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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 purpose of this investigation was to assess the relative risks of antithrombotic treatment following pulmonary angiography vs no angiography in patients with acute pulmonary embolism (PE). Comparisons of risks of diagnosis and therapy were made among patients treated on the basis of a pulmonary angiographic diagnosis vs patients treated on the basis of a ventilation/perfusion (V/Q) scan combined with clinical assessment in the presence of a single negative test for deep venous thrombosis. Calculations of risks assumed major complications of pulmonary angiography equal to 1.3 percent, major bleeding with heparin equal to 4.9 percent (1.1 percent among patients with a low risk of bleeding and 10.8 percent among patients with a high risk of bleeding), and major bleeding with warfarin (international normalized ratio 2 to 3) equal to 1.7 percent. Among patients with a risk of major bleeding from heparin followed by warfarin of 6.6 percent, if the estimated probability of PE was greater than about 80 percent, fewer major complications of diagnosis and treatment would occur if treatment was initiated on the basis of the V/Q scan. If the probability of PE in such patients was less than 80 percent, fewer major complications of diagnosis and treatment would occur if the diagnosis was established by pulmonary angiography. Among patients with a high (12.5 percent) risk of major bleeding, it was shown to be safer to treat on the basis of an angiographic diagnosis if the estimated probability of PE was less than 90 percent. If the patients, however, were at low (2.8 percent) risk of major bleeding, fewer major complications would occur if angiography was reserved for patients with an estimated risk of PE less than about 50 percent. Serial studies of the leg veins may eliminate the need for angiography in such patients.
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PMID:Relative risks of anticoagulant treatment of acute pulmonary embolism based on an angiographic diagnosis vs a ventilation/perfusion scan diagnosis. 808 49

Phlegmasia cerulea dolens (PCD) is an uncommon, severe form of lower extremity deep venous thrombosis characterized by extremity swelling, cyanosis, and pain. Progression of the thrombotic process may result in extremity gangrene, amputation, and death. The relative value of specific therapeutic regimens in the treatment of this disease remains uncertain. Twelve patients, 9 females and 3 males, with PCD were treated during a 10-year period. Eighteen lower extremities were involved. Pre-existing conditions included malignancy (eight), postoperative state (four), diabetes (three), previous deep venous thrombosis (three), and hypercoagulation (two). Venous gangrene was present in four patients. All patients were treated initially with bedrest, fluid resuscitation, extremity elevation, and systemic high-dose heparin therapy. Five patients had complete resolution with this regimen alone. One patient required cessation of heparin therapy due to heparin-induced thrombocytopenia and developed gangrenous toes. Two patients whose condition failed to respond to heparin therapy underwent catheter-based delivery of urokinase with marked clinical improvement. Four patients, two with venous gangrene, died, three of whom had disseminated malignant disease. A significant percentage of patients with PCD will respond to extremity elevation, fluid resuscitation, and aggressive systemic anticoagulation therapy. Thrombolytic therapy selectively administered is beneficial in patients whose disease fails to respond promptly. Venous thrombectomy should be reserved for patients with contraindications to thrombolysis.
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PMID:Advances in the treatment of phlegmasia cerulea dolens. 835 17

Acute arterial occlusions of the extremities present with the classical five P's: pain, pallor, pulselessness, paresthesia, paresis. Loss of sensitivity and motility are symptoms of the most severe grade of ischemia. The occlusions are due to embolism in about 70% of subjects and to local thrombosis in 30%. These patients have to be treated immediately with heparin. In the mildest forms, deobliteration is desirable, but in the more severe cases rapid restoration of flow not only saves limbs but also life. Deobliteration may be performed surgically or by means of catheters (local thrombolysis or thrombus aspiration) if available. Deep vein thrombosis, the other kind of emergency situation, requires immediate anticoagulation as soon as pulmonary embolism is suspected. It should be initiated by heparin and followed by oral anticoagulation. In patients presenting without pulmonary embolism but a swollen leg, ruptured Baker cysts or muscle hematomas should be ruled out before anticoagulation is started. Systemic thrombolysis or surgical thrombectomy is reserved for young patients with acute isolated thromboses. Thrombectomy must also be kept in reserve for the most severe form of deep venous thromboses, the phlegmasia cerulea dolens. In thrombophlebitis, no anticoagulation is indicated except in bedridden patients. The others must remain mobile and may be treated by systemic and local antiinflammatory drugs, incision of thrombosed varices, and bandages.
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PMID:[Emergencies in angiology]. 849 73

