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

The aim of this study was to evaluate the effect of lacidipine and nifedipine on lower limb veins. Forty hypertensive patients, aged 30-50 years, with no deep venous thrombosis, venous insufficiency, or hypothyroidism underwent double-blind treatment with placebo (1 week), lacidipine 4 mg once daily (1 week), and slow-release nifedipine 20 mg twice daily (1 week) in randomized sequence. Echo-color Doppler examination of superficial, deep, communicating, and perforating veins of the legs was performed. The results showed venous insufficiency and hypertension after 1-week administration of lacidipine (5 and 15%, respectively) and nifedipine (10 and 25%, respectively) and only two cases (5%) of venous hypertension during placebo administration. Lower limb edema was observed in two patients (5%) during treatment with nifedipine slow-release (SR). The hemodynamic effects of lacidipine and nifedipine were reversible but may contribute to the mechanism of lower limb edema.
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PMID:Effects of lacidipine and nifedipine on lower limb veins in nonphlebopathic patients. 760 97

Impedance plethysmography (IPG) and duplex scanning with color flow Doppler were performed in 100 consecutive high-risk patients with clinically suspected deep venous thrombosis. Risk factors included recent surgery (< three weeks) in 23%, malignant disease in 91%, clotting abnormalities in 32%, and limited activity in 70%. Lower limb findings of either edema, calf tenderness, or both occurred in 92%. There was agreement between the two tests in 76 patients (29 positive and 47 negative). In 12 patients the IPG was positive and the duplex negative. Four of these had extensive pelvic disease, 2 had lung cancer with an obstructive profile, and 2 had heart failure, all of which are known to cause false-positive IPG results. In the other 12 patients the IPG was negative and the duplex positive; however, 3 of these patients had nonocclusive thrombi, 5 had pelvic disease, and 1 had a hemiparesis of the involved lower limb. In 15 patients (11 with positive duplex studies and 4 with negative) a venogram was obtained and confirmed the results. All patients were followed up clinically and none developed complications suggesting inaccurate duplex results. In conclusion, the IPG is of limited utility in this population with a sensitivity of 71%, specificity of 80%, and false-negative rate of 29% when duplex Doppler and clinical outcome are used as the standard. Where available, duplex Doppler should be preferred for evaluation of suspected deep venous thrombosis in patients with extensive medical disease.
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PMID:Evaluation of suspected deep venous thrombosis in oncologic patients. 809 42

The diagnostic strategy of pulmonary embolism is based firstly on pulmonary scintigraphy, a non-invasive investigation which provides a definitive diagnosis in about 30% of patients, and then on pulmonary angiography, which remains the investigation of reference. However, new diagnostic methods have been introduced in order to reduce the number of angiographies. Measurement of plasma D-dimer, a fibrin degradation product, enables exclusion of the diagnosis in 20-50% of patients without pulmonary embolism when the result is normal on ELISA (< 500 micrograms/l with the commercialized Stago test). This is due to the very high sensitivity of D-dimer: in a compilation of recent series with a total of 1,159 patients suspected of having pulmonary embolism, their concentration was over the threshold of 500 micrograms/l in 96% (CI 95%, 93-98) of patients with pulmonary embolism. On the other hand, their low specificity makes them useless for a positive diagnosis of the condition. Lower limb venous compression ultrasonography enables detection of proximal deep venous thrombosis in about 57% (CI 95%, 52-62) of patients with pulmonary embolism, posing the indication for anticoagulation without further investigations because of its high specificity (98%) (CI 95%, 97-99). When venous ultrasonography is normal, however, pulmonary embolism cannot be excluded. A diagnostic strategy associating these two investigations and pulmonary scintigraphy reduces the number of diagnostic angiographies by 30 to 50% according to whether D-dimer and ultrasonography are performed before or after scintigraphy respectively. More extensive use of D-dimer in clinical practice requires more rapid and equally reliable unitary tests as the ELISA.
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PMID:[Contribution of laboratory tests and venous investigations in the diagnosis of pulmonary embolism]. 881 29

Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of fibrinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the five other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased significantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no significant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of fibrinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI1) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-five per cent of patients (prophylactically anticoagulated or not) had very high levels of fibrin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombin-antithrombin complexes and prothrombin fragments 1 + 2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of fibrinolytic potential suggests a proposal for the patients an indefinite antithrombotic treatment at curative doses.
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PMID:Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury. 907 65

Lower limb deep venous thrombosis is a common clinical disorder that can lead to fatal pulmonary emboli and postphlebitic syndrome. The clinical evaluation for deep venous thrombosis has been found to be useful in nonhospitalized patients, but a low-cost, easily available technique to confirm the presence of lower limp thrombi is still needed. Doppler ultrasound examination with compression has emerged as the diagnostic imaging study of choice for most patients. Contrast venography, magnetic resonance imaging or radionuclide scintigraphy may be useful in selected patients.
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PMID:Diagnostic imaging of lower limb deep venous thrombosis. 930 72

