Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

The effect of nursing intervention based on Autar scale results to reduce deep venous thrombosis incidence in orthopaedic surgery patients

Purpose:To reduce the incidence of deep venous thrombosis(DVT)with nursing intervention based on the Autar DVT risk assessment scale among orthopaedic surgery patients.Methods:We recruited 216 orthopaedic surgery patients at our hospital between September 2013 and March 2014.The patients were assigned to intervention and historical control groups based on the time of admission.Using the Autar DVT risk assessment scale,we assessed the DVT risk levels in both groups;the intervention group received the corresponding prophylactic measures while the control group received routine nursing.Results:The DVT incidence rate and the D-dimer level on postoperative day 3 in the intervention group were lower(1.82%;623±225 mg/L,respectively)than that of the control group(9.43%;825±201 mg/L,respectively);both differences were statistically significant(p<0.05).Conclusions:The Autar scale is beneficial when used in orthopaedic surgery patients;corresponding nursing intervention based on Autar scale assessment can prevent DVT effectively.

Clinical Study on Effect of Osteoking (恒古骨伤愈合剂) in Preventing Postoperational Deep Venous Thrombosis in Patients with Intertrochanteric Fracture

Objective： To evaluate the effect of Osteoking （恒古骨伤愈合剂） in preventing postoperational deep venous thrombosis （DVT） in patients with intertrochanteric fracture （ITF）. Methods： With prospective and randomized controlled clinical design adopted, 62 patients with ITF after operation were assigned into 2 groups, the tested group and the control group, Osteoking （25 ml every other day） and Sanchidansheng tablets （三七丹参片, 3 tablets thrice a day） were given orally to them respectively for 10 days. Difference of round length of thighs and shanks between two sides were measured on the 10th day and Doppler ultrasonic examination on the fractured leg was carried out. Results： The occurrence rate of DVT in the tested goup was 9.4%, which was lower than that in the control group （30.0%, P〈0.05）. All the difference of round lengths, either that of the thigh or the shank, was less in the tested group than that in the control group, showing statistical significance （P〈0.05）. Conclusion： Osteoking has a satisfactory effect in preventing postoperational DVT in patients with ITF.

Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

BACKGROUND: Deep venous thrombosis(DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department(ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT.METHODS: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical record.RESULTS: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379(15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT.CONCLUSIONS: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

Combined MR Imaging for Pulmonary Embolism and Deep Venous Thrombosis by Contrast-enhanced MR Volume Interpolated Body Examination

MR pulmonary angiography(MRPA)combined with indirect MR venography(MRV)was attempted by using 3D contrast-enhanced MR volume interpolated body examination(VIBE)sequence.Agreement rate for deep venous thrombosis(DVT)detection between MRV and duplex sonography(DUS)was evaluated;the potential of this method for venous thromoembolism(VTE)was also investigated.Thirty-four patients with DUS-identified DVT were enrolled in this study.MRI was performed after a single administration of Gadopentetate dimeglumine.Fatsuppressed 3D VIBE was applied for visualizing pulmonary arteries,abdominal veins,pelvic and leg veins,ranging from lung apex to ankle level.Two radiologists observed the MR images in consensus,recorded the location and number of emboli.MRV images were assessed based on per-vein segment.The agreement rate between MRV and DUS for venous segment-to-segment comparison was analyzed by Wilcoxon rank sum test.All the patients were diagnosed as having DV 1 by MRV.MRV detected 55 more venous segments with thrombi than DUS based on per-vein segment analysis.Twenty-three patients with pulmonary embolism(PE)were detected by MRPA.Twenty-one patients underwent both pulmonary CT angiography and MRPA,and consistency for PE detection was 100%.Total examination time of the combined MR protocol was 7 min for each patient.The contrast-enhanced VIBE sequence proves to be a feasible and reliable method for VTE diagnosis in one-stop MR scanning procedure,and contrast-enhanced VIBE performs better to depict DVT than DUS on per-vein segment basis.

