Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis

Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.

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.

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.

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.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

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.

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.

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

Pitfalls and sources of error of color duplex ultrasonography in detecting deep vein thrombosis of proximal lower extremities

Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

Analysis of curative effect of Bingxiao powder on lower limb deep vein thrombosis

Objective:To investigate the therapeutic effect of Bingxiao powder on edema caused by deep venous thrombosis in lower limb thrombosis.Methods:Selected in our hospital from September 2017 to April 2019 of 122 patients with lower limb deep vein thrombosis caused by edema.The patients were divided into two groups:Bingxio powder(61 cases)and magnesium sulfate(61 cases),the circumference difference of lower leg and thigh,the integral of edema and pain,the effective rate and the satisfaction rate of curative effect were compared between the two groups of patients with edema caused by thrombosis of lower limb.Results:in the observation group,the peripheral diameter difference of calf(1.08±0.21)cm,the peripheral diameter difference of thigh(1.76±0.28),the edema score(1.09±0.22)and the pain score(1.34±0.25)were all lower than those of the control group(P<0.05).The effective rate(95.08%)and satisfaction rate(96.72%)of the observation group were higher than those of the control group(P<0.05).Conclusion:Bingxiao powder can reduce the edema symptoms and pain symptoms of patients with edema caused by deep venous thrombosis of lower limbs,and reduce the circumference difference of the lower leg and thigh,with significant clinical effect.

纤维蛋白原/白蛋白比值、Caprini评分、D-二聚体对急性脑梗死后下肢深静脉血栓形成的预测价值

目的 探讨纤维蛋白原/白蛋白比值(FAR)、Caprini评分、D-二聚体(D-D)对急性脑梗死后下肢深静脉血栓(LDVT)形成的预测价值。方法 选取2019年7月至2023年3月在安徽省芜湖市中医医院神经内科住院的急性脑梗死患者122例,根据住院期间双下肢静脉彩超结果将其分为血栓组(42例)和无血栓组(80例),收集两组的基本资料,比较两组FAR、Caprini评分、D-D等指标的差异。建立logistic回归模型分析急性脑梗死后LDVT形成的影响因素,绘制受试者操作曲线比较FAR、Caprini评分、D-D单独及联合对急性脑梗死后LDVT形成的预测价值。结果 血栓组糖尿病患者占比、美国国立卫生研究院卒中量表评分>14分患者占比、格拉斯哥昏迷量表评分>8分患者占比、使用脱水药物>5 d患者占比、Caprini评分及D-D、FAR水平均高于无血栓组,差异有统计学意义(P<0.05)。多因素分析结果显示,Caprini评分(OR=1.803,95%CI:1.173~2.769)、D-D(OR=1.589,95%CI:1.235~2.043)、FAR(OR=1.609,95%CI:1.075~2.408)为急性脑梗死后LDVT形成的独立影响因素(P<0.05)。Caprini评分、FAR、D-D三者联合预测急性脑梗死后LDVT形成的受试者操作曲线下面积高于三者单独预测(P<0.05)。结论 FAR、Caprini评分、D-D与急性脑梗死后LDVT形成有关,可作为LDVT的预测指标,三者联合检测能提高预测效能。

Caprini评分联合纤维蛋白原水平对下肢骨折患者下肢深静脉血栓的预测价值

目的:探究Caprini评分联合纤维蛋白原(fibrinogen,FIB)水平对下肢骨折患者下肢深静脉血栓(deep vein thrombosis,DVT)的预测价值。方法:以2020年1月1日—2022年9月30日中国人民解放军联勤保障部队第904医院收治的下肢骨折患者作为研究对象,共100例。根据术前下肢深静脉彩色多普勒超声检查结果将研究对象分成DVT组(n=11)和非DVT组(n=89)。比较DVT组和非DVT组FIB水平和Caprini评分;基于模型公式:Y=β_(0)+β_(1)×A+β_(2)×B,构建Caprini评分、FIB回归模型;建立受试者操作特征(ROC)曲线,分析Caprini评分、FIB、Caprini评分联合FIB在下肢骨折患者下肢DVT预测中的应用价值。结果:DVT组的Caprini评分、FIB水平均高于非DVT组(P<0.05)。Caprini评分、FIB的二元logistic回归模型为:Y=-21.556+2.637×FIB+1.997×Caprini评分。经ROC曲线分析,FIB预测下肢DVT的曲线下面积(AUC)为0.908,敏感度为81.82%,特异度为92.13%;Caprini评分预测下肢DVT的AUC为0.939,敏感度为90.91%,特异度为85.39%;Caprini评分联合FIB预测下肢DVT的AUC为0.972,敏感度为100%,特异度为86.52%。结论:发生下肢DVT的下肢骨折患者术前的Caprini评分较高,FIB水平呈现异常增高的情况,Caprini评分联合FIB预测下肢DVT的价值更高。

