OBJECTIVE The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve. METHODS Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons. RESULTS In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted. CONCLUSION It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.
Objective To analyze the clinical features of rickettsial infection complicated with pulmonary embolism and to improve clinicians’ knowledge of rickettsial infection complicated by thromboembolism events. Methods We retrospectively analyzed the clinical data of a patient with pulmonary thromboembolism complicated by Rickettsial felis infection and conducted a review of the relevant literature. The search terms "Rickettsia/Scrub typhus, thrombosis" or "Rickettsia/ Scrub typhus, embolism" were used to search the Wanfang ,VIP ,Chinese National Knowledge Infrastructure and PubMed databases from January 1985 to May 2023, respectively. Results The 81-year-old male patient was admitted to the hospital on June 1, 2021 due to "dizziness, sore throat for 11 days, fever for 7 days, and shortness of breath for 3 days". Physical examination revealed a eschar-like rash behind the left ear, venous thrombosis in both lower limbs was detected by color ultrasound, computed tomographic pulmonary angiography indicated multiple pulmonary embolism in both lungs, and positive rickettsiae on peripheral blood next-generation sequencing, confirming the diagnosis of Rickettsial felis infection complicated by venous thromboembolism (VTE) in both lower limbs and pulmonary embolism. Twenty manuscripts, including 20 cases, were retrieved from databases. Among them, Rickettsial felis infection combined with thromboembolism event was not found. With the addition of our case, a total of 21 cases were analyzed in detail. Six of the 21 cases were complicated with VTE, 10 with pulmonary embolism, 5 with intracranial venous thrombosis, 6 with thrombosis at other sites (jugular venous thrombosis, mesenteric thrombosis, aortic thrombosis, etc), and 8 of which had concurrently involved systemic thrombosis. Of the 4 deaths, 2 cases had mesenteric embolism, 1 case had cerebral infarction, and 1 case had systemic multiple thrombus. Conclusions Rickettsial infection symptoms and signs are often atypical, can be complicated with lower limb VTE or pulmonary embolism. Early identification, diagnosis and treatment are very important, especially for patients with dyspnea, chest pain and other related symptoms.
ObjectiveTo compare the predictive value of six thrombotic risk assessment scales, including Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT, for the deep venous thrombosis (DVT) of lower extremity in patients with gastrointestinal tumors. MethodsThe patients with gastrointestinal tumors who received surgical treatment in the General Surgery Department of Lanzhou University Second Hospital from March 2023 to October 2023 were collected. The risk of DVT on day 3 after surgery for the patient with gastrointestinal tumors was prospectively evaluated using the Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT assessment scales. And the DVT was detected by ultrasound examination. The pionts of six thrombotic risk assessment scales were compared between the patient with DVT and without DVT based on the ultrasound examination results. The predictive value of the six thrombotic risk assessment scales for the lower extremity DVT in the patients with gastrointestinal tumors was evaluated by the area under receiver operating characteristic curve (AUC). ResultsA total of 108 patients who met the criteria, including 71 males and 37 females, were enrolled, age ranged from 18 to 85 years old, (58.3±11.2) years old. Fourty-two cases (38.9%) of DVT occurred. The age of patients with DVT was older than that of patients without DVT (P<0.05), but there were no statistical differences in the gender, body mass index, tumor location, comorbidities, and so on (P>0.05). The points of Autar, Padua, and Caprini in the patients with DVT were higher than those in the patients without DVT (P<0.05), while there were no statistical differences in the points of Wells, Khorana, and COMPASS-CAT between the two (P>0.05). The AUC for differentiating the occurrence of DVT in the patients with gastrointestinal tumors using the Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT assessment scales were 0.907, 0.548, 0.636, 0.627, 0.589, and 0.535, respectively; The sensitivities were 97.6%, 14.3%, 52.4%, 83.3%, 47.6%, and 21.4%; The specificities were 2.4%, 85.7%, 47.6%, 16.7%, 52.4%, and 78.6%, respectively. ConclusionAccording to the abilities of Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT to distinguish the occurrence of DVT in patients with gastrointestinal tumors after surgery, only the Autar evaluation scale is found to be more effective, while the other five evaluation scales are generally able to distinguish the occurrence of DVT.
To evaluate the efficacy and safety of comprehensive prophylaxis for deep venous thrombosis(DVT) after proximal femur fractures in geriatric patients. Methods From July 2003 to May 2006, 157 geriatric patients with proximal femur fractures treated with operation were divided into prophylaxis group and control group randomly. There were 82 patients (34 males, 48 females, aged 65-97 years) in prophylaxis group, 30 with femoral neck fracture and 52 with intertrochanteric fracture of femur. There were 75 patients (33 males, 42 females, aged 65-94 years) in control group, 28 with femoral neck fracture and 47 with intertrochanteric fracture of femur. In the prophylaxis group, comprehensive prophylaxis for DVT which included Aspirin, fibrinolytic enzyme, passive and active circumduction of the foot and ankle, CPM management wasappl ied. In the control group, no thromboproxylaxis was taken. All patients in the both groups received color doppler flow imaging (CDFI) examination before operation and on the 7th and 14th days after operation. Results CDFI found 2 cases of DVT in the prophylaxis group 7 and 14 days after operation respectively, while 21 and 15 cases of DVT in the control group respectively. The incidence of DVT was 48.0% in the control group compared with 4.9% in the prophylaxis group and the reduction was significant (P lt; 0.01). One patient gave up the intervention due to Melena 3 days after operation in the prophylaxis group. In the control group, 1 patient died 8 days after operation and another died 11 days after operation. Both died of acute pulmonary embol ism confirmed by autopsy. Conclusion The comprehensive prophylaxis can significantly decrease the incidence of DVT in geriatric patients after proximal femur fractures. There is no significant adverse effect during the intervention.
Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
Objective To summarize the research about the stability of deep venous thrombosis (DVT) of the lower extremity in recent years. Methods The literatures about the stability of DVT of lower limbs at home and abroad in recent years were reviewed. Results There are few studies on the stability of DVT at home and abroad, which limited on the floating thrombus. Conclusion The stability of DVT can be effectively evaluated by SOMATOM Force CT (The third generation dual source CT).
目的 探讨经大隐静脉-穿通支静脉入路行深静脉置管溶栓术(catheter-directed thrombolysis，CDT)治疗混合型下肢深静脉血栓形成(deep venous thrombosis，DVT）的临床疗效。 方法 对42例急性混合型下肢DVT患者，经踝大隐静脉-穿通支静脉入路，将溶栓导管置入深静脉行CDT治疗。回顾性分析该42例患者的临床资料，评价其溶栓疗效。 结果 42例患者均成功经大隐静脉-穿通支静脉入路行CDT治疗。溶栓时间为5～7 d、(4.22±1.43) d；术后所有患者的肢体肿胀均明显好转；大腿周径差由术前的（7.76±1.72）cm缩减为术后的（2.21±0.91) cm（t=14.18，P＜0.01），小腿周径差由术前的（4.45±1.33）cm缩减为术后的(1.43±0.69）cm（t=11.92，P＜0.01），静脉通畅度评分由术前的12分降为术后的3分（Z=-3.03，P＜0.01）。术后发生穿刺处渗血2例，血尿2例，少量咯血1例。38例获访3～26个月，中位数为15个月。随访期间，1例发生支架远端重度狭窄，1例对侧下肢发生DVT。 结论 经大隐静脉-穿通支静脉入路行CDT治疗混合型下肢DVT，其操作简便，溶栓效率高，是临床值得推广的溶栓途径之一。
Objective To investigate the origin of small saphenous vein of distally-based of sural nerve nutrient vessels flap and its clinical application. Methods The origins of nutrient vessels of small saphenousvein and communicating branches of superficial-deep vein were observed on specimens of 30 adult cadaveric low limbs by perfusing red gelatin to dissect the artery. Results The nutrient vessels of small saphenous vein originated from the heel lateral artery, the terminal perforator branches of peroneal artery and intermuscular septum perforating branches of peroneal artery. There were 2 to 5 branches ofsuch distally-based perforating branches whose diameters ranged from 0.6 to 1.0 mm. Those perforating branches included fascia branches, cutaneous branches nerve and vein nutrient branches. Those nutrient vessels formed a longitudinalvessel chain of sural nerve shaft, vessel chain of vein side and vessel networkof deep superficial fascia. The small saphenous vein had 1 to 2 communicating branches of superficial-deep vein whose diameter was 1.7±0.5 mm， 3.4±0.9 cm to the level of cusp of lateral malleolus, and converged into the fibular vein. Conclusion Distally-based sural nerve, small saphenous vein, and nutrient vessles of fascia skin have the same region. The communicating branches of superficial-deep vein is 3 to 4 cm to the level of cusp lateral malleolus. These communicating branches could improve the venousdrainage of the flap.
ObjectiveTo evaluate the treatment effective of deep vein thrombosis (DVT) of low extremities. MethodsThe clinical data of 86 patients with DVT were analyzed retrospectively, which were divided into thromboectomy group (12 patients) and thrombolysis group (74 patients) according to the therapy methods. The thromboectomy group patients were treated by thromboectomy using Fogarty balloon catheter plus thrombolytie, thrombolysis group patients were treated by thrombolysis (urokinase or antithrombus enzyme of viper). ResultsThere were 8 cases healed, 4 cases relieved, 0 invalidated in the thromboectomy group and 15 cases healed, 50 cases relieved, 9 cases invalidated in the thrombolysis group at discharge. During 3-100 months of following up with an average 27 months, 10 cases and 62 cases were examined by Bultrasonic in the thromboectomy group and thrombolysis group, respectively, 6 cases were not damaged in the function of valves of the thromboectomy group, 9 cases were not damaged in the function of valves of the thrombolysis group. The rates of acute response, longtime patency, and normal valve in the thromboectomy group were higher than those in the thrombolysis group (Plt;0.05), the rate of post-thrombotic syndrome in the thromboectomy group was lower than that in the thrombolysis group (Plt;0.05). ConclusionsEarly thromboectomy is an effective way of restoring the fluency of deep vein and protecting the efficiency of the vein value organization, and reducing the sequela of DVT. Thrombolysis can only relieve the symptomation, but it can not protect the crawling and relapsing of thrombus.