Comparison of four clinical scores for the predicting lower limb deep venous thrombosis in Chinese patients

Objective：To evaluate Wells, Kahn, St.Andr 6 and Constans scores for the prediction of deep venous thrombosis in Chinese patients. Methods：One hundred and seventy-two patients, prospectively, blinded referred for evaluation with four clinical-score systems for suspected deep venous thrombosis, were examined by ultrasonography. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores. The difference between areas of the ROC curve for each of the scores was compared with others and reference line. Results：Forty-six of 172 patients had deep venous thrombosis proven by sonography. The sensitivity, specificity, positive predictive value and negative predictive value for Wells score was 91.3%, 57.1%, 43.8% and 94.7%, respectively, for Kahn score; 65.2%, 71.4%, 45.5% and 84.9%, respectively, for St.Andr 6 score; 63%, 38.9%, 27.4% and 74.2% respectively, for Constans score; 95.7%, 34.9%, 34.9% and 95.7% respectively. Area under ROV curve of Constans score was 0.814, which was similar to that of Wells score, then followed by Kahn score and that of St.Andr 6 score was no difference with the reference line. Conclusion：Based on the results of our study, the sensitivity, negative prediction value and area under ROC curve are larger for Constans score and Wells score in Chinese hospitalized patients than that of Kahn score or St.Andr 6 score. Considering the aim of the clinical assessment, Constans score and Wells score are more efficient for Chinese hospitalized patients.

Carbohydrate Antigens as Potential Biomarkers for the Malignancy in Patients with Idiopathic Deep Venous Thrombosis:A Retrospective Cohort Study

A variety of biomarkers have been identified in recent prospective and retrospective re- ports as being potentially predictive of venous thromboembolis （VTE）, particularly idiopathic deep venous thrombosis （IDVT）. This study identified a serum tumor biomarker for early screening of IDVT. A total of 128 IDVT patients （54 females and 74 males; average age： 50.9＋17.4 years） were included. Carcinoembryonic antigen （CEA）, ferritin, β2-microglobulin, cancer antigen （CA） 125, CA 15-3, CA 19-9, squamous cell carcinoma antigen （SCC）, alpha-fetoprotein （AFP）, prostate specific antigen （PSA）, free PSA （f-PSA）, and beta-human chorionic gonadotropin （13-HCG） in patients with IDVT were detected. Malignancies were histo- or cytopathologically confirmed. Of the 128 IDVT patients, 16 （12.5%） were found to have malignarteies. Serum CEA, CA 125, CA 15-3, and CA 19-9 were found to be helpful for detecting malignancies in IDVT patients. Our study revealed a positive association between these markers and tumors in IDVT patients. On the other hand, SCC and AFP were not sensitive enough to be markers for detecting tumors in patients with IDVT. No significant differences were found in positive rates of ferritin and 132-microglobulin between turnor and non-ttmaor groups, and no significant difference exists in serum levels of ferritin and 132-microglobulin between the two groups. Carbohydrate antigens, CA 15-3 in particular, may be useful for differential diagnosis and prediction of malignancies in patients with IDVT.

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery:A case report and review of literature

BACKGROUND Deep venous thrombosis(DVT)is a serious complication of lumbar spine surgery.Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery.May-Thurner syndrome(MTS),a venous anatomical variation that may require invasive intervention,is an often overlooked cause of DVT.To date,no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery,and MTS was only considered after surgery,during a review of a gynecological enhanced computed tomography image taken before the procedure.CONCLUSION In conclusion,clinicians should consider MTS in the presence of a dangerous triad:spondylolisthesis,elevated D-dimer levels,and sonographically indicated unilateral deep vein dilation.Consultation with a vascular surgeon is also essential to MTS management.

Study on mechanism of Simiao Yong'an Decoction in treatment of deep venous thrombosis based on network pharmacology

Objective:To explore the mechanism of Simiao Yong'an Decoction in treating deep venous thrombosis based on the method of network pharmacology.Methods:Through TCMSP database,the effective components of each traditional Chinese medicine in Simiao Yong'an Decoction were obtained and their targets were predicted.The targets of deep venous thrombosis were collected by CTD database,and the key targets were obtained by intersection of the component targets and the disease targets;Protein-Protein Interaction(PPI)network was constructed by String database.The drugs-components-targets-disease network map was constructed by using the software of Cytoscape 3.7.2.GO function and KEGG pathway enrichment of Simiao Yong'an Decoction in the treatment of deep venous thrombosis were analyzed by using the plug-in of ClueGo.Results:121 effective components and 137 potential targets of Simiao Yong'an Decoction were obtained.There were 1172 targets of deep venous thrombosis.There were 214 biological processes analyzed by GO Biological Process and 72 pathways analyzed by KEGG analysis.Conclusion:Simiao Yong'an Decoction may act on ESR1,AR,PTGS2 and other key targets,as well as AGE-RAGE signaling pathway,PI3K-Akt signaling pathway,MAPK signaling pathway,IL-17 signaling pathway,TNF signaling pathway,RLX signaling pathway and other pathways to treat deep venous thrombosis.

