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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 natural history diagnosis and immediate treatment of patients suffering from pulmonary embolism has been discussed. Anaesthetists should use their influence to bring about a high standard of prophylactic care against deep venous thrombosis and consequently of pulmonary embolism. They are likely to be involved in the resuscitation and treatment in intensive care units of those cases who suffer from major symptoms and massive emboli and some of them will rarely be involved in anaesthetising for pulmonary embolectomy aided by cardiopulmonary by-pass and, less rarely, for IVC ligation or plication and venous disobliteration. Anticoagulant drugs appear to limit the mortality of pulmonary embolism to 5%. The mortality of IVC ligation or plication varies in different reports from 2 to 50%; it should therefore be reserved for the special indications which have been discussed. There is also an incidence of recurrent pulmonary embolism after IVC ligation and plication and leg troubles from stasis in about 30% of cases. Streptokinase is usually indicated in the immediate treatment of major pulmonary emboli which cause shock and severe distress with an immediate threat to life. In hospitals having access to cardiopulmonary by-pass, pulmonary embolectomy has a small role to play in major emboli with cardiovascular collapse, if surgery can start within 2 hours and pulmonary angiography is available. Cardiopulmonary by-pass on its own may be life-saving in supporting the circulation while the clot fragments. If cardiac arrest occurs, external cardiac massage should be undertaken as it is sometimes successful and disseminates and fragments the clot in the pulmonary artery.
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PMID:Pulmonary embolism. Prophylaxis diagnosis and treatment. 97 May 90

Ultrasound and more recently colour Doppler ultrasound has been successfully used in the diagnosis of lower limb venous occlusive disease. Colour Doppler ultrasound has shown promise in the diagnosis of calf vein thrombosis but to date there has been no prospective trial to specifically evaluate its potential. In view of this, we carried out a prospective trial of 50 patients comparing the accuracy of colour Doppler ultrasound with venography in the diagnosis of deep venous thrombosis both above and below knee but in particular with respect to the detection of calf vein clot. Of the 50 patients studied, 10 had only one imaging modality performed as there were eight venographic failures and two ultrasonic failures. Comparison was only thus possible in 40 cases. As in previous studies, colour Doppler ultrasound was shown to be accurate in the diagnosis of thrombosis within the femoro-popliteal veins and had a sensitivity and specificity of 100% respectively. With respect to calf vein lesions, there was one false negative scan using the ultrasonic technique giving a sensitivity of 95%, specificity of 100% and accuracy of 97.5%. We feel colour Doppler ultrasound can and should be used as a first line alternative to venography and can be employed for the exclusion of both above and below knee deep venous thrombosis. Venography should now be reserved for those patients who are unsuitable for ultrasound examination or who have an equivocal ultrasound scan.
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PMID:Colour flow imaging of calf vein thrombosis. 851 56

Deep vein thrombosis is still an underestimated and often unrecognised diseases both in Italy and abroad despite being far from rare and in spite of its severe complications and often disabilitating sequelae. It is a disease which is becoming more frequent due to increased life expectation, the larger number of operations on elderly patients, and the increased frequency of limb injuries. General and specialised surgery is often hampered by this complication. This has raised interest in a more detailed knowledge of the mechanisms leading to DVT, and the correct employment of the latest equipment which enable diagnosis to be made and daily monitoring of the disease during its evolution. But the greatest efforts must be reserved for preventive measures in order to achieve a statistically significant reduction in the incidence of the disease in operated patients. It is to be hoped that a greater awareness of thromboembolic diseases will allow this to be achieved in the future.
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PMID:[Deep vein thrombosis in surgery]. 146 22