急性下肢深静脉血栓患者置管溶栓前后D-D、F1+2、P-selectin变化及意义

目的 探究急性下肢深静脉血栓形成(DVT)患者置管溶栓前后D-二聚体(D-D)、凝血酶原片段1+2(F1+2)、P选择素(P-selectin)变化及临床意义。方法 选取2020年3月至2022年3月云南省第三人民医院186例急性DVT患者作为研究对象,均行置管溶栓术,术后12个月以门诊形式进行随访,4例失访,共182例完成术后随访。根据术后12个月是否发生血栓后综合征(PTS)分为PTS组(n=27)、非PTS组(n=155),比较2组一般资料及溶栓前后血浆D-D、F1+2、P-selectin表达,Logistic分析PTS发生影响因素,受试者工作特征曲线(ROC)、曲线下面积(AUC)分析血浆D-D、F1+2、P-selectin预测PTS发生价值,采用相对危险度(RR)分析不同血浆D-D、F1+2、P-selectin表达对PTS的影响。结果 PTS组年龄、BMI、静脉通畅评分及溶栓后1周、1个月血浆D-D、F1+2、P-selectin表达高于非PTS组(P <0.05);Logistic显示:BMI及溶栓后1周、1个月血浆D-D、F1+2、P-selectin是急性DVT患者发生PTS的影响因素(P <0.05);ROC曲线,溶栓后1个月血浆D-D、F1+2、P-selectin联合预测PTS效能明显优于溶栓后1周D-D、F1+2、P-selectin联合预测效能;溶栓后1个月血浆D-D、F1+2、P-selectin高表达患者发生PTS风险是低表达的4.211、2.550、3.189倍。结论 急性DVT患者置管溶栓后血浆D-D、F1+2、P-selectin表达升高,其联合预测患者发生PTS具有一定预测效能。

基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后患者下肢深静脉血栓形成的影响

目的:探讨基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后患者下肢深静脉血栓形成(deep venous thrombosis,DVT)的影响。方法:选取2020年3月至2022年2月北京积水潭医院收治并施行手术治疗的186例老年髋部骨折患者为研究对象。根据随机数字表法将患者随机分为对照组与观察组,每组各93例。比较2组患者DVT发生率、血栓最大宽度及DVT相关知识知晓情况;比较2组患者术前、术后3、5 d及出院时D-二聚体值、双下肢大腿周径差值,并记录干预期间其他并发症情况。结果:观察组患者DVT发生率为4.30%,低于对照组的12.90%(P<0.05)。观察组患者血栓最大宽度低于对照组(P<0.05)。出院时,观察组患者预防DVT相关知识知晓问卷总分及各维度评分均高于对照组(均P<0.05)。术后,随着时间推移,2组患者D-二聚体值随之下降,且观察组各时间点D-二聚体值均低于对照组(均P<0.05)。术后3 d,2组患者双下肢大腿周径差值均较术前上升,之后2组患者双下肢大腿周径差值随时间推移下降,且观察组患者各时间点双下肢大腿周径差值均低于对照组(均P<0.05)。观察组患者其他并发症发生率为6.5%,显著低于对照组的18.3%(P<0.05)。结论:基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后下肢DVT的预防效果较好,能明显减少DVT。

血栓弹力图与凝血因子Ⅴ、Serpine1对创伤性骨折患者术后下肢深静脉血栓的预测价值分析

目的探讨血栓弹力图(thrombelastography,TEG)与人纤溶酶原激活物抑制剂1(human plasminogen activator inhibitor-1,Serpine1)对创伤性骨折患者术后下肢深静脉血栓的预测价值。方法选取2019年10月至2021年10月于杭州整形医院就诊的疑似下肢深静脉血栓的创伤性骨折术后患者272例,以超声造影检查诊断为“金标准”,将确诊为下肢深静脉血栓的200例患者设为研究组,72例非下肢深静脉血栓患者设为对照组,两组患者均行TEG检查,检测两组的凝血因子Ⅴ、Serpine1水平。结果与对照组比较,研究组的TEG参数凝固时间(solidification time,K)、反应时间(reaction time,R)降低,最大幅度(maximum magnitude,MA)、凝固角(solidification angle,α)升高,且研究组重度患者的K、R较低,MA、α、凝血因子Ⅴ、Serpine1水平较高(P<0.05)。K、R、MA、α、凝血因子Ⅴ、Serpine1与研究组轻度、重度严重程度相关,且K、R、MA、α与凝血因子Ⅴ、Serpine1相关。K、R、MA、α、凝血因子Ⅴ、Serpine1联合检测对创伤性骨折患者术后下肢深静脉血栓的预测价值较高。结论TEG联合凝血因子Ⅴ、Serpine1对创伤性骨折患者术后下肢深静脉血栓有较高的预测价值,具有一定的临床价值。

