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PubMed2006

Risk of venous thromboembolism among hospitalized medically ill patients.

PURPOSE: The 90-day risk of venous thromboembolism (VTE) among medically ill patients admitted to a hospital was estimated and is discussed. SUMMARY: Patients aged > or =40 years who were hospitalized between January 1, 1998, and June 30, 2002, for reasons other than traumatic injury, labor and delivery, mental disorder, or VTE and who did not undergo surgery were identified in a large U.S. healthcare claims database. Patients receiving anticoagulants in the 90-day period preceding hospital admission were excluded. We estimated the percentage of study subjects who developed clinical deep-vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days of hospital admission using Kaplan-Meier methods. We also estimated hazard ratios (HRs) for potential risk factors for VTE using univariate and stepwise multivariate Cox proportional hazards regression models. Among 92,162 study subjects, 1468 (1.59%) developed clinical DVT or PE within 90 days of hospital admission; 18% of these events occurred postdischarge. In multivariate analyses, significant risk factors for clinical VTE included: 1) history of cancer (HR, 1.67; 95% confidence interval [CI], 1.45-1.93); 2) history of VTE within six months of index admission (HR, 6.14; 95% CI, 4.74-7.96); 3) operating room procedure within 30 days of index admission (HR, 1.81; 95% CI, 1.47-2.24); 4) peripheral artery disease during index admission (HR, 1.68; 95% CI, 1.28-2.21); and 5) heart failure during index admission (HR, 1.72; 95% CI, 1.52-1.95). CONCLUSION: The risk of clinical VTE among medically ill patients admitted to a hospital, although less than that of patients undergoing major surgery, is not negligible. Patients with a history of recent VTE or surgery, those who are admitted to the intensive care unit, those with an admitting diagnosis of heart failure, and those with active cancer are at especially high risk of VTE and deserve increased consideration for prophylaxis.

Aged↗
PubMed2002

Clinical presentation and anatomic distribution of chronic venous insufficiency of the lower limb in a typical Mediterranean population.

BACKGROUND: The aim of this study was to demonstrate the characteristics of lower limb chronic venous insufficiency (CVI) in a homogeneous Mediterranean population. METHODS: Investigation of 694 patients with uni- or bilateral symptoms and signs of lower limb CVI using colour duplex scanning. Limbs with previous venous surgery were excluded. The limbs were classified according to history and ultrasonic findings into those with post-thrombotic and those with primary CVI. The clinical presentation according to the CEAP classification was correlated to the anatomic distribution of venous reflux. RESULTS: Most of the symptomatic limbs (537/656, 81.5%) with primary CVI belonged to classes 1 to 3. In these limbs reflux confined to superficial veins was very common (64.5%, 424/656) whereas the prevalence of deep and perforator vein reflux was 18.5 and 25.5%, respectively. In contrast most of the limbs (69.5%) with post-thrombotic CVI belonged to classes 4 to 6, had a complex pattern of reflux, and involvement of deep and perforator veins was common (86.5 and 48%, respectively). In about a quarter (24%) of patients with suspected primary CVI no reflux was found in either limb on duplex scanning. Most of them (48%) had telangiectasis. Bilateral reflux was found in 71% of the patients with primary CVI. CONCLUSIONS: The clinical presentation was worse in limbs with post-thrombotic CVI than in those with a primary disease. Post-thrombotic CVI was associated with a complex pattern of reflux, affecting mostly the deep and perforator veins, whereas superficial reflux was the most common pattern in limbs with primary CVI. Therefore, surgery aiming to eliminate superficial reflux would confer only a minimal benefit in limbs with post-thrombotic CVI but would treat the majority of the limbs with the primary CVI. The high prevalence of bilateral reflux found in patients with primary CVI suggests a bilateral predisposition, which supports the hypothesis of the existence of a generalised venous disease.

Female↗
PubMed1975

Fallibility of the clinical diagnosis of venous thrombosis.

Doppler ultrasound examination confirmed the diagnosis of acute venous thrombosis in only 194 (37%) of 527 patients. Of the remaining 333 patients, 245 (74%) had some other evident cause of the limb complaints. The postphlebitic stasis syndrome; symptomatic varicose veins; congestive heart failure; leg trauma; venous or lymphatic obstruction by malignancy; cellulitis or lymphangitis; arthritis; and pregnancy were etiologic factors in these patients. The proved inaccuracy of the bedside diagnosis of leg vein thrombosis stresses the need for accurate objective verification of venous disease before committing the patient to a full course of anticoagulant therapy. For most clinicians, a contrast phlebogram is the most available and reliable diagnostic procedure.