Since PE is the result of DVT, predominantly of the lower extremities, prevention of DVT in patients who are at high risk is important. Regimens including Coumadin, heparin, and physical intervention have all been beneficial. In the presence of pulmonary symptoms, especially when risk factors for DVT are present, an imaging diagnostic work-up is indicated. Ventilation/perfusion scans and duplex scans of the lower extremities will be diagnostic in most cases. Pulmonary angiography should be performed when there is diagnostic uncertainty. Heparin followed by Coumadin is the mainstay of therapy. Fibrinolytic therapy is reserved for cases requiring medical thromboembolectomy. In patients for whom anticoagulation is contraindicated and in patients who have PE while on therapy, the inferior vena cava should be interrupted with a transvenously inserted filter.
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PMID:Diagnosis and treatment of pulmonary embolism. 181 76

The authors report on an epidemiological study carried out in Basle, Switzerland, which prospectively included 341 consecutive patients (226 men, 115 women, mean age 52 +/- 16 years) who had developed deep venous thrombosis evidenced by phlebography. The treatment of the acute phase most often consisted in thrombolysis, conventional heparin being reserved for the contra-indications of thrombolysis. A second phlebographic examination allowed dividing up the series into two groups, ie. positive and negative, according to the presence or absence of a complete or partial return of patency. Each group was subdivided according to the location and extension of the thrombosis. Both groups (positive vs. negative) are different as regards the location and extent of the thrombosis. The selective comparison of both groups according to the objective subdivision demonstrated: the absence of post-phlebitis disease in sural phlebitis; the same risk of post-phlebitis disease in thrombosis extending to 4 levels, whether patency was restored or not; lower incidence of post-phlebitis disease in the positive group for single -, two - or three-level phlebitis. Leg ulcers occur within an average of 5.5 +/- 2.1 years after the acute episode in 6.7% of all patients. Complete return of patency is obtained in 23% of cases only.
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PMID:[Sequelae of venous thrombosis. Incidence in of the post-thrombosis syndrome after 5 years]. 186 Nov 2

Experience and review of the literature suggest that when deep venous thrombosis does occur, standard anticoagulation with heparin followed by Coumadin is the mainstay of treatment for both deep venous thrombosis and pulmonary emboli. However, thrombolytic therapy with urokinase or streptokinase may benefit selected patients. Percutaneous caval interruption is the optimal technique to prevent pulmonary embolization, but should be reserved for patients who have contraindications to anticoagulation therapy or recurrent emboli despite adequate anticoagulation. Selected high risk patients may also be candidates for caval interruption.
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PMID:Venous thromboembolism: anticoagulation, lysis, or filter? 194 28

Among patients with deep vein thrombosis (DVT), the frequency of pulmonary embolism seems conditioned by the location of DVT and thrombus adherence. Consequently, patients with free-floating iliac thrombus are at high risk of life-threatening pulmonary embolism. As regards their definition, non adherent thrombus and free-floating thrombus are not synonymous. Non adherent thrombi are usual in recent DVT and have the same prognosis and treatment as common DVT. The term of free-floating thrombi should be reserved for the iliac location when a small area of the thrombus is attached to the iliac vessel wall but the rest of it does not adhere to the wall. At present, venography is the gold standard for diagnosis but duplex scanning and scanner or magnetic resonance imaging should also be evaluated for this purpose. The treatment comprises the usual anticoagulant therapy with heparin and a specific treatment for the free-floating thrombus. 1) Vena cava filter is a rapid safe solution that avoids severe pulmonary embolism, but in the case of thrombus detachment, vena cava obliteration might occur with the subsequent risk of severe bilateral venous stasis and insufficiency. The indications for such treatment might be elderly patients in a poor general condition. 2) Venous thrombectomy. Venous thrombectomy only removes the free part of the thrombus, thus preserving the contralateral iliac vein from further complications. A clip is positioned on the inferior vena cava. 3) Protected fibrinolysis. The latest catheters allow transient vena cava filter device placement. Thrombolytic therapy with rTPa might achieve thrombolysis and subsequently restore the venous circulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[What to do with a free-floating venous thrombus]. 201 Jul 10