The main complication of totally implantable venous access devices is deep venous thrombosis on catheter. It may dramatically reduce the already limited venous capacity of patients undergoing chemotherapy and obturate catheters, causing pulmonary embolism or functional disorders. These thromboses usually involve veins of the superior vena cava system where the catheters are implanted. Generally, they occur early, are extensive and often asymptomatic. Doppler ultrasonography is the diagnostic investigation of choice, phlebography being reserved for particular cases or to specify the limits of the thrombus. In a series of 412 vein access devices implanted and systematically monitored by Doppler ultrasonography, we found 57 thromboses (13.8%), 15 partial and 42 complete. The lowest thrombosis rate was observed in the right internal jugular vein (10% vs 20 to 23%, p = 0.006). Thirty-two patients received a systemic fibrinolytic treatment, 16 with streptokinase (SK), five with urokinase (UK), four with tissue plasminogen activator (rt-PA) and seven with SK/UK association. No serious side effects were observed. Sixteen repermeabilizations (50% of fibrinolysis) were obtained. There were no significant differences with respect to the fibrinolytic, the initial characteristics of thrombosis or the patients. Patients without fibrinolysis received 3 weeks of low molecular weight heparin (curative doses) then warfarin. Only one patient was repermeabilized with this treatment (significative difference with fibrinolysis: p = 0.009). Fibrinolysis is indicated in symptomatic thrombosis and/or in cases of extension to the innominate vein or the superior vena cava. Systematic monitoring by Doppler ultrasonography and prophylactic anti-thrombotic treatment are recommended in patients with implantable venous access devices in order to decrease the occurrence of thromboses, to detect asymptomatic patients at an early stage and to increase the effectiveness of fibrinolysis.
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PMID:[Fibrinolysis of deep venous thrombosis on implantable perfusion devices. Apropos of a consecutive series of 57 cases of thrombosis and 32 cases of fibrinolysis]. 868 80

At present, most common initial treatment of deep vein thrombosis is anticoagulant therapy with i.v. heparin. Recently, some reports in literature suggest the efficacy of low molecular weight heparin fractions administered also to outpatients. Thrombolytic therapy as compared to heparin seems to be favorable as for the valvular integrity and function with minor postphlebitic sequels. It is however burdened with a higher incidence of hemorrhagic complications. Probably, it should be reserved for those patients with massive phlebothrombosis or phlebothrombosis associated with relevant clinical signs. At present, it has not definitely been proved that one of the commonly used drugs, streptokinase, urokinase and r-TPA affords substantial advantages in terms of efficacy and safety. Locoregional administration by a catheter inserted into the thrombus with the protection of a caval filter enhances the efficacy of thrombolytic agents, even if data on long-term results of this method are still lacking. Discordant opinions exist on the validity of thrombectomy. As a prophylaxis of pulmonary embolism, thrombus removal has been replaced by caval filters. At present it is commonly indicated for phlegmasia coerulea dolens. In the other forms, even if the vascular patency is restored in a good percentage of cases, it is not similarly effective in preventing the postphlebitic syndrome. For these reasons it should be applied in selected cases.
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PMID:Treatment of deep vein thrombosis. 906 58

Interruption of vena cava for prevention of pulmonary embolism (PE) was achieved in the past with surgical ligation or placement of clips outside the infrarenal vena cava. At present, this procedure is performed with percutaneous insertion of vena cava filters. Vena cava filters can be permanent or temporary, catheter-retrievable. Main indications for placement of a vena cava filter are: contraindication for anticoagulant therapy in patients with severe PE in whom a further embolic episode would be fatal or patients with PE (or its recurrence) undergoing adequate anticoagulant therapy. Temporary filters are reserved to patients where the risk of PE is limited in time as in posttraumatic, post-partum or postoperative thromboembolism. The incidence of recurrence after placement of a vena cava filter varies between 0.5 and 7%. Procedure-associated complications are usually mild. However, severe complications as filter migration into the pulmonary artery or vena cava perforation were described. Our experience concerns the insertion of 61 vena cava filters (47 permanent and 14 temporary). Indications were as follows: iliofemoral thrombosis at embolic risk (37 cases), contraindication for anticoagulant therapy in the presence of deep vein thrombosis with embolic risk (7 cases), protection during fibrinolytic therapy (3 cases), PE during anticoagulant therapy (5 cases) complications of anticoagulant therapy which required discontinuation (5 cases), prophylaxis in view of surgery at high risk for PE (2 cases), protection for surgical venous thrombectomy (2 cases). Mortality was nil. Clinically evident PE was not observed in any patient in whom vena cava filter was inserted. Complications were mild and asymptomatic. Vena cava filters represent an effective prevention of PE together with medical and surgical treatment. At present, problems of this procedure are not technical but rather concern correct indications. Interruption of vena cava is effective if planned within a global strategy for prevention of thromboembolism.
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PMID:Venous interruption as prophylaxis of pulmonary embolism: vena cava filters. 906 63

