    Energy Technology Data Exchange (ETDEWEB)

    Giordano, A. [Inst. of Nuclear Medicine, Catholic Univ. of the Sacred Heart, Rome (Italy); Muzi, M. [Chair of Surgical Pathology, Dept. of Surgery, Univ. Rome (Italy); D`Antini, P. [Chair of Surgical Pathology, Dept. of Surgery, Univ. Rome (Italy); Rulli, F. [Chair of Surgical Pathology, Dept. of Surgery, Univ. Rome (Italy)

    1993-12-31

    Most venous leg ulcers are due to the incompetence of perforating veins. The principal aim of surgery in the treatment of chronic ulcers which are not responsive to conservative therapy, is the identification, division and ligation of those incompetent perforating veins which transmit the hig venous pressure to the ulcerated area. Both radionuclide scanning and contrast venography may be accurate methods of evaluating the deep venous system and incompetent perforating veins; however, the role of radionuclide scanning in this setting is not fully exploited. The authors present one case of chronic, refractory postphlebitic ulcer in which radionuclide venography was employed to detect the incompetent perforating vein responsible for the development of the ulcer. Radionuclide venography (with Tc-99m red blood cells) allowed the main perforating vein to be clearly detected among others already identified by contrast venography. After surgical treatment the ulcer healed, and the perforating vein had disappeared when venoscintigraphy was repeated. In the author`s opinion radionuclide venography is a useful support to contrast venography in planning the surgical treatment of venous stasis ulcers. (orig.) [Deutsch] Die meisten Ulcera cruris entstehen auf der Grundlage von Perforansveneninsuffizienzen. Der prinzipielle Ansatz der chirurgischen Behandlung chronischer Ulcera, die nicht auf eine konservative Therapie ansprechen, ist die Identifizierung und Ligierung der insuffizienten Perforansvenen, die den hohen venoesen Druck in die ulzerierten Areale weiterleiten. Sowohl szintigraphische Methoden als auch die aszendierende Phlebographie sind geeignete Methoden zur Untersuchung des tiefen Beinvenensystems bzw. der insuffizienten Perforansvenen. Der Wert des szintigraphischen Verfahrens fuer diesen Zweck wurde jedoch bis jetzt nicht ausreichend untersucht. Die Autoren berichten ueber den Fall chronischer, therapieresistenter postthrombotischer Ulcera cruris, bei dem zur

  15. Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.

    LENUS (Irish Health Repository)

    Reekers, J A

    2011-02-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1]. The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and\\/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the "venous hemodynamic insufficiency severity score" (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits [2]. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called "liberation treatment," and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists

  16. Venous hemodynamic changes in lower limb venous disease

    DEFF Research Database (Denmark)

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

    2016-01-01

    aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT...

  17. 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

  18. Chronic venous disease.

    Science.gov (United States)

    Wolinsky, Claire D; Waldorf, Heidi

    2009-11-01

    Identifying characteristic cutaneous findings is important in determining the appropriate management of certain venous diseases. The health care provider should be familiar with the classic description of patterns and distributions of skin manifestations, such as varicose veins, stasis dermatitis, palpable cord, petechiae, and telangiectasias. In addition to the gross appearance of the skin, a skin biopsy may help elucidate a diagnosis. General treatment and prevention of the underlying venous pathology is essential. Furthermore, specific management of skin findings should include therapy to ameliorate progression of disease and symptomatology when warranted.

  19. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  20. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    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...

  1. Catheter-Directed Therapy Options for Iliofemoral Venous Thrombosis.

    Science.gov (United States)

    Sudheendra, Deepak; Vedantham, Suresh

    2018-04-01

    Proximal deep venous thrombosis (DVT) is linked to a 50% risk of pulmonary embolism and a 50% risk of postthrombotic syndrome. This article reviews catheter-directed thrombolysis options for iliofemoral DVT and discusses the risks, benefits, and techniques commonly used in performing endovascular procedures for iliofemoral DVT. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. 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

  3. clinical features and patterns of imaging in cerebral venous sinus

    African Journals Online (AJOL)

    2013-09-01

    Sep 1, 2013 ... thrombosis. Neuroradiology 2002; 44: 481–488. 12. Lovblad KO, Bassetti C, Schneider J, et al. Diffusion- weighted MRI suggests the coexistence of cytotoxic and vasogenicoedema in a case of deep cerebral venous thrombosis. Neuroradiology2000; 42: 728–731. 13. Oppenheim C, Domigo V, Gauvrit JY, ...