急性期下肢深静脉血栓的T1 mapping成像特征及诊断价值

目的探讨磁共振T1 mapping技术对于急慢性下肢深静脉血栓的诊断价值。方法对57例有下肢深静脉血栓的患者行磁共振T1 mapping成像,以获取血栓的T1弛豫时间(T1 time)。根据下肢水肿的持续时间不同,将57例患者分为急性组和慢性组。急性组下肢水肿时间短于2周,慢性组下肢水肿时间长于2周。使用Mann Whitney检验方法比较两组血栓的T1 time有无统计学差异。使用受试者工作特征(ROC)曲线进一步评估T1 time鉴别急慢性血栓的价值。结果急性组血栓的T1 time显著低于慢性组[(819.4±223.7)ms vs.(1264.8±270.7)ms,P<0.01]。T1 time用于鉴别急性血栓和慢性血栓的ROC曲线下面积为0.93。如果使用1015 ms作为划分急性和慢性血栓的阈值,T1 time的诊断敏感性为91%,特异性为86%。结论磁共振T1 mapping技术对下肢深静脉急性血栓和慢性血栓有一定的鉴别诊断价值,值得进一步研究。

基于Caprini模型风险的集束化护理在重症急性心肌梗死患者下肢静脉血栓预防中的应用效果

目的探讨基于Caprini模型风险的集束化护理在重症急性心肌梗死(AMI)患者下肢静脉血栓预防中的应用效果。方法选取鹰潭市人民医院于2019年1月至2022年3月收治的80例重症AMI患者为研究对象,按照随机数字表法将其分为对照组与观察组,每组40例。对照组采用常规护理,观察组采用基于Caprini模型风险的集束化护理。比较两组患者术后深静脉血栓(DVT)发生率、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)水平及血栓弹力图参数。结果观察组患者术后DVT发生率低于对照组,差异有统计学意义(P<0.05)。干预前,两组患者APTT、PT、D-D、凝血时间(R)、血块动力(K)、血块强度(MA)、血细胞凝块形成速率(ε)、综合凝血指数(CI)比较,差异无统计学意义(P>0.05);干预后,两组患者APTT、PT均短于干预前,D-D、ε均低于干预前,R、K均长于干预前,MA、CI均高于干预前,且观察组患者APTT、PT均短于对照组,D-D、ε均低于对照组,R、K均长于对照组,MA、CI均高于对照组,差异有统计学意义(P<0.05)。结论基于Caprini模型风险的集束化护理可有效降低重症AMI患者DVT发生率,改善凝血指标。

基于Caprini风险评估模型的护理干预预防颅脑术后下肢静脉血栓的效果

目的:探究分析基于Caprini风险评估模型的护理干预预防颅脑术后下肢静脉血栓的效果。方法:抽取我院神经外科2020年2月-2022年2月间收治的67例需实施颅脑术治疗的患者为观察对象并纳入本组研究,将其依照随机数字表法(由计算机随机生成数字1-67号)分成两组,对照组33例,观察组34例。其中,对照组术后施以常规护理干预,观察组采取基于Caprini风险评估模型的护理干预预防对策,比较两组患者护理前后神经功能缺损、心理状态评分、下肢静脉血栓发生率及对护理的满意度。结果:(1)观察组经护理干预后评估发现,其组中患者NIHSS、SAS、SDS评分均低于对照组(t=-4.657、-7.504、-8.031,P<0.05);(2)观察组无下肢静脉血栓高危发生风险,低危2例,中危1例,均低于对照组的风险发生数,但中高危数据对比差异无统计学意义(χ^(2)=1.133、3.077,P>0.05);低危数据对比结果显示差异有统计学意义(χ^(2)=4.566,P<0.05);(3)观察组患者护理总满意度为94.12%,高于对照组护理总满意度78.79%,两组比较差异具有统计学意义(χ^(2)=10.034,P<0.05)。结论:基于Caprini风险评估模型的护理干预预防颅脑术后下肢静脉血栓效果良好,不但有助于脑神经功能恢复,还能稳定心理状态,而高质量的护理服务可提高患者满意度。

Indigo经皮机械血栓抽吸术治疗May-Thurner综合征合并急性髂股静脉血栓

May-Thurner综合征为髂静脉受压所致下肢及盆腔静脉回流障碍性疾病,是下肢深静脉血栓(deep venous thrombosis, DVT)形成的重要原因^([1]);合并急性髂股静脉血栓(ilofemoral venous thrombosis, IFVT)时可出现下肢疼痛、肿胀及功能障碍,血栓脱落可引发肺栓塞^([2])。

Caprini风险评估护理对中青年妇科恶性肿瘤患者术后下肢深静脉血栓形成的影响

目的 探讨Caprini风险评估护理模式对中青年妇科恶性肿瘤患者术后下肢深静脉血栓形成的影响。方法 选取安阳市肿瘤医院妇三科2017年9月到2020年6月行手术治疗的180例恶性肿瘤患者,利用随机数表法分为对照组、观察组,各90例。对照组接受常规风险护理措施,观察组接受Caprini风险评估护理措施,比较两组患者对护理的满意程度、患者下肢周径、血流速度以及凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)]水平。结果 观察组护理满意度高于对照组(P<0.05)。观察组患者的下肢周径短于对照组,血流速度快于对照组(P<0.05)。干预后观察组PT、APTT、TT升高幅度均高于对照组(P<0.05)。结论 Caprini风险评估护理模式能够降低中青年妇科恶性肿瘤患者术后下肢深静脉血栓发生率,改善患者下肢深静脉血液淤滞状况,效果明显。