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PubMed2004

[The reason and treatment of portal vein thrombosis in patients with portal hypertension postoperation].

OBJECTIVE: To investigate reason and the management of portal vein thrombosis in patients with portal hypertension postoperatively. METHODS: 329 patients with portal hypertension in liver cirrhosis who had splenectomy was reviewed from 1992 to 2001. In whom 43 (13.1%) patients with portal vein thrombosis postoperative were analyzed. RESULTS: In these patients, except 1 died for portal vein phlebitis, all patients were recovered. There are 138 patients who underwent splenectomy or splenectomy and devascularization, 26 (18.8%) of them had thrombosis. 191 patients underwent splenectomy and portacaval or portasplenic shut, 17 (8.9%) of them had thrombosis. The data of these two groups have significant difference (chi(2) = 8.44, P < 0.01). CONCLUSIONS: Thrombocytosis postsplenectomy as well as the changes of portal hemodynamics is the main reason of portal vein thrombosis. Portal vein thrombosis is also in association with the operative ways. Operation standardization, dynamic examining platelet count, routine color ultrasonography examining and early anticoagulation therapy are the effective methods in preventing and managing portal thrombosis postoperation for portal hypertension.

Adult↗
PubMed1992

Assessment of acute and old deep venous thrombosis in upper extremity by venous strain gauge plethysmography.

The purposes of this study were to evaluate the efficiency of occlusion strain gauge plethysmography in the diagnosis of symptomatic deep venous thrombosis in upper extremities, to compare early (one month) and late clinical evolution (many years) to plethysmography data and, finally, to set up normal and pathological values. Four groups of patients were tested. Sixteen patients with confirmed acute thrombosis, 6 patients with unconfirmed thrombosis, 15 with an old thrombosis (mean follow-up: 7 years) as well as 15 healthy volunteers. The outflows measurements were significantly lowered (p less than 0.05) in the arms with acute thrombosis compared to the contralateral arms, to the affected arms of patients with thrombosis excluded and to both volunteers' arms. Pathological values for the different outflow parameters could be defined as follows: Maximum venous output less than 110 ml/100 ml/minute, Outflow after 3 seconds less than 1.2 ml/100 ml, Strandness index less than 0.16. On month after the acute episode we found a good correlation between the usually favourable clinical evolution and venous haemodynamics assessed by plethysmography. The mild late post-thrombotic syndrome of most patients with an old thrombosis was not well demonstrated by plethysmography.

Adult↗
PubMed2006

Idiopathic eosinophilia associated with portal vein and massive thrombosis: successful thrombolysis with streptokinase.

BACKGROUND: Portal vein thrombosis in adults is usually related to cirrhosis. There are several possible therapies. including anticoagulation, transjugular intrahepatic portosystemic shunt, balloon dilatation, local and systemic fibrinolytics agents. Hypercoagulable states are also reported in association with this disease entity. Eosinophilia may activate platelets and promote thrombosis due to proteins contained in intracytoplasmic granules, such as eosinophil cationic protein and major basic protein. There is only one paper in the medical literature linking eosinophilia and portal vein thrombosis. CASE REPORT: We present here the case of a middle-age woman with idiopathic eosinophilia and acute portal vein thrombosis with massive venous thrombosis, involving the mesenteric, splenic, inferior cava, iliac and femoral veins, successfully treated with systemic streptokinase. CONCLUSIONS: Acute portal vein thrombosis with associated mesenteric and splenic vein thrombosis is a potentially lethal coagulation disorder that can be treated successfully with systemic streptokinase.

Budd-Chiari Syndrome↗
PubMed1990

Deep-vein thrombosis after fracture of the pelvis: assessment with serial duplex-ultrasound screening.

Sixty patients who had had a major fracture of the pelvis and were in stable condition on the orthopaedic ward three to five days after the injury were tested serially with duplex ultrasound, beginning approximately seven days after the injury, in order to determine the incidence of deep-vein thrombosis. Contrast venography was performed to confirm all positive non-invasive studies. Deep-vein thrombosis developed in eight patients (approximately 15 per cent). The thrombosis was in the popliteal or a more proximal vein in six of the eight patients, whereas in two it was distal to the popliteal vein. In four patients, evidence of thrombosis developed after one or more normal duplex-ultrasound studies. In one patient, symptoms that were suggestive of deep-vein thrombosis developed fifty-two days after the injury (four days after the fourth normal duplex-ultrasound examination), and ascending venography was entirely normal. Another patient had a pulmonary embolus fifteen days after the injury, and on the same day a duplex-ultrasound study was positive for thrombosis. During six weeks of follow-up after discharge from the hospital, symptoms of deep-vein thrombosis or pulmonary embolism did not develop in any patient in whom serial duplex-ultrasound studies had been negative.