  4. Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

    Science.gov (United States)

    Januário, Virginia; de Ávila, Dione Augusto; Penetra, Maria Alice; Sampaio, Ana Luisa Bittencourt; Noronha Neta, Maria Isabel; Cassia, Flavia de Freire; Carneiro, Sueli

    2016-01-01

    BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy. PMID:26982773

  5. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    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

  6. Cerebral venous thrombosis

    NARCIS (Netherlands)

    Silvis, Suzanne M.; de Sousa, Diana Aguiar; Ferro, José M.; Coutinho, Jonathan M.

    2017-01-01

    Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults. Data from large international registries published in the past two decades have greatly improved our knowledge about the epidemiology, clinical manifestations and prognosis of CVT. The presentation of symptoms is

  7. [Innovative therapy for leg ulcers: Electrostimulation].

    Science.gov (United States)

    Maillard, H

    2015-01-01

    Chronic wounds can take a long time to heal despite appropriate therapy based upon aetiology and use of suitable dressings. The success of electrostimulation is based upon the existence within the skin of the endogenous currents involved in the wound healing process. Where skin continuity is broken by a wound, these electrical potentials are short-circuited, resulting in leakage of electrical current. Woundel(®) therapy is the only such treatment currently available in France and is based on the use of continuous pulsed current that generates an electrical field near the endogenous electrical fields. It utilises a console to deliver the electrical impulses, a dressing electrode and a dispersion electrode. The electrode dressing is left on the wound for 3 days, and venous compression bandaging may be applied to the leg, taking care to leave the connector free. Negative polarity stimulates migration of fibroblasts, resulting in elimination of fibrin. Positive polarity causes keratinocyte migration, which in turn leads to epidermisation. Electrostimulation is of recognised utility in the healing of chronic wounds: it has been assigned a high-level recommendation in the European and American guidelines for the treatment of venous ulcers and bedsores with proof level of A. Further, the analgesic effect of electrostimulation has been demonstrated in several studies. Electrostimulation is already well developed in France among wound specialists, but prospective studies are planned so that it may be used at patients' homes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Femoral Venous Blood pH Changes in Response to External ...

    African Journals Online (AJOL)

    Aim: To measure in vivo the femoral venous blood pH in response to external lower limb compression in cardiac catheterization patients. Patients and Method: The pH was measured in discrete samples of blood withdrawn from the femoral vein before, during and after insertion of the catheterized leg into the graduated ...

  9. Simple wound exudate collection method identifies bioactive cytokines and chemokines in (arterio) venous ulcers

    NARCIS (Netherlands)

    Kroeze, K.L.; Vink, L.; de Boer, E.M.J.; Scheper, R.J.; van Montfrans, C.; Gibbs, S.

    2012-01-01

    A major challenge for clinicians treating (arterio) venous leg ulcers is to decide between standard therapy and advanced interventions. Here, we developed a simple method to collect human material representative of the ulcer wound bed, which can be used to identify biomarkers for prognostic test

  10. Cancer and risk of cerebral venous thrombosis: a case-control study

    NARCIS (Netherlands)

    Silvis, S. M.; Hiltunen, S.; Lindgren, E.; Jood, K.; Zuurbier, S. M.; Middeldorp, S.; Putaala, J.; Cannegieter, S. C.; Tatlisumak, T.; Coutinho, J. M.

    2018-01-01

    Background: Cancer is an established risk factor for leg vein thrombosis and pulmonary embolism. Controlled studies assessing the risk of cerebral venous thrombosis (CVT) in patients with cancer have not been performed. Objective: To assess whether cancer is a risk factor for CVT. Patients/Methods:

  11. The study of human venous system dynamics using hybrid computer modeling

    Science.gov (United States)

    Snyder, M. F.; Rideout, V. C.

    1972-01-01

    A computer-based model of the cardiovascular system was created emphasizing effects on the systemic venous system. Certain physiological aspects were emphasized: effects of heart rate, tilting, changes in respiration, and leg muscular contractions. The results from the model showed close correlation with findings previously reported in the literature.

  12. VENOUS ULCER--A NEW THERAPEUTIC APPROACH.

    Science.gov (United States)

    Popa, R F; Cazan, I; Baroi, Genoveva; Cazan, Simona; Lefter, G; Strobescu, Cristina

    2016-01-01

    Trophic leg ulcer is a major health problem affecting approximately 1-2% of the population, the incidence being higher in the elderly (70-80 years). It is a multifactorial condition, but the most common cause is chronic venous insufficiency. This can be attributed to reflux in the saphenous system and calf perforator vein incompetence. These were first described by Linton, the first intervention designed to correct perforator vein incompetence bearing his name. Today Linton's operation has been abandoned due to the large unaesthetic incision and great postoperative pain. Also, ulcer healing time is long (2 months) and recurrence rate is high. Currently a series of minimally invasive procedures are used to close these perforator veins, such as ultrasound-guided sclerotherapy. The advantages of these techniques are less discomfort to the patients, low rate of complications, short hospital stay.