Vascular complications following orthopedic procedures at the lower extremity are mainly thrombotic or thromboembolic events. Damages to vascular structures during operations close to the knee joint, like injuries of the popliteal artery, are extremely rare and receive a reserved consideration in the evaluation of postoperative complications. The extent of the vessel injury affects the grade of clinical symptoms-from acute arterial bleeding as far as slowly developing disturbances of haemodynamic, with effects to the different functions and pattern of the concerned tissues. Arterial bleeding into muscle compartments do not necessarily appear as an acute emergency, therefore it may occasionally be difficult to place the clinical symptoms into the right context of pathophysiological processes. In the present case a deep vein thrombosis of the affected extremity was initiated by a haemorrhage into the fossa popliteal and the compartments of the lower leg after injury of the popliteal artery. Subsequently a compartment syndrome, a false aneurysm of the popliteal artery and an arteriovenous fistula from popliteal artery into a lower leg vein developed.
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PMID:[Angiological complications following high tibial head correcting osteotomy--a case report]. 919 78

Patients with risk factors for VTE and developing signs or symptoms remotely consistent with DVT or PE should undergo formal testing. Ultrasound and IPG have good sensitivity and specificity in symptomatic DVT. V/Q lung scans should be obtained in all patients with suspected PE or proven DVT. A prior clinical assessment of probability, based on risk factors, history, physical examination, chest film, and arterial blood gas analysis, can aid in the interpretation of V/Q scans. Normal scans exclude PE. High-probability scans confirm PE if the clinical probability is at least intermediate. Nondiagnostic scans are common, but diagnosis in such cases can be aided by noninvasive leg studies. Heparin therapy should be started when there is suspicion of VTE. To avoid recurrence, a therapeutic aPTT of 1.5 to 2.5 times the control rate should be achieved as soon as possible after the diagnosis of VTE is confirmed. Thrombolytics are reserved for hemodynamically compromised patients. Warfarin should be administered to achieve an INR of 2.0 to 3.0 and should be continued for at least 3 months in patients with low risk of recurrence and probably for at least 6 months in all other patients.
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PMID:Venous thromboembolism. A contemporary diagnostic and therapeutic approach. 933 5

The most frequent indication for placement of a central venous access device in hemophiliacs is in very young boys (ages 1-2 years) with severe hemophilia who are started on a program of long-term factor prophylaxis designed to eliminate target joint bleeding and the development of chronic musculoskeletal disease. Although expensive, this strategy is extremely successful. It involves intravenous infusion of 25-40 factor units per kg on alternate days (minimum 3 times a week) for boys with severe hemophilia A, and twice a week for boys with severe hemophilia B. To facilitate this prophylaxis regimen some hemophilia clinics routinely recommend placement of a central venous access device; others, more concerned about associated complications such as sepsis, stress the importance of using peripheral veins wherever possible, with central access devices reserved for occasional, selected cases only. A decision to use such a device should only be made after discussion of the risks/benefits with parents (or guardians) and with patients if of an appropriate age. If such a system is to be used, we recommend that a totally implantable device (Port-A-Cath) be placed because of the lower risk of infection, and because totally implantable devices allow children to take part in activities such as swimming. Important complications include catheter-related sepsis, which may occur in 25% or more of devices over time and, much less frequently, catheter-related deep vein thrombosis.
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PMID:Central venous access devices in children with hemophilia: an update. 935 30

This case illustrates a potential pitfall of color flow duplex Doppler ultrasonography with compression in the evaluation of suspected deep venous thrombosis (DVT). Because of its low cost, accuracy, and noninvasiveness, ultrasonography is the appropriate first choice in the evaluation of suspected DVT, but there does exist the possibility of a false-negative examination. Magnetic resonance venography (MRV) should be reserved for cases in which there is a high clinical suspicion for DVT, as well as either morbid obesity that would limit the evaluation of deep pelvic and deep femoral veins or conflicting results of other imaging studies. All cases of suspected thrombosis, including those not adequately evaluated by ultrasonography, can be accurately assessed by MRV, which is not as invasive as standard venography.
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PMID:Thrombosis of the deep femoral vein: a potential pitfall of color flow duplex Doppler ultrasonography. 940 15


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