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

This study was designed to compare duplex scanning with contrast venography for the diagnosis of acute deep vein thrombosis of the lower extremity, both at the femoropopliteal (above-knee) and tibioperoneal (below-knee) levels. A total of 216 patients with 220 limbs suspected of acute deep vein thrombosis underwent duplex scanning followed within 24 h by ascending venography. The two studies were interpreted independently by two physicians who were blinded to the results of the corresponding alternative study. Venography was positive for deep vein thrombosis in 44.5% of cases (98/220). Duplex scanning was inadequate at the above-knee level in two cases (0.9%) and at the below-knee level in 17 cases (7.7%). Sensitivity and specificity of duplex scanning at above-knee level were 98.7% and 100% respectively while corresponding values were 85.2% and 99.2% at below-knee level. By excluding technically inadequate duplex studies, the sensitivity at below-knee level was clearly improved (93.8%). It is concluded that with meticulous technique, duplex scanning is highly accurate in diagnosing acute deep vein thrombosis of symptomatic lower extremities, avoiding contrast venography in over 90% of the cases, even at the tibioperoneal level.
Cardiovasc Surg 1996 Aug
PMID:A prospective study comparing duplex scan and venography for diagnosis of lower-extremity deep vein thrombosis. 886 90

A total 30,040 pregnancies were reviewed at one institution over 5 years to determine the incidence of venous thrombotic complications. Thirty-one patients experienced such complications related to pregnancy (incidence 0.1%); 13 had deep venous thrombosis and 14 had superficial venous thrombophlebitis diagnosed by duplex ultrasound. Four had pelvic vein thrombophlebitis diagnosed by computed tomography scan; three patients (one from each group) sustained a non-fatal pulmonary embolus. Of those with deep venous thrombosis, 10 (77%) were left-sided, and three (23%) were right-sided. Three had a prior history of deep venous thrombosis and one of pulmonary embolism. Of those with superficial venous thrombophlebitis, seven (50%) were left-sided, six (43%) were right-sided, and one (7%) was bilateral. Most with deep venous thrombosis presented later in pregnancy; three in the first trimester, two in the second, three in the third, and five early postpartum. Most (10/14) with superficial venous thrombophlebitis presented within 48 hours of delivery. Distribution of thrombi in those with deep venous thrombosis was compared with 643 non-pregnant women with a similar condition. A pattern of proximal involvement on the left was found, with left common femoral vein (54% versus 28%, P = 0.03) and superficial femoral vein (62% versus 26%, P = 0.006) more often involved in pregnant patients. The average number of vein segments involved was greater on the left than the right (5.3 versus 3.7). Symptoms of chronic venous insufficiency developed in three with deep venous thrombosis (25%) and in three with superficial venous thrombophlebitis (27%). None had recurrence of deep venous thrombosis. It is concluded that venous thrombotic complications associated with pregnancy are not necessarily benign, with the risk of pulmonary embolism and chronic venous insufficiency not limited to patients with deep venous thrombosis only.
Cardiovasc Surg 1996 Dec
PMID:Venous thrombotic complications of pregnancy. 901 9

A 35-year-old patient, physically very active, developed symptoms and signs of postphlebitic venous obstruction in the right lower extremity that was complicated by deep venous thrombosis, while recovering from a motorcycle accident. Duplex and venography demonstrated occlusion of the right superficial femoral vein and right external iliac vein. Strain-gauge plethysmography and measurements of venous pressures demonstrated functional obstruction. The patient underwent saphenous cross-femoral vein bypass, right saphenous-popliteal anastomosis accompanied with distal posterior tibial to saphenous vein arteriovenous fistula. Ten days following surgery, the arteriovenous fistula and the distal great saphenous vein closed spontaneously. The rest of the reconstruction remained patent as documented by duplex up to 24 months following the surgery. Clinically, the patient is doing well, tolerating heavy physical exertion as before his accident. The importance of selection of patients for venous bypass surgery is stressed. Only patients with co-existing anatomical and functional obstruction are good candidates for these procedures.
Cardiovasc Surg 1996 Dec
PMID:Complex venous reconstruction for chronic iliofemoral vein obstruction. 901 21

The purpose of this report is to examine the outcomes for patients with an underlying diagnosis of malignancy who have had Greenfield vena caval filters placed for protection from pulmonary embolism, and to identify areas requiring further study. This was a retrospective review of data obtained from the Greenfield filter registry and the University of Michigan Tumor Registry for 166 patients treated at the University of Michigan Medical Center between January 1988 and June 1994. The 84 men and 82 women (mean age 57.8 years) had a mean survival time of 10 (range 1-68) months. This differs significantly from patients in the filter registry who do not have malignancy (P<0.0001). Some 51% experienced recurrence of their malignancy at a mean of 20 months; this timing corresponds to development of new or recurrent thrombembolism and filter placement. Distant metastases were present in 72% of patients at the time of filter placement. In conclusion, as anticipated, filter patients with malignancy have a significantly shorter survival time than those with other concurrent diseases. A temporal association between the progression of the malignancy and the occurrence of thromboembolism is observed in this population and requires further study. Future studies regarding the use of vena caval filters in these patients and the role of diagnostic screening for deep venous thrombosis and occult recurrence of malignancy should focus on efficacy, safety, cost and patient quality of life rather than on survival.
Cardiovasc Surg 1997 Apr
PMID:Clinical results of Greenfield filter use in patients with cancer. 921 99