Acetabulum↗
PubMed1990

Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement.

A randomized trial was performed in consecutive patients undergoing total hip replacement to evaluate the effectiveness of sequential intermittent calf and thigh compression for preventing venous thrombosis compared with a control group given no prophylaxis. Both groups underwent case finding for deep vein thrombosis using combined fibrinogen I 125 leg scanning, impedance plethysmography, and venography. Deep vein thrombosis by venography was present in 77 (49%) of 158 control patients compared with 36 (24%) of 152 patients given intermittent compression. Proximal vein thrombosis was present in 42 controls (27%) compared with 22 patients (14%) given intermittent compression. Combined impedance plethysmography and leg scanning was insensitive in this patient group (sensitivity, 46%); venography was required to detect more than half the patients with venous thrombosis. Sequential intermittent leg compression clinically and statistically significantly reduced the frequency of both proximal vein and calf vein thrombosis. Case finding resulted in early detection and treatment of patients with venous thrombosis.

Female↗
PubMed1990

B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement.

A prospective study of the accuracy of real-time B-mode ultrasonography in detecting deep venous thrombosis in the femoral and popliteal veins of the lower extremity was conducted on a consecutive series of patients who had had a total hip replacement. Ascending venography was used as a diagnostic standard. One hundred and forty-three patients had ultrasound studies of both lower extremities and a venographic study of the operatively treated lower extremity at an average of 7.6 days postoperatively. The two tests were done within twenty-four hours of each other. Both ultrasonography and venography were done on 152 extremities. Two paired studies were excluded from the analysis of results because the ultrasound scans could not be interpreted. In 131 extremities, both diagnostic tests were negative for proximal thrombosis. Eight extremities had isolated thrombosis of a vein in the calf that was detected only by venography. In nineteen extremities, old or fresh thrombosis was diagnosed by venography. In four extremities, an old thrombosis of the superficial femoral vein was detected by both studies. In four of the extremities that had a new thrombus in the common femoral vein and in nine that had a new thrombus in the superficial femoral vein, abnormal findings on ultrasound scans correlated with those on venograms. There were two false-negative ultrasound scans and one false-negative venogram. The sensitivity, specificity, and accuracy of ultrasonography were 89, 100, and 99 per cent for the diagnosis of thrombosis of the proximal veins of the lower limb and 63, 100, and 93 per cent for the diagnosis of thrombosis when the entire venous system of the limb was included.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Propagation of deep venous thrombosis identified by duplex ultrasonography.

To investigate the efficacy of anticoagulation in preventing continuing thrombosis, we prospectively evaluated 24 patients with acute deep venous thrombosis using duplex ultrasonography. All patients were hospitalized with conclusive ultrasonic evidence of deep venous thrombosis identified in one of four levels: I, calf only; II, calf-popliteal; III, calf-popliteal-femoral; or IV, calf-popliteal-femoral-iliac. Duplex scans were obtained on admission and on three subsequent occasions during therapy. Progression of thrombosis was defined as advancement of thrombus to the more proximal venous level. Demographic data, symptoms, risk factors for deep venous thrombosis, physical findings, anticoagulation regimens, and hematologic variables were ascertained. Adequacy of anticoagulation was defined as elevation of baseline activated partial thromboplastin time by 150%. Nine patients (38%) had progression of thrombosis, and 15 (62%) had stable or improving duplex scans. Progression occurred as follows: I----II (2), I----III (2), II----III (1), and III----IV (4). Of the demographic and clinical variables examined, only smoking correlated with progression of thrombus (p = 0.04). Average heparin dose in the stable group was 1214 +/- 294 units/hr and 1122 +/- 248 units/hr in the group that progressed (p = 0.8): activated partial thromboplastin time was 45.6 +/- 7 seconds in the stable group and 49.8 +/- 9 seconds in the progression group (p = 0.7). Nine patients in the stable group had consistently adequate anticoagulation, whereas six did not; six in the progression group were consistently anticoagulated, and three were not. Two patients (one with stable thrombus and one with progressive thrombus) suffered nonfatal pulmonary emboli. Clot progression as determined by duplex scanning did not predict acute complications of deep venous thrombosis.

