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American Family Physician Nov 2012Venous thromboembolism manifests as deep venous thrombosis (DVT) or pulmonary embolism, and has a mortality rate of 6 to 12 percent. Well-validated clinical prediction... (Review)
Review
Venous thromboembolism manifests as deep venous thrombosis (DVT) or pulmonary embolism, and has a mortality rate of 6 to 12 percent. Well-validated clinical prediction rules are available to determine the pretest probability of DVT and pulmonary embolism. When the likelihood of DVT is low, a negative D-dimer assay result excludes DVT. Likewise, a low pretest probability with a negative D-dimer assay result excludes the diagnosis of pulmonary embolism. If the likelihood of DVT is intermediate to high, compression ultrasonography should be performed. Impedance plethysmography, contrast venography, and magnetic resonance venography are available to assess for DVT, but are not widely used. Pulmonary embolism is usually a consequence of DVT and is associated with greater mortality. Multidetector computed tomography angiography is the diagnostic test of choice when the technology is available and appropriate for the patient. It is warranted in patients who may have a pulmonary embolism and a positive D-dimer assay result, or in patients who have a high pretest probability of pulmonary embolism, regardless of D-dimer assay result. Ventilation-perfusion scanning is an acceptable alternative to computed tomography angiography in select settings. Pulmonary angiography is needed only when the clinical suspicion for pulmonary embolism remains high, even when less invasive study results are negative. In unstable emergent cases highly suspicious for pulmonary embolism, echocardiography may be used to evaluate for right ventricular dysfunction, which is indicative of but not diagnostic for pulmonary embolism.
Topics: Algorithms; Angiography; Biomarkers; Echocardiography; Fibrin Fibrinogen Degradation Products; Humans; Magnetic Resonance Imaging; Phlebography; Plethysmography, Impedance; Pulmonary Embolism; Risk Factors; Tomography, X-Ray Computed; Venous Thrombosis
PubMed: 23157144
DOI: No ID Found -
Journal of Vascular Surgery. Venous and... Jan 2017Duplex ultrasound (DUS) is performed by the majority of physicians after endovenous ablation (EVA) of the great saphenous vein to screen for endovenous heat-induced... (Review)
Review
BACKGROUND
Duplex ultrasound (DUS) is performed by the majority of physicians after endovenous ablation (EVA) of the great saphenous vein to screen for endovenous heat-induced thrombosis (EHIT) at the saphenofemoral junction extending into the femoral vein. Several factors should be considered in assessing the value and cost of routine DUS after EVA: the natural history of EHIT is poorly defined, the incidence appears low, and the majority are both asymptomatic and Kabnick type 2 (projecting only slightly into the femoral vein). Moreover, routine postoperative DUS screening is not recommended for procedures with higher thromboembolic complication rates, such as joint replacement or bariatric surgery.
METHODS
Data on the incidence of death, EHIT, and deep venous thrombosis (DVT) were derived from a systematic review after either radiofrequency or laser ablation of the saphenous vein from two sources: (1) EVA randomized controlled trials (N = 1482) and a (2) large (>150 patients) EVA case series (N = 12,363). The number of tests required to detect one case of EHIT/DVT was calculated from the incidence in the EVA and case series data bases; the cost to detect a case was estimated using the 2013 Medicare global fee schedule for the cost of a unilateral venous DUS study.
RESULTS
This analysis included 13,845 EVA-treated limbs. There were no reported deaths. The incidence of DUS-detected venous thromboembolism after EVA is 0.7%. The cost of unilateral DUS according to the Medicare global reimbursement fee for office-based studies is $106.71. The total cost of performing DUS in this study population is estimated to be at least $1,477,399, and the amount of dollars expended per venous thromboembolism detected is $14,667.
CONCLUSIONS
The current Society for Vascular Surgery/American Venous Forum recommendation is to perform screening DUS after EVA within 72 hours postoperatively with a weak level of recommendation (grade 2C). The current analysis demonstrates a low incidence of EHIT/DVT with a corresponding high cost to detect each case with routine DUS screening. These data combined with the unclear clinical significance of EHIT suggest that the policy of universal post-EVA screening should be revised in the near future.
Topics: Catheter Ablation; Costs and Cost Analysis; Health Care Costs; Humans; Postoperative Care; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 27987602
DOI: 10.1016/j.jvsv.2016.07.001 -
International Journal of Molecular... Aug 2018The present study aimed to investigate the effect of the expression of interleukin (IL)‑18 and related markers on deep venous thrombosis (DVT) to examine their...
