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

A single-centre experience of military vascular injuries in the recent conflict in Yugoslavia is reviewed. From 1 April to 13 December 1991, 1020 casualties were admitted to the Surgical Clinic at the Teaching Faculty of the University in Zagreb, Croatia. A total of 120 injured blood vessels in 76 patients were treated in the department of vascular surgery. Casualties were transported to the hospital after treatment by forward surgical facilities. The transportation time ranged from 3 to 18 (mean 7) h. The most common injuries were to the popliteal artery (12.5%) and brachial veins (10.0%). After segmental resection, arterial and venous revascularization with saphenous vein graft interposition was the preferred option. Twenty-six fasciotomies were performed because of compartment syndrome. Indications for six amputations included sepsis, deep vein thrombosis and extensive myonecrosis. Concomitant bone fractures were stabilized by an external fixator in 90.4% of cases. Vascular injuries were repaired before orthopaedic stabilization. Completion arteriography was used to delineate concomitant distal lesions.
Cardiovasc Surg 1993 Feb
PMID:Military vascular injuries in Croatia. 807 91

Phlegmasia cerulea dolens is a rare form of deep vein thrombosis. A patient with recurrent episodes of such thrombosis caused by protein C deficiency who developed phlegmasia cerulea dolens is reported. Limb perfusion with urokinase successfully restored venous outflow after unsuccessful attempts at thrombectomy.
Cardiovasc Surg 1993 Feb
PMID:Thrombectomy and isolated limb perfusion with urokinase in the treatment of phlegmasia cerulea dolens. 807 98

Previous use of the greater saphenous vein limits the subsequent availability of conduit for coronary artery bypass grafting (CABG). One readily available alternative conduit is the lesser saphenous vein (LSV). During a 4-year period, 34 LSVs were explored in 23 patients using a novel surgical approach. The incision used for LSV harvest was carried through and deep into the muscular fascia, posterior to the tibia, along the length of the leg, developing a fascial-cutaneous flap. The LSV in all patients was imaged before operation by venous duplex scanning. Important anatomic details were mapped on the patient's leg before surgery using indelible ink. Findings at operation correlated well with the duplex imaging results. Of the 34 LSVs explored 31 were judged usable by the operating surgeon. In eight patients bilateral LSVs were used and in two this vein was the only conduit available. Among patients undergoing LSV harvest there was no operative mortality and minimal operative morbidity related to harvesting. Only one wound infection developed at the incision site. There were no documented cases of deep vein thrombosis. A case-control study was performed in which a control group of 25 patients undergoing CABG without use of the LSV were compared with the 23 who had LSVs harvested; patients in both groups underwent preoperative venous duplex studies. There were no significant differences in operative mortality or morbidity rate between groups (statistical power > 0.8 for these negative observations), suggesting that harvest of the LSV is usually successful when used in conjunction with preoperative venous duplex scanning.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovasc Surg 1993 Jun
PMID:Alternative conduits for coronary revascularization: a novel approach for harvest of the lesser saphenous vein. 807 46

Pulmonary angiography is the definitive study for the identification of embolism. The development of accurate noninvasive methods for the detection of deep venous thrombosis has altered the indications for angiography. Many angiographic techniques have been developed, providing the opportunity to tailor the angiogram to the clinical situation of individual patients. Strict criteria must be used for interpretation of angiographic studies, and using state of the art equipment will diminish technically unsatisfactory examinations. CT and MR angiography will assume a significantly larger role in the identification of PE in the very near future. MR may become the method of choice, because it is the one noninvasive technique that shows promise for the study of both the deep venous system of the legs and pelvis and the pulmonary circulation.
Prog Cardiovasc Dis
PMID:Pulmonary angiography and the diagnosis of pulmonary embolism. 807 79

Epidemiologic studies over the past 30 years have provided much of the basis for the understanding of venous thromboembolic disease. There has been an evolution from simple descriptive studies using clinical diagnosis to various forms of comparative studies using objective diagnoses. Identification of high-risk cases in the hospitalized population has led to the development of both general and specific antithrombotic prophylactic regimens. This has occurred against a background of an increased understanding of the pathophysiology of venous thrombosis. Inhospital case interventions have allowed direct questions concerning pathophysiology to be addressed. Examples would include the use of certain types and dosages of anticoagulants and the use of mechanical devices to avoid stasis. Despite these advances, there are still areas that require further attention. One aspect of importance is to evaluate the thrombotic risk of new procedures. The possibility that a new procedure may be either less or more thrombotic than its predecessor should be addressed. In the case of the former, additional antithrombotic measures are needed. An example of this is the relatively disappointing results of regular low-dose heparin treatment in some orthopedic procedures. In the case of the latter, less severe measures may be indicated. Current antithrombotic methods are not without risks and may not be necessary with some of the new endoscopic surgical procedures. Another area of importance relates to the monitoring of compliance. The information on antithrombotic methods has been available for two decades, yet surveys of the application of these methods consistently show that antithrombotic protocols are used less in North America relative to their use in equivalent institutions in Europe. A third area that still needs further epidemiologic study is the incidence and effects of venous thrombosis in the general community. Despite the two recent descriptive studies cited above, relatively little, as compared with the in-patient perspective, is known about community risk factors and their prevention. With respect to the natural history of hospital-based cases it seems unlikely that much is to be gained from surveying the efficacy of heparin or heparin-like treatment for mortality end points. However, a large and still unsatisfactorily examined area is the true frequency and impact of the postphlebitic syndrome. This aspect is germane to both hospital- and community-acquired DVT and, with an aging population, clearly deserves a lot more attention.
Prog Cardiovasc Dis
PMID:The natural history and epidemiology of venous thrombosis. 818 96