Thirty patients with Stage III/IV cancer and thromboembolic complications between 1987-89 were reviewed. Twelve patients had a deep venous thrombosis proximal to the calf diagnosed by duplex scanning or contrast venography, 15 patients had a pulmonary embolism diagnosed by a high-probability pulmonary ventilation/perfusion scan or arteriogram, and three patients had both deep vein thrombosis and pulmonary embolism. Patients were treated primarily with anticoagulation (Group A = 20 patients) or a Greenfield filter (Group B = 10 patients). Seventy-five percent (15/20) of the Group A patients developed 19 bleeding or thrombosis-related complications: major bleeding (7), recurrent deep venous thrombosis/pulmonary embolism (4), inability to attain consistent therapeutic anticoagulation levels (3), heparin-induced thrombocytopenia (3), or progression of deep vein thrombosis (2). A Greenfield filter was eventually placed in 10 (50%) of the Group A patients without complications. Thirty percent (3/10) of the Group B patients developed progression of deep vein thrombosis that required anticoagulation. One other Group B patient died due to a guidewire-induced arrhythmia. Although patients with advanced cancers and venous thromboembolic disease have a high complication rate with either treatment, initial treatment with a Greenfield filter appears more definitive. Anticoagulation should be reserved for patients with progressive, symptomatic deep vein thromboses after placement of a filter.
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PMID:Thromboembolic complications in patients with advanced cancer: anticoagulation versus Greenfield filter placement. 201 91

The aim of prophylaxis in venous thromboembolism is firstly to prevent fatal pulmonary embolism and secondly to reduce the morbidity associated with deep vein thrombosis and the post-phlebitic limb. Particularly high-risk groups are identifiable and include those over 60 years of age undergoing major surgery, patients with malignancy and those undergoing hip operations. Low-dose subcutaneous heparin (5000 U s.c. commenced two hours preoperatively and continued eight to twelve hourly until the patient is fully mobile) is unequivocally effective in preventing deep vein thrombosis in medical and surgical patients and, most importantly, significantly reduces the incidence of fatal postoperative pulmonary embolism and total mortality. Furthermore, in established deep vein thrombosis, low-dose heparin limits proximal clot propagation, which is the prelude to pulmonary embolism. Despite this, surveys have demonstrated an alarming deficiency amongst clinicians in the application of measures to prevent venous thromboembolism. Heparin prophylaxis carries a small risk of increased bleeding complications, mostly evidenced by the frequency of wound haematoma rather than major haemorrhage. Low molecular heparin fragments (e.g. Fragmin, Choay, Enoxaprin) are now emerging as useful alternative agents, having the advantage of once daily administration and yet providing similar efficacy in the prevention of deep vein thrombosis. However, protection against fatal pulmonary embolism has yet to be demonstrated. Mechanical methods of prophylaxis designed to counteract venous stasis, such as graduated elastic compression stockings, are also beneficial in protection against deep vein thrombosis but by themselves do not achieve such consistently good prophylaxis as low-dose heparin. However, clinical trials with combinations of mechanical methods and low-dose heparin indicate that this may be the optimum approach to very high-risk patients. In the presence of established acute deep vein thrombosis, anticoagulant therapy is the mainstay in preventing pulmonary embolism. Vena caval interruption procedures should be reserved for patients in whom anticoagulation is contraindicated or for those who develop recurrent pulmonary embolism despite adequate anticoagulation.
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PMID:Prevention of venous thromboembolism. 266 85

Complications of popliteal cysts may closely mimic the clinical features of a deep venous thrombosis. We assessed the sensitivity and specificity of the non-invasive procedures of radionuclide venography and popliteal space ultrasound examination compared with those of contrast venography and arthrography, respectively, and then prospectively studied 23 non-surgical patients with acutely painful, swollen calves to determine the utility of these techniques. The cause of this symptom was popliteal cyst complications in 10 patients, deep venous thrombosis in seven patients, and both conditions in two patients. Radionuclide venography was highly reliable and ultrasound examination was specific but only moderately sensitive in these studies. The painful, swollen calf may be investigated adequately in most cases by means of noninvasive invasive techniques; contrast venography and arthrography should be reserved for only a minority of patients.
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PMID:The painful swollen calf. A comparative evaluation of four investigative techniques. 300 54


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