Acute Disease↗
PubMed2003

[The role of endoscopic ligation of the perforating veins in the treatment of chronic venous insufficiency under conditions of the one-day surgery center].

The present work is concerned with the results of endoscopic ligation of the perforating veins (SEPS) in 179 patients with chronic venous insufficiency, class 4-6, performed at the one-day surgery center. In patients suffering from varicosity, SEPS was accomplished in combination with phlebectomy in 52 (29.1%) patients. The second stage after phlebectomy involved the combination of SEPS with microsurgical reconstruction of the femoral vein valve. SEPS alone was provided to 89 (49.7%) patients suffering from postthrombotic disease. No life-threatening complications or lethal outcomes were recorded. The postoperative events were observed in 20 (11.2%) patients. Good results were obtained in 128 71.5%) patients, satisfactory in 42 (23.5%) and unsatisfactory in 9 (5%) subjects. The data obtained allow to regard SEPS as an effective, drastic and little traumatic technique which can be used successfully under conditions of the one-day surgery center.

Adult↗
PubMed2003

The first experience with endovascular stenting of the iliac veins in patients suffering from post-thrombophlebitic disease.

This paper describes the results of the first experience with endovascular stenting of the iliac veins in patients suffering from post-thrombophlebitic disease. During 11 months, the patient with a history of segmental venous thrombosis and involvement of the left iliac veins received conservative treatment which included phlebotropic therapy and elastic compression. Despite these measures the patient demonstrated the symptoms of venous insufficiency such as edema, and pains in the left lower extremity. In addition, control ultrasonography and radionuclide examinations revealed chronic occlusion of the left iliac veins. In view of this circumstance we performed endovascular dilatation and stenting of the iliac veins. The postoperative period was uneventful. After two months the pains in the left lower extremity and its edema were fully removed. Control radionuclide phleboscintigraphy demonstrated complete patency of the left iliac veins. So, endovascular stenting is an effective and safe modality for the treatment of the occlusive forms of post-thrombophlebitic disease.

Acenocoumarol↗
PubMedDate not supplied

Importance of valvular incompetence after acute deep venous thrombosis.

The color Doppler scanner was used to analyze acute deep venous thrombosis in 14 patients. A thrombus was found in the superficial femoral vein in 4 patients and in the superficial femoral and popliteal veins in 6 patients; a popliteal occlusion was found in 4 patients. All 14 patients were treated with intravenous heparin followed by at least 3 months of warfarin therapy. Patients were re-examined between 24 and 48 months. Six patients were symptomatic; 8 were asymptomatic. Five patients had occluding thrombus in the distal popliteal vein; major competent collateral channels developed from the proximal superficial femoral vein, and they remained asymptomatic. Three patients whose superficial femoral veins recanalized without valvular incompetence were asymptomatic. Valvular incompetence was observed in all of the symptomatic patients. Patients with persistent popliteal occlusion and collateral channels have fewer symptoms than patients with valvular incompetence in the superficial femoral and popliteal veins.

Adult↗
PubMedDate not supplied

[Socioeconomic impact of venous diseases in Italy].

The data's from National Statistic Institute referring to all Italians hospitalized during 1988 are: 37,312 patient due venous diseases, 2.03 p. cent of all hospitalized patients. Varicose veins diseases are more represented in female (10,948 f. and 4,476 m.). A regional study shows an increase in the north of Italy. The medium amount of days in hospital per patient is reduced in the last years at 11 day (from 18 d). The days in hospital in phlebophatic patients were 409,568 (20,522,122 d. for all diseases) during 1988. The expenses for hospital charges due to venous diseases were estimated in 163,827,000,000 of Italian liras, 136,522,500 US. dollar. Other report consider the factory working as the most important in the scale of job inducing phlebophaties. The first seems to be textile industries, at the second place the food factory, the last are builders. In 1974 were lost 2,300,000 working days. We suppose that increasing of private angiological assistance and having a poor public assistance in Italy the patients undergone to hospitals are reducing (81,599 with venous diseases in 1974 and 37,312 in 1988).

Absenteeism↗