Adult↗
PubMed1989

[The advantages and disadvantages of surgical prevention of thrombosis].

The need for providing for a prophylaxis against thrombosis in surgery is now generally acknowledged in view of a basic risk of 10-60% thromboses and 1-5% fatal pulmonary embolisms. Initial efforts to recognise risk of thrombosis in patients on the basis of certain characteristic signs have not been successful, so that general prophylaxis is now fundamentally preferred. Measures of physical prophylaxis of thrombosis have been only partly successful, but the effort required to apply them in practice is out of all proportion to the effect achieved, so that this type of prophylaxis can only be used as a complement to drug therapy and with special high-risk patients. Although anticoagulation is effective, its rate of side effects is so high and the technical difficulties involved are so great that this method cannot be recommended in general prophylaxis of venous thrombosis. This also applies, albeit less dramatically, to thrombose prophylaxis with dextranes; in fact, these must be used with caution only, especially in elderly patients. Completely useless but characterised by considerable side effects is the attempt to achieve venous thrombosis prophylaxis via aggregation inhibitors. Today the standard method in surgery is low-dose heparin prophylaxis according to the effectivity-risk calculation. By applying the conventional non-fractionated heparins according to the low-dose schema it was possible to lower the pulmonary embolism mortality in all surgical disciplines with the exception of traumatology and orthopaedics to one third and the thrombosis rate to one third and the thrombosis rate to one third to one fourth of the original risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMedDate not supplied

Venous thrombosis after cardiac catheterization in infants.

Factors influencing the rate of post-catheterization venous thrombosis were studied in 180 infants below one year of age. The initial cardiac catheterization was performed either with cutdown technique or percutaneously. At repeat catheterization on the ipsilateral side presence or absence of thrombosis was noted. The overall thrombosis frequency was higher than previously reported, 15.6 per cent. The rate increased with decreasing weight. An increased rate of thrombosis was also found with indwelling femoral vein catheter left in place for more than 24 hours, and infection. In 6 cases, thrombosis involved only the catheterized side and would have been missed by recatheterization from the contralateral side. It was noteworthy that 9 of the thromboses spared the catheterized vessel and engaged only the vena cava. Among factors not influencing thrombosis rate were age, type of cardiac malformation, cyanosis, early operation, catheterization time or balloon septostomy. Percutaneous or cutdown technique did not influence thrombosis rate.

Body Weight↗
PubMedDate not supplied

Value of real time B mode ultrasound imaging in the diagnosis of deep vein thrombosis of the lower limbs.

In order to determine the value and the role of real time B mode ultrasound imaging (USI) in the diagnosis of deep vein thrombosis (DVT) of the lower limbs, it was compared to bilateral contrast ascending venography used as a standard of reference, prospectively and systematically on 430 patients suspected of having DVT or pulmonary embolism. A total of 854 limbs were thus studied double blindly both by the two methods. The results corresponded in 95% of the legs with a sensitivity of 98% and a specificity of 95% for USI. Isolated thrombosis of the calf were detected in 91% of the legs and proximal thrombosis were in 100% in this series whatever their topography and extent should be and whatever be the degree of obstruction of the vein. The discrepancies between the two methods are related to: (a) Vein thrombosis especially located in the calf, in the soleal sinuses and the gastrocnemius with in most cases the direct image of the thrombus detected by U.S.I. more often than by venography, provided that the technique and the equipment are appropriate. (b) The absence of visualisation of venous segments with venography which is not specific of venous thrombosis. These veins when non affected by the thrombosis are not filled by the contrast medium if located above an occluded ilio-femoral or ilio-caval junction or when they are the site of extrinsic compression. The direct imaging of the vein and the surrounding structures obtained with USI enhances the diagnostic sensitivity and specificity and provides precision of the exact extension of the thrombosis. Venous study by USI is always coupled with the Doppler.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1983

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

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

Adolescent↗
PubMed1981

[Prevention of deep vein thrombosis in internal medicine].

