ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
Objective To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity. Methods A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups. Results Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383). Conclusion For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Objective To summarize the clinical manifestation and the causes of lower limb deep venous thrombosis （DVT） complicated with pulmonary embolism （PE）. Method The clinical data of 45 cases of PE confirmed by CTPA from May 2009 to May 2012 in this hospital were summarized retrospectively. Results Five patients with PE had no obvious clinical manifestation， 9 patients （20.0%） had chest stuffiness and short of breath， 8 patients （17.8%） had cough. In the causes of thrombosis defluxion：11 patients （24.4%） had early mobilization after operation， 9 patients （20.0%） had functional exercise after operation， 7 patients （15.6%） had turn over or defecate on bed， 2 patients （4.4%） had sneeze， 14 patients （31.1%） had no definite causes. Conclusions Patients with lower limb DVT have high risk of thrombosis defluxion， although adequate anticoagulation. Early mobilization， functional exercise， and transient increased abdominal pressure are easy to lead to thrombosis defluxion， so lead to PE. Absence of the protection of inferior vena cava filter， patient should be required for bed ridden in order to avoid the thrombosis defluxion.
Objective To study the significance of the levels of plasma inflammatory cytokines (IL-6，IL-8，IL-10 and TNF-α) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-α were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P＜0.001). The results of the correlation analysis showed that there were positive correlations between IL-6 and TNF-α (r=0.383, P＜0.05), IL-10 and TNF-α (r=0.390, P＜0.05), respectively, within the DVT group; whereas there were no correlations between IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10, and IL-8 and TNF-α. Conclusion The levels of plasma cytokines increased significantly in patients of DVT. Inflammatory cytokines may play an important role in acute DVT by accelerating the pace of thrombosis, intensifying the inflammatory reaction around thrombus and aggravating the injured blood vessel.
ObjectiveTo summarize the experience of treating lower extremity deep venous thrombosis (DVT) after repair of inguinal hernia. MethodThe clinical data of 1 812 patients who underwent herniorrhaphy from January 2002 to December 2012 were reviewed, and we analyzed such data as age, gender, and the formation of DVT. ResultsFive of them suffered from DVT (0.28%), including 2 cases involving both lower extremities, 1 right and 2 left extremity. All of them were discharged from hospital by anticoagulant therapy and there was no pulmonary embolism and death case. DVT recovered well in 4 cases half a year after being discharged from the hospital. One had a sequela of recurrent swelling of the left lower extremity. ConclusionsReasonable precautions and treatment against DVT are very important even though DVT rate after inguinal hernia repair is low.
目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。 方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。 结果2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×106 U，B组平均4.925（3.715，5.810）×106 U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。 结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。
Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis （TDT） approach in treatment for deep venous thrombosis （DVT） of lower limbs and as compared with trans-dorsal pedis vein thrombolysis （TPVT） approach. Methods The clinical data of 437 patients with acute DVT （184 males and 253 females） at the age of （43±12） years （range 19-76 years） from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Patients in the group TDT received TDT were 293 cases， 32 inferior vena cava filters were implanted. Patients in the group TPVT received TPVT were 65 cases， 4 inferior vena cava filters were implanted. Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT （6 d versus 9 d， P＜0.05）. The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group （P＜0.05）. The rate of venous patency was （65.2±15.4）% and preservation rate of valvular function was （78.2±12.6）% in the group TDT， and which was （63.8±16.3）% and （91.1±10.7）% in the group TPVT， respectively. The differences of venous patency rate was not statistically significant（P＞0.05） between two groups， but the prevervation rate of valvular function was significant difference （P＜0.05） .Hematomas in 3 cases and gross hematuria in 4 cases were observed， and displacement of inferior vena cava filter occurred in 1 patient in the group TDT. The gums bleed or gross hematuria in 5 cases were observed in the group TPVT. Conclusions Both TDT and TPVT can effectively relieve symptoms. TDT can shorten the course of disease， but itincreases functional damage of the deep vein valvular.
Objective To study the effect of interleukin-6,10 (IL-6,10), C-reactive protein (CRP), and fibrinogen (FIB) on inflammatory response of lower limbs deep vein thrombosis (DVT). Methods Thirty patients with acute lower limb DVT (DVT group) and 30 volunteers (normal control group) were included in this study, and then the concentrations of serum IL-6, IL-10, CRP, and FIB were detected. Results The concentrations of serum IL-6, IL-10, CRP, and FIB of patients in DVT group before treatment were higher than those in normal control group (Plt;0.001). Compared with before treatment, the concentrations of serum IL-6, CRP, and FIB of patients after treatment were lower in DVT group (Plt;0.001), however, the concentration of serum IL-10 was higher (Plt;0.001). There was no difference of the concentrations of serum FIB between DVT group after treatment and normal control group (Pgt;0.05), but the concentrations of serum IL-6, IL-10, and CRP of patients in DVT group after treatment were higher than those in normal control group (Plt;0.05). Conclusion Inflammatory factors may involve in DVT. Therein IL-6, CRP, and FIB play important roles in acute stage of DVT, and IL-10 may have an anti-inflammatory effect.