The present study aimed to investigate the effect of the expression of interleukin (IL)‑18 and related markers on deep venous thrombosis (DVT) to examine their correlation. Sprague‑Dawley rats of different models were established and were randomly assigned into three groups. The expression of IL‑18, nuclear factor (NF)‑κB and von Willebrand factor (vWF) were detected in blood samples. The inferior vena cava (IVC) was ligated to establish the DVT model. Rat IL‑18 overexpression and inhibition vectors were constructed. The expression levels of IL‑18 and related markers in the venous wall were compared between the model group and the control group using reverse transcription‑quantitative polymerase chain reaction and western blot analyses. Following the culture of human umbilical vein endothelial cells (HUVECs), IL‑18 was added to the cells, following which the growth of the HUVECs, and changes in vWF and other endothelial functional markers were analyzed. The IVC model demonstrated complete thrombosis at 8 h and stable thrombosis at 24 h. At 24 h following model establishment, the expression levels of IL‑18, NF‑κB and vWF were high in the blood samples with the occurrence and development of thrombosis (P<0.05). The weight, length and weight/length ratio of thrombi in each model group showed significant differences from those in the control group (P<0.05) with the overexpression of IL‑18, and the expression levels of NF‑κB and vWF in venous tissues were altered with abnormal expression levels of IL‑18. IL‑18 damaged HUVECs and significantly increased viability in early‑stage apoptosis, promoted the upregulation of vWF and P‑selectin, and reduced tissue plasminogen activator. IL‑18 and the related markers were closely associated with the occurrence and development of DVT.
Topics: Animals; Down-Regulation; Female; Gene Expression; Human Umbilical Vein Endothelial Cells; Humans; Interleukin-18; Rats, Sprague-Dawley; Up-Regulation; Vena Cava, Inferior; Venous Thrombosis
PubMed: 29786104
DOI: 10.3892/ijmm.2018.3682 -
European Journal of Vascular and... Oct 2022
Topics: Humans; Vena Cava, Inferior; Iliac Vein; Venous Thrombosis; Vascular Malformations
PubMed: 35820611
DOI: 10.1016/j.ejvs.2022.06.026 -
Saudi Medical Journal Jan 2022To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention...
OBJECTIVES
To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention in these patients.
METHODS
A record-based descriptive study was carried out in Radiology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia, including patients who underwent lower limb duplex ultrasounds between January 2015-2021. Patients with bilateral DVTs, known pelvic masses, and pelvic surgeries were excluded. All patients positive for DVTs were identified and further imaging was reviewed. Left common iliac vein compression of 50% or more on computed tomography (CT) was considered positive for MTS. Endovascular interventions (venoplasty alone or with stenting) were evaluated and success recorded by observing patency of vein on follow-up imaging or improvement of symptoms on follow-up visits.
RESULTS
Of 182 patients with left lower limb duplex studies, 51 patients were positive for DVTs. A total of 37 patients had CTs and 21 patients had MTS (17 females, 3 males). A total of 15 patients underwent endovascular interventions, 2 patients had venoplasties alone (one successful) and 13 patients had venoplasties with stenting (10 successful).
CONCLUSION
Patients with MTS as cause of DVT may benefit from early endovascular intervention.
Topics: Endovascular Procedures; Female; Humans; Lower Extremity; Male; May-Thurner Syndrome; Stents; Treatment Outcome; Venous Thrombosis
PubMed: 35022292
DOI: 10.15537/smj.2022.43.1.20210473 -
JACC. Cardiovascular Interventions Apr 2016Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of... (Review)
Review
Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter. Due to the substantial increase in the number of IVC filters placed in the United States and the very low filter retrieval rates, clinicians are faced with a very large population of patients at risk for developing IVC thrombosis. Nevertheless, there is a paucity of data and societal guidelines with regards to the diagnosis and management of IVC thrombosis. This paper aims to enhance the awareness of this uncommon, but morbid, condition by providing a concise, yet comprehensive, review of the etiology, diagnostic approaches, and treatment strategies in patients with IVC thrombosis.
Topics: Angioplasty, Balloon; Anticoagulants; Combined Modality Therapy; Humans; Risk Factors; Stents; Stockings, Compression; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Vascular Malformations; Vena Cava Filters; Vena Cava, Inferior; Venous Thrombosis
PubMed: 26952909
DOI: 10.1016/j.jcin.2015.12.268 -
Journal of Vascular Surgery. Venous and... May 2020The most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by...
OBJECTIVE
The most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by atorvastatin and rosuvastatin. The aim of this study was to test the influence of lipid-lowering therapy with statins on PTS development.
METHODS
All patients between January 2002 and June 2018 with diagnosed DVT were enrolled in this study and analyzed retrospectively. Documentation was performed using the standardized system M1 (CompuGroup Medical, Koblenz, Germany) throughout the observation period. Patients received therapeutic anticoagulation and compression stockings. In case of recurrent DVT, patients received lifelong therapeutic anticoagulation. All patients received clinical examination and duplex ultrasound evaluation 3 to 6 months after primary diagnosis and annually thereafter.
RESULTS
A total of 579 patients with DVT were enrolled in this study. Of these patients, 414 (71%) developed PTS (337/414 [81%] presented with the mild version; mean Villalta score, 5.79). Risk factors for PTS development were recurrent DVT (P = .001) and malignant disease (P = .001). Protective factors were therapy with platelet aggregation inhibitors (P = .049) and lipid-lowering therapy with statins (P = .001). After multivariable analysis, the only risk factor was recurrent DVT (P = .001), and the only protective factor was lipid-lowering therapy (P = .001).