14 prospective, randomized trials dealing with non-operated patients were analyzed. In all of them the presence of deep vein thrombosis was measured by the radioactive iodine fibrinogen uptake test. Various prophylactic regimens were tested. 13 studies concern patients after myocardial infarction and one a cerebral hemorrhage patient. Only 2 trials confirm the value of oral couramin administration for the reduction of deep vein thrombosis after myocardial infarction. Two studies show that prophylactic anticoagulation with a full dose of heparin reduces the incidence of deep vein thrombosis after myocardial infarction. In 3 studies, again after myocardial infarction, a statistically significant reduction in the incidence of deep vein thrombosis is found when small doses of heparin are given. In 1 study investigating a few patients no effect could be shown. Low doses of heparin reduce the incidence of deep vein thrombosis after acute cerebral hemorrhage. Early mobilization has reduced the incidence of deep vein thrombosis in 21 patients after myocardial infarction, as compared to 8 patients treated with bed rest. Heavy smokers suffering myocardial infarction show a statistically significant lower incidence of deep vein thrombosis than non-smokers, as 3 papers confirm.

Cerebrovascular Disorders↗
PubMed1980

[Pulmonary embolism in leg and pelvic vein thrombosis. Results of a prospective study - diagnosis, frequency, nuclearmedical and clinical appearance (author's transl)].

In a prospective study 169 patients with clinically suspected leg/pelvic-vein thrombosis were tested by 131 I fibrinogen uptake-test and radionuclide venography for confirmation of this diagnosis and also by a nuclearmedical lung investigation. In all cases of an abnormal perfusion scan a supplementary ventilation scan was performed. The perfusion scan has a sensitivity for pulmonary embolism of near 1.0 but its specificity is only 0.57. An additional ventilation study (133 Xenon, 81m Krypton) improves the specificity to 0.95. A mismatch of regional ventilation and perfusion is the nuclearmedical substrate of pulmonary embolism. The diagnosis of thrombosis was confirmed in 105 of 169 cases (62%). Thrombosis was located in the lower legs in 56%, in the thigh veins in 23% and in the external iliac veins in 21%. From 105 patients with leg/pelvic-vein thrombosis 60 (57.1%) had pulmonary emboli, from 64 patients with negative tests concerning thrombosis only 3 (4.7%) (p < 0.001). Pulmonary emboli were present in 46% when thrombosis was located in the lower legs, in 67% when thigh veins and in 77% when pelvic veins were involved. The average frequency of 57% emboli found in patients with leg and pelvic vein thrombosis agrees with data from pathologic-anatomical studies. An analysis of these patients with embolism showed that 70% of them were over 70 years old, that 52% of the emboli originated from thigh and pelvis and 43% from the lower leg and that 59% had no clinical signs of embolism. 80.4% of the patients had multiple perfusion defects (up to 9) which correlated in size with the severity of the clinical symptoms and which were about equally distributed in both lungs. Larger perfusion defects occure more frequently with thromboses of the thigh and pelvis than in thromboses of the lower leg. According to the chest x-ray pulmonary emboli were suspected to only 6 of 26 patients with clinical evidence of embolism (23%).

Adult↗
PubMed1995

[Venous thrombosis in relation to central venous catheters: pathogenesis, diagnosis, therapy, possibilities of prophylaxis].

Thrombosis represents one of the most frequent and severe complication of central venous catheterization. The incidence of catheter-related venous thrombosis is not well established. This complication was found in 3.3% patients in the analysis of 23 studies with central venous access devices-ports. We have found it in 3% of our patients with implanted port. The types of catheter related thrombosis are following: mural thrombosis, fibrin sheath, thrombosis on the catheter tip. Venography has been shown to be highly reliable in identification of upper-extremity deep venous thrombosis. The up-to-date possibility of treatment and prophylaxis of venous thrombosis associated with central venous catheters are reviewed in this paper.

Catheterization, Central Venous↗
PubMed1995

Long-term outcomes of deep-vein thrombosis.

OBJECTIVE: To assess the long-term outcomes of patients with acute deep-vein thrombosis. METHODS: We followed up 124 patients with deep-vein thrombosis 6 to 8 years after the index thrombosis to determine the frequency of death, recurrent venous thromboembolism, postphlebitic symptoms, and their relationship to three domains of health-related quality of life. RESULTS: Fifty-two (42%) of the 124 patients died. The cumulative incidence of death was 17% at 1 year and 39% at 5 years. Death was especially common among patients older than 75 years and those with cancer or stroke (5-year cumulative incidence, 66%, compared with 12% among other patients; P < .0001). Most deaths were attributable to cancer or cardiovascular disease. Venous thromboembolism recurred in 18 patients (15%); the cumulative incidence was 6% at 1 year and 13% at 5 years. Recurrence was more common, however, among patients younger than 65 years with a history of recurrent venous thromboembolism (5-year cumulative incidence, 34%, compared with 10% among other patients; P < .01). In interviews with 52 patients 6 to 8 years after the index deep-vein thrombosis, 42% reported pain, swelling, or discoloration in the leg affected by the index thrombosis. Perceptions of health, physical functioning, and role limitations attributed to physical health were worse (P < .01 for each domain) in symptomatic patients than in asymptomatic patients. CONCLUSIONS: Six to 8 years after deep-vein thrombosis, many patients had died of preexisting cancer or cardiovascular disease. Recurrent venous thromboembolism was uncommon. Symptoms in the leg affected by the index thrombosis were common, however, and were associated with worse health-related quality of life.