A patient with a pulmonary embolism due to deep vein thrombosis of a lower extremity developed hypotension and cor pulmonale despite prior placement of an inferior vena caval filter and treatment with a thrombolytic agent. After failure of percutaneous guidewire fragmentation and thrombosuction, self-expandable bilateral Z stents were positioned into the lower branches through the pulmonary arterial trunks. The patient experienced immediate relief of her cor pulmonale and successful recovery from hypotension.
Cardiovasc Intervent Radiol
PMID:Emergent Z stent placement for treatment of cor pulmonale due to pulmonary emboli after failed lytic treatment: technical considerations. 962 47

A 77-year-old man had an inferior vena cava Greenfield filter placed for bilateral deep venous thrombosis acquired during a complicated hospitalization for a hip fracture. The filter migrated and lodged at the level of the tricuspid valve. We describe a transvenous retrieval approach which is safer and performed under more controlled technique than previously reported.
Cathet Cardiovasc Diagn 1998 Jul
PMID:Transvenous retrieval of a Greenfield filter lodged in the tricuspid valve. 967 3

Duplex scanning was used to determine patterns of recurrent varicose veins in 264 limbs and to relate these to clinical factors. All limbs had previously undergone sapheno-femoral ligation in the groin. A recurrent sapheno-femoral junction was present in 172 (65.2%). Incompetence was found in long or short saphenous veins in 232 limbs (87.9%), perforators in 176 (66.7%), and deep veins in 156 (59.1%). Residual long saphenous veins were present in 43.4% and 73.6% of limbs that were with and without stripped long saphenous veins, respectively. An incompetent thigh perforator was present in 14.0% and 15.3% of these two groups, respectively. Multiple sites of incompetence were observed in the majority (75.4%). In general, no particular reflux pattern in the groin was related to an increased incidence of ulceration. However, ulceration was more frequent in limbs with deep reflux to knee or below-knee levels. None of those with isolated reflux in the groin that was unrelated to the common femoral vein had ulceration. The pattern of reflux was unrelated to striping or non-striping of the long saphenous veins and the time since initial surgery. A history of deep vein thrombosis was invariably associated with some degree of deep reflux. A system of recurrent patterns in the groin is described for the purpose of surgical audit. In 15.1%, recurrence was attributed with some confidence to inadequate surgery. These results indicate that the pattern of recurrence is highly variable and often with multiple sites of incompetence. In a few instances, the pattern of recurrence was associated with specific clinical factors. A full work-up including duplex scanning is recommended.
Cardiovasc Surg 1999 Apr
PMID:Recurrent varicose veins: patterns of reflux and clinical severity. 1038 52

Two 25-year-old males with symptomatic venous hypertension (venous claudication, n = 1; swollen leg, n = 1) were evaluated for iliofemoral venous occlusive disease. One patient had a common femoral vein/external iliac vein occlusion with no history of deep vein thrombosis or trauma. The second patient had an acute deep vein thrombosis superimposed on a chronic external iliac vein stenosis. No source of extrinsic venous compression was identified in either patient. Venous reconstruction with vein bypass (patient no. 1) and vein patch angioplasty (patient no. 2) led to resolution of their hypertensive symptoms. Intraoperative examination of the involved vein segments revealed chronic changes consistent with a prior occult deep vein thrombosis in both patients. Occult iliofemoral deep vein thrombosis in young healthy males is rarely seen. The acute deep vein thrombosis may manifest minimal or no symptoms but it can lead to chronic venous occlusive disease and serious post-phlebitic morbidity. In this context, these two cases are discussed with a review of the pertinent literature.
Cardiovasc Surg 1998 Dec
PMID:Symptomatic venous hypertension because of occult iliofemoral deep vein thrombosis: a report of two cases. 1039 63

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.
Cardiovasc Surg 1998 Dec
PMID:Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia. 1039 65

Thrombolytic therapy is well established in the management of a select group of atherothrombotic and thromboembolic diseases at the expense of definite but increased risk of intracranial hemorrhage. The incidence of intracranial hemorrhage is higher (6.4% to 20%) in the thrombolytic treatment of acute ischemic stroke, whereas the cerebral hemorrhagic complications of thrombolytic treatment in acute myocardial infarction, acute pulmonary embolism, deep venous thrombosis, and arterial and graft occlusion is less than 2%. Although systemic fibrinolysis after thrombolysis is responsible for hemorrhagic complications, many factors are implicated in predisposition to cerebral hemorrhagic complications such as old age, untreated or chronic hypertension, history of cardiac disease, hyperglycemia, patients with small body mass, previous stroke, longer therapeutic treatment window, increasing neurological deficit or severity of neurological deficit, higher thrombolytic dose and computed tomography findings of mass effect, edema, or extended infarct sign involving more than one third of the territory of the middle cerebral artery. Although the knowledge of different factors associated with intracranial hemorrhage is important, it is the judicious use and strict adherence of appropriate clinical protocols in different clinical settings of thrombolytic treatment and avoidance of the contra-indications that will minimize the rate of hemorrhagic complication to achieve good clinical outcome and desired benefit.
Prog Cardiovasc Dis
PMID:Cerebral hemorrhagic complications of thrombolytic therapy. 1059 22


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