CONCLUSIONS
Post-thrombotic changes might be reduced by lipid-lowering therapy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Germany; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Incidence; Male; Middle Aged; Platelet Aggregation Inhibitors; Postthrombotic Syndrome; Prognosis; Protective Factors; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Venous Thrombosis; Young Adult
PubMed: 31843481
DOI: 10.1016/j.jvsv.2019.10.012 -
Journal of Vascular Surgery. Venous and... Mar 2020Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence...
BACKGROUND
Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence guidelines suggest that this can be reduced by prompt thrombolytic therapy or thrombectomy. We aimed to evaluate the characteristics of IFDVT patients and to identify whether patients are being offered the recommended treatment pathway.
METHODS
A multicenter cross-sectional study was conducted across eight hospital sites in the North West London region, of which two were hub hospitals in their local vascular service networks. Patients with proximal DVT were identified using International Classification of Diseases, Tenth Revision coding during a 1-year period. Data on demographics, diagnostic methods used, interventions, and referrals were extracted from electronic and paper medical records.
RESULTS
During the study period, 132 patients with IFDVT were identified (mean age, 59.4 years; 55% female); 75% of these patients had an IFDVT. In this cohort, the biggest predisposing factors were previous DVT (n = 35), malignant disease (n = 35), and immobility (n = 20). In total, 104 patients were administered anticoagulation, and 88 of these patients received anticoagulation within 24 hours. The cases of 45 patients were either discussed with or promptly referred to a vascular service, after which 20 patients were treated solely with anticoagulation, whereas 20 patients received thrombolysis of varying methods.
CONCLUSIONS
A significant proportion (56%) of symptomatic IFDVT patients are not being appropriately referred to or discussed with vascular services. Of these, 43% would have been eligible for consideration of early thrombus removal. Adherence to the National Institute for Health and Care Excellence guidelines could be improved by increasing awareness among emergency department colleagues.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Cross-Sectional Studies; Female; Femoral Vein; Guideline Adherence; Humans; Iliac Vein; London; Male; Middle Aged; Postthrombotic Syndrome; Practice Guidelines as Topic; Practice Patterns, Physicians'; Referral and Consultation; Thrombolytic Therapy; Time Factors; Treatment Outcome; Venous Thrombosis
PubMed: 31327742
DOI: 10.1016/j.jvsv.2019.04.011 -
Journal of Orthopaedic Surgery and... Jun 2021The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence,...
BACKGROUND
The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture.
METHODS
Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT.
RESULTS
Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1-8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1-4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2-5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity.
CONCLUSION
The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).
Topics: Aged; Female; Fibrin Fibrinogen Degradation Products; Fractures, Closed; Heart Disease Risk Factors; Humans; Lower Extremity; Male; Middle Aged; Patella; Preoperative Period; Prevalence; Prospective Studies; Risk Assessment; Ultrasonography; Venous Thrombosis
PubMed: 34162417
DOI: 10.1186/s13018-021-02558-4 -
Fa Yi Xue Za Zhi Apr 2021Objective To investigate the correlation between the polymorphism of 4 coagulation-related genes, rs1799963 (coagulation factor V gene Leiden), rs6025 (prothrombin...
Objective To investigate the correlation between the polymorphism of 4 coagulation-related genes, rs1799963 (coagulation factor V gene Leiden), rs6025 (prothrombin gene G20210A), rs1042579 (thrombomodulin protein gene c.1418C>T) and rs1801131 (methylenetetrahydroflate reductase gene) and lower extremity deep venous thrombosis (LEDVT). Methods The 4 genotypes mentioned above of 150 LEDVT patients and 153 healthy controls were detected by the kompetitive allele specific polymerase chain reaction (KASP), then related blood biochemical indicators were collected, binary Logistic regression was established to screen the independent risk factors of LEDVT, and the correlation between polymorphism of 4 coagulation-related genes and LEDVT and its indicators under different genetic modes after adjusting confounding factors were analyzed. Results Five variables, D-dimer, fibrinogen degradation product, homocysteine, sex and age might be the risk factors of LEDVT. These variables were put into 4 genetic inheritance models, and adjusted in binary Logistic regression. The results suggested that the mutations of rs1042579 were correlated with LEDVT under dominant inheritance mode. Conclusion The gene polymorphism of rs1799963, rs6025 and rs1801131 has no significant correlation with the formation of LEDVT. The gene polymorphism of rs1042579 plays a role under dominant inheritance mode, and might be an independent risk factor for formation of LEDVT.
Topics: Blood Coagulation; Humans; Lower Extremity; Polymorphism, Genetic; Risk Factors; Venous Thrombosis
PubMed: 34142473
DOI: 10.12116/j.issn.1004-5619.2019.491213