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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighteen items of clinical and laboratory information were measured on the day before operation in 85 patients who underwent elective major abdominal surgery. Postoperatively, deep venous thrombosis (DVT) was detected by 125I-fibrinogen scan in 23 patients. Stepwise logistic discriminant analysis was used to identify factors which predicted DVT. Seven such factors were identified, which were then used to construct a predictive index. In descending order of predictive power, they were: age, euglobulin lysis time (ELT), previous abdominal surgery, varicose veins, antithrombin III concentration, cigarette smoking, and platelet count. Pre-operatively, the predictive index correctly identified 91% of the patients in whom DVT developed, and wrongly allocated to the high-risk group 19% of those in whom it did not. A shortened version of the predictive index based only on age and ELT (I = -11.5 + 0.133 age + 0.006 ELT) was 91% sensitive and 63% specific in the prediction of DVT. In a prospective study of 43 patients, this shortened predictive index correctly identified pre-operatively 93% of patients in whom DVT developed, and wrongly allocated to the high-risk group only 17% of those in whom it did not.
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PMID:Pre-operative identification of patients at high risk of deep venous thrombosis after elective major abdominal surgery. 287 19

Chronic lower-leg edema in patients with venous disorders was studied by means of lymphoscintigraphy. Lymphatic patterns of flow were evaluated prospectively in 26 patients with technetium 99m antimony trisulfide colloid injected subcutaneously in the interdigital web spaces on the feet. Most patients in this study had postphlebitic syndrome, and all of these patients had abnormal lymphoscintigraphic flow patterns. Nine had evidence of lymphatic obstruction, and one had an enhanced flow pattern. Three patients had veins used for distal arterial bypass, and all these veins showed decreased lymphatic flow. Two patients with Klippel-Trenaunay syndrome (congenital varicose veins associated with limb elongation, a capillary nevus, and an abnormal deep venous system) had obstruction to lymphatic flow, and two others had normal and enhanced patterns. Normal studies were seen in four of five patients who had veins used for coronary artery bypass grafting. The finding of decreased lymphatic flow in patients appears to be the result of the length of time from an episode of deep venous thrombosis, the occurrence and number of episodes of cellulitis and lymphangitis, and mobilization of the vein for use in distal arterial bypass surgery. This study shows that the edema attributed previously to primary venous disorders may have a significant lymphatic component. The degree of lymphatic obstruction can be determined by lymphoscintigraphy with technetium-labeled antimony trisulfide colloid.
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PMID:Abnormalities of lymphatic drainage in lower extremities: a lymphoscintigraphic study. 291 Nov 34

The effect of hypobaric spinal anaesthesia or narcotic-halothane-relaxant general anaesthesia on the incidence of postoperative deep vein thrombosis was studied in 140 elective total hip replacements in a prospective randomised manner. Deep vein thrombosis was diagnosed using impedance plethysmography and the 125I fibrinogen uptake test, combined, in selected cases, with ascending contrast venography. The overall incidence of deep vein thrombosis was 20%. Nine patients (13%) developed deep vein thrombosis in the spinal group and nineteen (27%) in the general anaesthetic group (p less than 0.05). The incidences of proximal thrombosis and of bilateral thrombi were also less with spinal anaesthesia than with general anaesthesia. It is concluded that spinal anaesthesia reduces the risks of postoperative thromboembolism in hip replacement surgery. The presence of varicose veins, being a non-smoker and having a low body mass index were associated with an increased incidence of deep vein thrombosis.
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PMID:Deep vein thrombosis after total hip replacement. A comparison between spinal and general anaesthesia. 292 31

In eight of 14 patients who were deficient in protein S and who belonged to two unrelated families thrombosis presented as thrombophlebitis in seven and deep vein thrombosis in six, complicated by pulmonary embolism in four and leg ulcers in two. In four patients superficial thrombophlebitis preceded deep vein thrombosis by one to 11 years. Post-thrombotic varicose veins and venous insufficiency had developed in four patients. In three of those and in a fourth patient symptomatic superficial thrombophlebitis, deep vein thrombosis, and pulmonary embolism did not recur while they were taking oral anticoagulant treatment for six to 12 years. The anticoagulation intensity corresponded to international normalised ratio values of over 2.5. It is concluded that the benefits of anticoagulant treatment for patients with congenital thrombotic disease are great, and thus it is necessary to make an early diagnosis and treat patients at risk of developing thrombosis.
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PMID:Effectiveness of long term oral anticoagulation treatment in preventing venous thrombosis in hereditary protein S deficiency. 295 50

We studied the venous capacity of the lower limbs by strain gauge plethysmography during venous occlusion (delta v60) and by a dependency test (delta v postural) (from the supine to the sitting position). We were also interested by the performance of the calf musculovenous pump, assessed in two positions: sitting and standing (delta v exercise). The volume changes are increasing when we consider limbs with sequelae of deep vein thrombosis, normal lower limbs and extremities with primary varices. delta v60: 2.13%, 2.84%, 4.24%; p less than 0.01. delta v postural: 1.32%, 1.94%, 3.66%; p less than 0.01. delta v exercise: 0.48%, 1.47%, 2.09%; p less than 0.01. The study of the expelled volume during calf muscle exercise is easier in the sitting than in the standing position and it leads to a better discrimination between normal limbs and limbs suffering from sequelae of deep vein thrombosis. The dependency test with measurement of the venous capacity when going from the supine to the sitting position (with the leg dependent) and the assessment of the calf muscles pump, also in the sitting position, are the basis of a simple approach to the quantitation of venous insufficiency.
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PMID:[Venous plethysmography in a sitting position]. 319 32