The aim of this study was to assess the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) until 45 days after elective total hip replacement (THR) and the efficacy of prolonged unfractioned heparin (UH) prophylaxis up to postoperative day 30. To this end 79 of 96 patients admitted consecutively to the University Hospital of Pisa for THR were randomly assigned to short- or long-term UH prophylaxis. Sixty-one patients completed the study: 28 of them received short-term prophylaxis (subcutaneous UH 15,000 IU/24 h for 15 days) and 33 prolonged prophylaxis (subcutaneous UH 15,000 IU/24 h for 30 days). Lower limb phlebography was performed in all patients on day 45 after THR. DVT was demonstrated in 10 (16.3%) cases after hospital discharge. Among them, 2 patients also had symptomatic PE. The incidence of DVT was 21.4% in short- and 12.1% in long-term UH-treated patients. The incidence of only proximal DVT was 17.8% in short- and 3.0% in long-term UH-treated patients; although the difference was only close to significance (p = 0.085), the relative risk of developing proximal DVT was about six times greater in the former group of patients. We concluded that the risk for thromboembolism persists at least until 45 days after surgery in patients subjected to THR. Prophylaxis with UH given up to postoperative day 30 appears more effective and safer in reducing the delayed thromboembolic risk compared to prophylaxis with UH given up to discharge only.
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PMID:Prolonged prophylaxis with unfractioned heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. 978 15

Two common prophylactic measures to prevent deep vein thrombosis (DVT) in patients after orthopedic lower limb surgeries are pneumatic foot and calf compression and antithrombotic treatment. These preventive measures differ in their mechanisms of operation. Antithrombotic agents are aimed to minimize the risk of clot formation, whereas pneumatic foot and calf compression therapy prevents venous stasis, which is a primary factor leading to thrombus formation in patients with leg trauma. DVT, however, is not the only consequence of patient immobility and venous stasis. Additional sequelae of venous stasis include lower limb swelling and pain resulting from the increase in venous pressures and change of normal compartmental circulatory pressures. We therefore hypothesized in the present study that antithrombotic treatment alone is not as effective as combined with pneumatic foot compression in reducing limb swelling and pain. Forty-eight patients after total knee arthroplasty participated in this randomized, controlled study. Low-molecular-weight heparin was the prophylactic measure used for the control group, whereas the pneumatic compression group received low-molecular-weight heparin and foot compression therapy for approximately 7 days after surgery. Lower limb swelling and pain were significantly reduced for the foot compression group in relation to the control group. Ultrasound and venography demonstrated no significant DVT in either group. We conclude that foot compression therapy is an important prophylactic addition to antithrombotic treatment in overcoming the hazardous clinical implications of venous stasis.
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PMID:Sequential foot compression reduces lower limb swelling and pain after total knee arthroplasty. 1022 Jan 88

Lower limb venography remains the imaging modality of choice for detection of asymptomatic deep vein thrombosis (DVT) in clinical trials of anticoagulant agents. A variety of techniques of venography have been described. Here, we describe a modified technique (the "King's" technique) developed to increase the overall adequacy of identification of lower limb veins and detection of small asymptomatic DVT. Essential elements include proper preparation of patients prior to their arrival in the radiology department, intermittent use of tourniquets to ensure complete and adequate deep vein filling, use of a consistent image acquisition sequence and visualization of all veins in at least two different planes. Use of this technique minimizes technical difficulties, provides improved patient through-put in "busy" fluoroscopy units and, ultimately, improves "off-site" levels of adjudication.
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PMID:Lower limb contrast venography: a modified technique for use in thromboprophylaxis clinical trials for the accurate evaluation of deep vein thrombosis. 1790 20

Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.
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PMID:Endovascular treatment options in the management of lower limb deep venous thrombosis. 1964 57

Patients with trophic ulcers of lower extremities are relatively frequently diagnosed with diabetes mellitus with venous aetiology being the cause of these defects in up to 70% of patients. Chronic venous insufficiency most frequently results from primary venous insufficiency (mostly lower limb varices) or occurs secondarily as a result of deep vein thrombosis. Lower limb varices are common in human population; they affect 20-25% of women and 10-15% of men, and the incidence increases with age. With respect to radicality of treatment approaches, surgical management is unequivocally considered as the most effective. Apart from the traditional open surgery, clinical practice of the recent years has seen the advance of mini-invasive endovascular methods to treat varices of the main (stem) veins--radiofrequency and laser thermocoagulation. The main principle behind radiofrequency ablation is thermocoagulation of insufficient saphenous vein by bipolar radiofrequency current; endovenous laser uses, for the same purpose, energy of a beam of light. Both methods inactivate the insufficient veins while leaving them in the patient body. Thermal damage of the pathological venous wall leads to contraction and obliteration of the vein and, gradually, to its full resorption. Apart from minimizing recurrence, the technique is also valuable with respect to its cosmetic effect and gentleness of the procedure, allowing fast return to full activity. Studies comparing endovascular interventions with the traditional surgeries confirmed that radiofrequency or laser techniques are safe and well tolerated with the outcomes fully comparable to open surgery in its modern form.
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PMID:[Veins and diabetes]. 2046 6


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