Discussion on Prevention and Treatment of Lower Extremity Deep Venous Thrombosis in Orthopedic Perioperative Period from Spleen and Stomach Meridians

Deep venous thrombosis of lower extremity is one of the common complications in orthopedic perioperative period.It is caused by many factors,such as peripheral vein dilation,slow blood flow;long-term immobilization,bed rest and so on.On the one hand,it affects the early postoperative functional exercise and functional recovery,on the other hand,it increases the length of hospital stay and economic burden,increases the pain of patients and even endangers their lives.Effective treatment of traditional Chinese medicine combined with western medicine can play a better role in the prevention and treatment of lower extremity deep venous thrombosis.This study expounds the concept of spleen and stomach meridians in the prevention and treatment of lower extremity deep venous thrombosis,and puts forward some opinions on the dialectical treatment and daily conditioning of lower extremity deep venous thrombosis,hoping to provide ideas for the clinical prevention and treatment of lower extremity deep venous thrombosis in traditional Chinese medicine.

Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity(second edition)

This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome.

Comparison of Clinical Results in Deep Vein Thrombosis of Total Knee Arthroplasty with Rivaroxaban and Dalteparin Sodium

This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical results in groups treated with Rivaroxaban versus Dalteparin sodium as prophylactic antithrombotic medications. This prospective study was performed in 300 patients who underwent TKA between November 2011 and December 2012. The prophylactic therapy was given to 150 patients in Rivaroxaban group and Dalteparin sodium group, respectively. In addition, intermittent compression pump and stocking were used in all the groups immediately after TKA. In order to determine the incidence of DVT, color Doppler ultrasonography, D-dimer, and clinical symptom examination were conducted. There were 17 cases (11.3%) of DVT in Rivaroxaban group and 18 cases (12.0%) of DVT in Dalteparin sodium group after TKA, and no significant difference was seen between both groups. Between patients with DVT and those without DVT after TKA at 4 days in both groups, there was a significant difference in the swelling indices. Moreover, a significant difference was observed in the evaluation of bruise. The early signs of DVT after TKA are unknown, however, some initial clinical signs such as swelling have been observed. After using the said prophylactic drugs, the lower incidence of DVT was seen, and there was no difference between the types of drugs. Pharmacological therapy (either Rivaroxaban or Dalteparin sodium) after TKA is considered effective for DVT prevention. There is also a need to consider constant monitoring of clinical symptoms.

Perioperative Management of Case of Gynecological Malignancy with Bilateral Deep Venous Thrombosis of Lower Limbs Along with Pulmonary Embolism

We describe the anaesthetic management of 45 year female patient with pre-existing deep venous thrombosis (DVT) and pulmonary embolism (PE) who was subsequently scheduled for an laparotomy. Before planning the surgical procedures, adequate anticoagulation must be achieved to prevent further complications of DVT, thromboembolism, and pulmonary embolism in particular. The risk of stopping the anticoagulation prior to surgery must be considered and adequately discussed with the patient and surgeons. The anaesthetic plan must be selected keeping in mind the coagulation status and the need of anticoagulation in the postoperative period.

Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

The Clinical Characteristics of Combined Deep Vein Thrombosis Prophylaxis of Rivaroxaban and Mechanical Therapy after Total Knee Replacement Arthroplasty