We report 4 cases of deep venous thrombosis and/or pulmonary embolism after diagnostic cardiac catheterization. Two of these cases followed left heart catheterization alone.
Cathet Cardiovasc Diagn 1993 Nov
PMID:Deep venous thrombosis and pulmonary embolism following cardiac catheterization. 826 94

Venous stasis associated with prolonged bed rest can enhance the risk of deep venous thrombosis (DVT). Pneumatic compression of the lower extremities can reduce this risk by preventing venous stasis. When selecting a method of leg compression for their patients, physicians must chose between two distinctly different types of compression devices. One device applies pressure with a single-chambered sleeve to the below knee region while the other applies pressure in a sequential gradient fashion from the ankle to the thigh. The current prospective study was designed to evaluated the ability of two such devices to increase blood flow in the profunda femoral vein. Venous blood flow velocity, compression time, and vein diameter were measured in nine normal experimental subjects using an Accuson duplex-Doppler before, during and after leg compression. Compression with the single-chambered device produced a significant rise in venous blood flow velocity; however, this could not be maintained and our results indicate a higher average velocity was achieved with the sequential gradient device. The sequential gradient device also moved a greater volume of blood and achieved a higher average blood flow rate. The time between deflation of the sleeve and return of a phasic respiratory signal was greater after compression with the sequential gradient device. These results suggest that sequential gradient compression produces the type of hemodynamic alterations needed to reduce the risk of DVT by achieving a sustained increase in venous blood flow and more completely emptying of the veins in the leg.
J Cardiovasc Surg (Torino) 1993 Oct
PMID:Hemodynamic alterations in venous blood flow produced by external pneumatic compression. 828 51

Twenty-eight patients treated with thrombolytic therapy for acute deep venous thrombosis were monitored prospectively with non-invasive testing every 12-24h during treatment to evaluate thrombus response and whether duration of therapy was appropriate. Some 75% (21 of 28) of patients demonstrated improvement with lytic therapy with 36% (10 of 28) demonstrating complete lysis; 95% of responders (20 of 21) initiated lysis within 24h. Some 33% (7 of 21) of all responders and 64% (7 of 11) of those having partial lysis had treatment terminated during thrombus resolution but before maximal lysis. Non-invasive testing indicated that thrombolytic therapy for acute deep venous thrombosis is frequently terminated before maximal lysis of the thrombus. Monitoring thrombus response with venous duplex imaging should be part of the treatment strategy of deep venous thrombosis if thrombolytic therapy is used. This approach should increase efficacy and potentially reduce complications of thrombolytic therapy for acute deep venous thrombosis.
Cardiovasc Surg 1996 Feb
PMID:Thrombolytic therapy for acute deep venous thrombosis: how much is enough? 863 37

A 52-year-old woman with an extensive superficial femoral artery occlusion was treated with percutaneous transluminal angioplasty. Because of extensive dissections, two covered stents were placed percutaneously. The intervention was successful with respect to vessel patency, but local pain and fever developed 5 hr after the intervention. Swelling of the thigh occurred, but deep venous thrombosis was excluded. MRI revealed pronounced soft-tissue edema in the adductor canal that persisted for 4 weeks. The fever responded to antiinflammatory medication, but the pain remained for 4 weeks. The vessel was patent at the last follow-up, 8 weeks after graft placement. Soft-tissue edema after percutaneous placement of covered stents has been reported previously. The cause of the inflammatory reaction is unclear.
Cardiovasc Intervent Radiol
PMID:Perivascular inflammatory reaction after percutaneous placement of covered stents. 878 Nov 57

This study was conducted to identify patients at high risk of the development of Pulmonary Embolism (PE) after open heart surgery, to evaluate pertinent diagnostic methods, and to assess the mortality associated with this complication. We evaluated the records of 2,551 consecutive patients who underwent open heart surgery over a 10-year period to identify those patients in whom PE developed. All surgical reports, ventilation/perfusion scans, pulmonary angiograms, and autopsies from the same period were also reviewed. Preoperative and postoperative risk factors for pulmonary embolism were also analyzed, as well as the outcome of this complication in each type of surgical procedure. Pulmonary embolism was identified in 69 (2.7%) patients after open heart surgery, in 43 (62.3%) of whom the diagnosis was established within the first week of surgery. Factors associated with high incidence for PE were hyperlipidemia, congestive heart failure and heparin-induced thrombocytopenia (P < 0.001); obesity and prolonged mechanical ventilation (P < 0.005); and prior right heart catheterization by the femoral approach and prior PE and/or deep vein thrombosis (P < 0.05). The diagnosis of PE was established by a high-probability ventilation/perfusion scan in 25 patients, by pulmonary angiography in 42 (29 of whom had prior V/Q scan read as intermediate or low probability for PE) and by autopsy in two patients. The mortality rate in patients who had PE was 7.2%, while in those without this complication it was 3.2%. These findings suggest that aggressive approach for the diagnosis of PE by pulmonary angiography whenever the V/Q scan is not read as high probability is crucial in patients with recent open heart surgery; such approach may identify patients with PE at an early stage and may have an impact in reducing mortality incurred by this complication. This diagnostic assessment should be emphasized in the perioperative period, especially in patients with multiple significant and identifiable risk factors for PE.
Cathet Cardiovasc Diagn 1995 Oct
PMID:Critical role of pulmonary angiography in the diagnosis of pulmonary emboli following cardiac surgery. 882 30


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