ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied. The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured, furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%, 66.7%, 97.0%, 100%, and 97.1%, and 98.4%, 83.3%, 98.4%, 83.3%, and 97.1%, respectively. The plasma D-dimer in acute phase 〔(6 451±4 012.22) μg/L〕 and subacute phase 〔(2 063±1831.35) μg/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310±66.70) μg/L〕, Plt;0.01 and Plt;0.05, which was not different from that in chronic phase 〔(466±350.52) μg/L〕. Meanwhile, the plasma D-dimer in mixed limb venous thrombosis group 〔(4 464±3 753.16) μg/L〕 and central limb venous thrombosis group 〔(2 149±1 911.53) μg/L〕 were significantly higher than that in control group (Plt;0.05 and Plt;0.01), which was not different from that in peripheral limb venous thrombosis group 〔(560±315.62) μg/L〕. Conclusion Color Doppler ultrasonography is an optimal method and the plasma D-dimer is a predictive index in diagnosis of lower limb DVT.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
In recent years, with the development of neuroimaging and the improvement of people’s awareness, the incidence of cerebral venous sinus thrombosis (CVST) has been increasing year by year. CVST with venous infarction or haemorrhage is severe, accounting for about 60% of CVST, and its clinical manifestations are serious. The current therapies including anticoagulation and intravascular treatment have not significantly improved the prognosis of severe CVST patients. The incidence of long-term poor prognosis (modified Rankin scale score≥2) is up to 56.1%. Recent research indicates that inflammation may be an important factor leading to severe CVST and is significantly associated with poor prognosis. Anti-inflammatory treatment with glucocorticoids may provide a novel method for severe CVST, but further clinical studies are needed to verify it. This paper introduces the relationship between inflammation and severe CVST in order to explore the feasibility of glucocorticoid for severe CVST.
ObjectiveThis study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis.MethodsThe clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system. Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy wasanalyzed.ResultsEighteen (90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was (4.2±1.4) d and (1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were (35.80±12.30) ×104 U and (45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheter-directed thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after surgery, and 2 patients had lower extremity ulcer caused by lower extremity ischemia symptoms. During the follow-up period, no lower limb necrosis, amputation, and death occurred in the remaining patients.ConclusionsThe AngioJet mechanical thrombectomy system is safe and effective. Combined with the use of catheter-directed thrombolysis and stent implantation, the AngioJet mechanical thrombectomy could lead to quick recovery of the perfusion of the lower extremity and improve the limb salvage rates, exhibiting excellent clinical value.
Objective To evaluate the clinical effect of staging endovascular angioplasty in treatment for iliofemoral venous post-thrombotic syndrome （PTS）. Methods The clinical data of 45 patients with iliofemoral venous PTS from May 2008 to October 2011 in this hospital were analyzed retrospectively. After the identification of the stenosis or occlusion by angiography via femoral vein by percutaneous puncture or incision puncture， recanalization of the occlusion was done by guide wire. Then the percutaneous transluminal angioplasty （PTA） was performed. Results A total of 45 cases （45 legs） had been undergone PTA. The procedures were technically successful in all the patients. No serious complications such as lumen rupture happened. Follow-up time was 6-30 months with （18.06±3.12） months， the symptoms of the affected limb were obviously relieved in 31 cases， partly relieved in 10 cases， not relieved in 4 cases. Reexamination of venous angiography， 9 cases were cured， 18 cases were excellent， 14 cases were improved， 4 cases were ineffective. The total effective rate was 91.11% （41/45）. Conclusion PTA is a safe and effective method in treatment for iliofemoral venous PTS.
【Abstract】ObjectiveTo detect the levels of homocysteine (Hcy) and anti-phospholipid antibodies (APLA) in the hematoplasma of the patients with deep venous thrombosis (DVT), discuss the reason of DVT recurrence and search for the predictors of it. MethodsSixty cases with DVT in our department from January 2001 to April 2003 were collected, which were divided equally into two groups as primary and recurrent, and first degree relative of the 30 DVT recurrent patients were also collected. The author established a control group using 30 cases of outpatient clinic without varicose veins of lower extremity or insufficient venae profundae. Hcy was detected with fluorescence polarization immunoassay (FPIA) and APLA 〔anticardiolipin antibody, ACLA (IgG, IgM); lupus antibody (LA)〕were detected with enzyme linked immunosorbent assay (ELISA). Odds ratios (OR) were also calculated to assess the relative risk of each study group. ResultsThe values of Hcy and ACLA （IgG， IgM） in the primary group and recurrent group were both significantly higher than those of control group and first degree relative group of DVT recurrent patients (Plt;0.01). The values of Hcy in first degree relative group of DVT recurrent patients was were also much higher than that of control group (Plt;0.05). The 90% quantity of Hcy in control group was 13.1 μmol/L and if taking it as the normal value, the number of cases exceeded this value in primary group, recurrent group and first degree relative group of DVT recurrent patients were 14, 21 and 13 and the OR of them were 2.31, 2.20 and 1.90, respectively. The positive rates of LA were not statistically significant in each group. Conclusion The values of Hcy and APLA both rise in the hematoplasma of DVT patients. There are close relationship between the levels of Hcy and APLA and DVT. The recurrence of DVT is related to high level of Hcy and Hcy is possibly a predictor of DVT.
Objective To explore the influencing factors of muscle calf vein thrombosis (MCVT) after hip and knee arthroplasty. Methods Convenience sampling method was used to select patients who underwent hip or knee arthroplasty in 4 hospitals in Beijing, Jiangsu and Hainan between March 2021 and May 2022 as the research subjects. They were divided into MCVT group and non-MCVT group according to whether the lower limb MCVT occurred on the 3rd postoperative day. Generalized linear mixed model was used to analyze the influencing factors of MCVT. Results A total of 278 patients were included, including 47 patients in the MCVT group, accounting for 16.91%, and 231 patients in the non-MCVT group, accounting for 83.09%. Generalized linear mixed model analysis showed that the ambulation on the first postoperative day [odds ratio=0.364, 95% confidence interval (0.159, 0.832), P=0.017] and preoperative activated partial thromboplastin time [odds ratio=0.884, 95% confidence interval (0.785, 0.994), P=0.040] were protective factors for MCVT after hip and knee arthroplasty. Conclusions The ambulation on the first postoperative day and preoperative activated partial thromboplastin time are protective factors for MCVT after hip and knee arthroplasty. The relationship between hypertension, drainage and MCVT needs to be further explored. Clinical medical staff should pay close attention to the postoperative ambulation of patients undergoing hip and knee arthroplasty, encourage and guide patients to get out of bed early, comprehensively assess the patients’ condition and the risk of postoperative MCVT, and flexibly formulate individualized prevention and treatment plans to avoid the occurrence of MCVT and improve the prognosis.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.