Purpose: To investigate the clinical characteristics of combined prophylaxis of rivaroxaban (Xarelto?) and mechanical therapy (foot sole pump, antiembolism stocking) after total knee replacement arthroplasty, for prevention of deep vein thrombosis (DVT). Materials and Methods: The subjects of this study were 110 patients who underwent total knee replacement arthroplasty (TKA) between November 2011 and May 2012, and were prospectively evaluated. They consisted of 13 men (11.8%) and 97 women (88.2%) with the mean age of 68.7 years (±7.9). All of the patients received 10 mg of rivaroxaban once daily for 14 days from Day 1 postoperatively, and used an intermittent pneumatic compression (IPC) pump and compression stockings immediately after the operation. To determine the presence of postoperative DVT, clinical symptoms examination, D-dimer test, color Doppler ultrasound imaging were performed to analyze the risk factors of DVT events. Results: There were a total of 13 patients (11.8%) with DVT in the distal lower limbs among the entire 110 patients. At Day 4 after the operation, a statistically significant difference was seen only in femoral swelling of several clinical symptoms between DVT group and non-DVT group (p = 0.043). D-dimer tests showed no statistically significant difference between the two groups, however with the boundary value of 0.3 mg/L, diagnostic sensitivity, specificity, positive predictability and negative predictability were equivalent to 100%, 8.2%, 12.7% and 100%, respectively. There was no significant difference between the two groups in terms of well-known risk factors including age, gender, obesity, hypertension, diabetes, smoking, and anesthesia method, and no case of pulmonary embolism was observed. Conclusion: A combination of pharmacological therapy (rivaroxaban, Xarelto?) and mechanical therapy (foot sole pump system) after TKA is considered effective for DVT prevention.

Deep Venous Thrombosis in Breast Cancer Patients Using Tamoxifen, a Hypothesis

Breast cancer is the most frequently diagnosed cancer in women and systematic therapy is an essential component of disease. Hormonal therapy, cytotoxic chemotherapy and the more recently introduced biological therapies are routinely employed in the vast majority of patients. Several pharmaceuticals that affect the estrogenic pathways have been studied as chemopreventive agents. Tamoxifen is an anti-estrogenic drug used in the treatment of estrogen receptor positive breast cancer patients. One of the important side-effects of tamoxifen is thromboembolic events like deep venous thrombosis. Tamoxifen also causes an increase in mean platelet volume. We hypothesize that thromboembolic effect of tamoxifen is via increase of mean platelet volume.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Incidence of deep venous thrombosis after gynaecological laparoscopy

Objective To evaluate the incidence of deep venous thrombosis (DVT) after gynaecological laparoscopy.Methods The incidence of DVT was studied in 72 consecutive patients who underwent gynaecological laparoscopy in the Liverpool Health Service between May and September 1997. B-mode ultrasound supplemented by Doppler was used to examine venous patency and intraluminal echoes to diagnose DVT. Sixty-one patients who had pneumoperitoneum less than 60 minutes were classified a minor procedure and 11 who had pneumoperitoneum more than 60 minutes were classified as major procedure. Two Doppler ultrasound scans were planned for every patient. The first one was done within 24 hours and the second was performed on day 7 post-surgery. All 72 patients had the first scan and 40 out of 61 in the minor procedure group and 9 out of 11 in the major procedure had the second scan. Twenty-three patients who did not come for the second scan were followed up by phone.Results No DVT was found in our study.Conclusion This study confirms an impression that gynaecological laparoscopic procedure has a very low incidence of DVT. If it occurs, the diagnosis and treatment must be made as soon as possible so that the fatal complications such as pulmonary embolus can be avoided.

Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease

Background Acute exacerbation of chronic obstructive pulmonary disease （COPD） is always associated with a high incidence and mortality. Because of the presence of some concomitant risk factors such as immobilization, bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. In this study, we investigated the prevalence and the clinical manifestations of deep venous thrombosis （DVT） in patients with acute exacerbation of COPD.Methods From March 2007 to March 2009, 520 consecutive patients were included in this study. On admission, color Doppler ultrasound of lower extremities in all cases was performed for diagnosing DVT. Patients with DVT were compared with those without DVT from such aspects as demographics, symptoms, physical signs and risk factors.Results Among the 520 patients, DVT was found in 46 cases （9.7%）. In patients with DVT, the duration of hospitalization was longer （P=0.01）, and the mechanical ventilation requirement increased （P 〈0.001）. Other indicators for patients with more possibility of DVT were immobility exceeding 3 days （P 〈0.001）; pneumonia as concomitance （P=0.01）; respiratory failure type Ⅱ （P=0.013）; current smoking （P=0.001）. Lower extremity pain was more common in DVT cases in comparison to those without DVT （34.8% vs. 15.2%, P=0.01 ）.Conclusions The acute exacerbation of COPD patients, who were immobilized for over 3 days, complicated by pneumonia and had respiratory failure type Ⅱ, had a higher risk of DVT. In addition, DVT detection awareness should be increased in cases that had a lower extremity pain.