  13. Coagulation disorders in the patients with deep vein thrombosis of lower extremity

    Directory of Open Access Journals (Sweden)

    Milić Dragan J.

    2003-01-01

    Full Text Available PURPOSE Venous thromboembolism is a relevant social and health care problem for its high incidence, pulmonary embolism-related mortality and long-term sequelae which may be disabling (post-thrombotic syndrome and ulceration. PROCEDURES The aim of our work was to establish the presence of coagulation disorders (hypercoagulable states in the patients with deep vein thrombosis (DVT of the leg. Prospectively we have analyzed a group of 30 patients with echosono-graphicaly verified DVT of the leg who were admitted to the department of vascular surgery from August 1st 2000 to July 31st 2001.The following parameters were monitored: prothrombin time (PT partial thromboplastin time (PTT, fibrinogen (Fib, alpha 2 antiplasmin (A-2 AP, D-dimer (DD, antithrombin III (AT III and factor VII. FINDINGS Activation of the coagulation process was registered. The values of monitored coagulation parameters are shown in table 1. Plasma levels of monitored parameters in the patients with DVT of the leg were significantly higher than in the control subjects. CONCLUSION In patients with a DVT a hypercoagulable state is common finding. Some parameters of coagulation activity such as D-dimer might be of great interest in the diagnostic strategy of DVT.

  14. Venous ulcer: what is new?

    Science.gov (United States)

    Raffetto, Joseph D; Marston, William A

    2011-01-01

    The pathophysiology of venous dermal abnormality in chronic venous ulcers is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in the microcirculation, cytokine and matrix metalloproteinase activation, and altered cellular function. Red blood cells and macromolecules extravasate into the interstitium and activate endothelial cells. Endothelial expression of specific adhesion molecules recruits leukocytes and causes diapedesis of these cells into the dermal microvasculature, promoting an inflammatory response with activation of cytokines and proteinases. Altered cell function enhances a state of vulnerability in the surrounding tissues, initiating specific changes associated with venous disease. Ultimately, the persistent inflammatory-proteinase activity leads to advanced chronic venous insufficiency and ulcer formation. The mainstay of therapy in venous ulcer abnormality is correction of the underlying venous hypertension through compression therapy and/or surgery. Understanding the science involved in the pathophysiology of venous ulcer formation has led to the development of adjunctive treatment directed at the dysregulated molecular pathways. Randomized clinical trials are critical for determining the most effective evidence-based treatments for venous ulcer, and this review discusses important trials that have had a significant impact on venous ulcer healing. In addition, the authors have included subsections referred to as "Translational Implications for Therapy" in the basic science sections of the review to help bridge the basic science knowledge with clinical applications that may help to modulate the molecular abnormalities in the pathophysiologic cascade leading to venous ulcers.

  15. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    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.

  16. Effect of elastic bandage wraps on leg edema in patients before and after liver transplant.

    Science.gov (United States)

    Mathews, Susan; James, Shantell; Anderson, Janet D; Merchant, Mehwish; Benenati, Sonia; Henry, Samantha; Comrie, Gem; Pirani, Shamsa; Zellinger, Mary

    2015-12-01

    Few studies have evaluated the benefits of short-term use of compression therapy to prevent or minimize edema and/or pain in the legs of acutely ill, hospitalized patients without venous leg ulcers. To determine if the use of elastic bandage wraps of the leg in patients before and after liver transplant decreases edema formation and pain in the leg. Study Population-A convenience sample of inpatients before and after liver transplant. Pretest, posttest, randomized controlled trial with each participant serving as his or her own control. Intervention-Elastic bandage wrap applied to leg for 8 hours. Edema and pain in leg. In 13 patients before and 11 patients after liver transplant, the mean (SD) change in leg circumference after a single 8-hour application of an elastic bandage wrap was -2.6 (2.2) cm at the ankle and -3.1 (2.9) cm at midcalf for wrapped legs, as opposed to -0.4 (1.6) cm at the ankle and 1.0 (2.8) cm at midcalf for unwrapped legs (PLeg pain, measured on a visual analog scale, was significantly lower for the wrapped (mean [SD], 10.3 [26.5] mm) versus the unwrapped (20.3 [33.5] mm) leg (P=.04). In inpatients before and after liver transplant, the application of elastic bandage wraps to 1 leg for an 8-hour period led to significantly less edema formation and pain compared with the unwrapped leg. These results support the use of elastic bandage wraps in liver transplant patients to reduce leg edema and improve comfort.

  17. Limits and possibilities experienced by nurses in the treatment