Adolescent↗
PubMed1995

Color Doppler flow imaging for deep venous thrombosis screening in patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic carcinoma.

Patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy are traditionally considered to be at high risk for postoperative venous thromboembolic complications. A prospective deep venous thrombosis screening regimen was initiated at our medical center in 1990 following 2 cases of fatal pulmonary embolism that occurred after hospital discharge. During a 3-year period 245 consecutive patients undergoing radical retropubic prostatectomy for prostate cancer were screened postoperatively for lower extremity deep venous thrombosis using ultrasound duplex scanning with color Doppler flow imaging. The results were correlated only with the development of clinical deep venous thrombosis. No additional diagnostic modalities were used to confirm a normal venous system in asymptomatic patients. Venous thromboembolic complications were encountered in 9 of the 245 patients (3.6%). In 2 patients deep venous thrombosis was associated with nonfatal pulmonary embolism. Only 2 of the 9 cases of deep venous thrombosis were detected by color Doppler flow imaging screening. The striking decrease in the incidence of deep venous thrombosis following radical prostatectomy in the last decade and the low yield of screening at a single point in time may warrant reconsideration of the need for deep venous thrombosis screening among patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostate cancer.

Adult↗
PubMed1996

Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis.

BACKGROUND: Some recent publications have emphasized the risk (up to 25%) of deep venous thrombosis (DVT) coexisting with a clinical evidence of superficial venous thrombosis (SVT). However, most papers on this topic are old and do not consider the use of the duplex scanning. OBJECTIVE: To determine what the spontaneous risk is of venous thrombosis and emboli in varicose patients, in the superficial veins, and in the deep veins; what the risk is of extension or coexistence between superficial and deep thrombosis; and whether the treatments of varicose disease are responsible for thrombosis? METHODS: Review of the literature. RESULTS: The frequency of venous thrombosis appears to be increased in patients with varicose disease. CONCLUSIONS: In all cases of clinical SVT a duplex scan examination of both deep and superficial veins is necessary in order to provide a complete diagnosis. The treatment of SVTs depends on the situation and the size of the thrombi. In case of associated DVT, the most important treatment is of the DVT. The interest of heparin or low molecular weight heparin (therapeutic doses) is proved for patients with coexisting DVT, and thought so for ascending SVT. Interest and doses have not been stated in other cases. SVT must be considered as a risk factor of DVT and treated from this point of view. Biological analysis and a complete check-up are mandatory in cases of varicose thrombosis in young patients and in cases of recurrence.

Aged↗
PubMed1996

[Superficial venous thrombosis of the lower limbs].

With regard to deep vein thrombosis, superficial thrombophlebitis of lower limbs have a reputation of mildness disease that the experience gained from widely used duplex scanning in their evaluation comes to question. Short superficial thrombophlebitis on non-varicose veins often remain a symptom belonging to or revealing a systemic disease. Superficial thrombophlebitis on varicose veins are of two kinds: short superficial thrombophlebitis remain a common complication of varicose phlebectasia but they must be differenciated from extensive saphenous thrombophlebitis. The first ones are of local symptomatic treatment and of varicose vein surgery. The last ones are associated--with deep vein thrombosis in 10 to 30% of case (either by extension from the saphenous to the deep veins, either without anatomical link), with clinical pulmonary embolism in 5% of cases, and with a cancer in about 10% of cases. Numerous superificial venous thrombosis occur without inflammatory signs and the clinical diagnosis of extensive superficial venous thrombosis is as difficult as the one of deep vein thrombosis. So the diagnosis, the treatment, the etiological investigation of extensive superficial venous thrombosis are in fact not very different from those of deep vein thrombosis.

Humans↗