Fatal pulmonary embolism is a major cause of postoperative death. When no prophylaxis is given in general surgery, it has a frequency of about 1%. Apart from the immediate risk to life, one must also consider the late sequelae of extensive deep vein thrombosis--swelling of the legs, varicose veins, ulceration and other trophic changes which represent an equally distressing situation. Recently, three large-scale surveys have been published, where the data of over 100 randomized controlled clinical trials of prophylaxis against venous thromboembolism has been analysed. The purpose of this talk is to provide an overview of the currently available prophylactic methods analysed in these surveys, with an aim to define a policy for preventing venous thromboembolism, with particular emphasis on the surgical patients. There is evidence suggesting that the frequency of fatal pulmonary embolism can be reduced by such prophylactic remedies as low-dose heparin, dextran, the combination of dihydroergotamine plus heparin, and low molecular weight heparin.
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PMID:Current recommendations in prevention of thrombosis in surgery. 333 8

Forty-seven patients with phlebographically confirmed lower extremity deep vein thrombosis (DVT) were reexamined 5 to 10 years (mean, 7 years) after the thrombotic event. Clinical symptoms were recorded and the following noninvasive venous vascular laboratory tests were performed: Doppler examination to determine venous valve competence and photoplethysmography to measure ambulatory venous pressure and venous recovery time. Twenty-eight control subjects underwent similar examination. Although only 10 of 47 patients (21%) were asymptomatic, venous ulceration had developed in only two patients. The symptomatic patients had varying degrees of edema, pigmentation, and varicosities. Eighty-three percent of DVT patients had abnormal vascular laboratory findings. Both the severity of clinical symptoms and the magnitude of the hemodynamic abnormalities generally correlated with the extent of the initial thrombus. However, only 47% of patients whose initial thrombus appeared limited to the calf were asymptomatic, and only 25% of this group had normal venous hemodynamic findings. This study indicates that 5 to 10 years after lower extremity DVT 80% of patients will have both symptoms and abnormal venous hemodynamics regardless of the initial site of the thrombosis.
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PMID:Long-term hemodynamic and clinical sequelae of lower extremity deep vein thrombosis. 353 23

Defibrotide, a new antithrombotic compound without anticoagulant activity, has been tested for prevention of deep venous thrombosis (DVT) in patients undergoing gynecological surgery (mainly hysterectomy). Eighty-nine women (mean age 48.5) were randomly allocated to defibrotide (44 patients) or placebo (45 patients). 800 mg defibrotide was given daily (200 mg intravenously 4 times a day), starting on the day before operation and then for the next 7 days. DVT were detected by the conventional 125I-fibrinogen test. The two groups were homogeneous for known risk factors (age, varicosities, obesity, neoplasia and previous thromboembolic episodes). The results showed a statistically significant reduction of DVT incidence in patients on defibrotide, as compared with those on placebo: 4/44 = 9% vs. 13/45 = 28.8% (p less than 0.05). There were no side effects, including hemorrhagic complications. The numbers of units transfused were comparable for the 2 groups. In conclusion, the trial shows that defibrotide is an effective and safe drug for the prevention of DVT in gynecological surgery.
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PMID:Effectiveness of defibrotide for prophylaxis of deep venous thrombosis in gynecological surgery: a double-blind, placebo-controlled clinical trial. 375 34

Deep venous thrombosis is a major complication following gynecologic surgery. Assessing a patient's risk of developing deep venous thrombosis is important for patient selection and in choosing appropriate prophylactic methods. Four hundred eleven patients undergoing major gynecologic surgery were evaluated prospectively. All known variables associated with deep venous thrombosis were recorded. Deep venous thrombosis was diagnosed by 125I fibrinogen leg counting of all patients. Univariate analysis of all variables identified the following to be significantly related (P less than .05) to postoperative deep venous thrombosis: a prior history of deep venous thrombosis, leg edema or venous stasis changes, venous varicosities, degree of preoperative ambulation, type of surgery, nonwhite race, recurrent malignancy, prior pelvic radiation therapy, age above 45 years, excessive body weight, intraoperative blood loss, and duration of anesthesia. A stepwise logistic regression analysis of these variables was performed. The following preoperative prognostic factors remained significant: type of surgery, age, leg edema, nonwhite patients, severity of venous varicosities, prior radiation therapy, and prior history of deep venous thrombosis. Duration of anesthesia was also important when intraoperative factors were considered in the analysis. Using these factors, a prognostic model was created and tested. The model resulted in a degree of concordance of 0.82 and allows one to evaluate the risks of postoperative deep venous thrombosis for an individual patient.
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PMID:Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model. 380

Noninvasive investigative methods are valuable for the practical diagnosis of several peripheral vascular disorders. Doppler ultrasound is very useful for the detection of incompetent saphenous and perforating veins and for the measurement of systolic ankle pressure, which today is the best screening method for arterial stenoses or occlusions. Acral oscillography, photoplethysmography and thermography, combined with vasodilator (nitroglycerin) or vasoconstrictor (cold) stress tests, may disclose small vessel disease and vasospastic disorders (Raynaud phenomenon). To answer the question of whether varicosities should be eliminated by surgery or sclerotherapy in patients with severe stages of chronic venous insufficiency (e.g. crural ulcers), investigations of the venous pump by venous pressure measurement or (photo-)plethysmography with and without digital occlusion of the suspected leakage points are recommended. Doppler probe, plethysmography and thermography are valuable screening methods for deep vein thrombosis and help to restrict phlebography to patients on whom fibrinolysis or thrombectomy is carried out. For the majority of patients undergoing conservative treatment, these noninvasive diagnostic procedures are usually sufficient.
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PMID:[Supplementary instrumental examinations in the most frequently occurring peripheral vascular diseases in general practice]. 388 24


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