Graded compression stockings for the prevention of deep-vein thrombosis.
Explore the source record for details and available documents.
Bandages↗
Biomedical subjects
E Kalodiki
Publications and source records attributed to E Kalodiki.
Low molecular weight heparins in the initial treatment of deep vein thrombosis.
All major trials to-date provide strong evidence that, for the initial treatment of DVT, adjusted-dose LMWHs are at least as effective and safe as unfractionated heparin (UFH). When compared with UFH, LMWHs achieved better thrombus lysis and had less bleeding complications (21-91% risk reduction) and mortality (51% reduction). They also reduced the incidence of recurrent DVT and PE at 90 days follow-up while there was no need for monitoring. Despite these exciting findings however, long-term evaluation of mortality rate, recurrent venous thromboembolism, blood monitoring tests efficacy and thrombus propagation/reduction are open issues. Furthermore, venous haemodynamics have never been tested. There is an ongoing Canadian study today, aiming to determine LMWHs effectiveness in reducing death, recurrent venous thromboembolism and haemorrhagic complications; it is obvious however that further studies are needed. We must determine if a prolonged use of LMWHs (i.e. 90 days) is more effective in preventing the post-thrombotic sequelae, reducing also the incidence of haemorrhagic complications; we also need to know the nature of the haematological changes that develop and the relationship between these changes and the recurrence rate; and finally, we must identify effective blood tests to monitor this treatment.
Anticoagulants↗
V/Q defects and deep venous thrombosis following total hip replacement.
Seventy-two patients undergoing elective total hip replacement were studied with bilateral venography, pre-operative and post-operative lung scans. Twelve belonged to a control group that received placebo injections and 60 patients to treatment groups that received low molecular weight heparin. The incidence of deep venous thrombosis was 11 (92%) of 12 patients in the control group and 18 (30%) of 60 patients in the treatment group (X2: P < 0.001). The incidence of pulmonary embolism (new unmatched perfusion defects) was five (42%) of the 12 patients in the control group and five (8.3%) of the 60 patients in the treatment groups (X2: P < 0.002). The incidence of pulmonary embolism (new unmatched perfusion defects) was eight (27.5%) of 29 patients with deep venous thrombosis and two (4.6%) of 43 without deep venous thrombosis (X2: P < 0.02). Of the ten patients who had pulmonary embolism according to this study's criteria (one or more new defect on perfusion, unmatched on the ventilation scan), eight would have been classified as high probability by the Biello criteria, and only five by the PIOPED criteria, if the pre-operative scans were not available. We conclude that having a pre-operative lung scan improves ability to interpret the postoperative lung scans in high risk patients.
Elective Surgical Procedures↗
Colour flow duplex scanning in suspected acute deep vein thrombosis; experience with routine use.
OBJECTIVES: To determine the accuracy of colour flow Duplex scanning (CFDS) in the diagnosis of deep vein thrombosis (DVT) and subsequently to investigate its diagnostic value in patients who have normal deep veins despite symptoms. DESIGN: Prospective open clinical study. SETTING: Vascular laboratory and radiology departments of University Hospital. MATERIALS AND METHODS: In the first part 112 limbs in 103 patients, 94 with symptoms of acute DVT and nine with pulmonary embolism (PE) were examined prospectively with CFDS and venography. Subsequently, in the second part, 328 legs in 304 patients were examined by CFDS alone for acute symptoms of DVT or PE. MAIN RESULTS: DVT was detected in 55 limbs by venography: proximal DVT was seen in 23 limbs, distal DVT in 25 limbs and both proximal and distal in seven limbs. CFDS was 100% sensitive and 98.8% specific in detecting proximal DVT whereas its sensitivity and specificity was 87.5% and 98.7% for distal DVT. Positive and negative predictive values were over 95% for both limb segments. The overall accuracy for the proximal DVT was 99.4% and for the distal 93.1%. In the second part, CFDS alone detected DVT in 156 limbs (47.6%); DVT was in the proximal segment in 82, distal segment in 61 and both in 13. In 172 limbs other causes of symptoms were identified in 34 (20%). CONCLUSIONS: We have demonstrated that CFDS is as accurate as venography when used by experienced operators. The average time of examination is 15-20 minutes and compares favourably with venography. Other causes of leg symptoms can also be diagnosed by CFDS in around 20% of patients who are found to have normal veins.
Humans↗
The carotid intima-media thickness as a marker of the presence of severe symptomatic coronary artery disease.
High resolution ultrasound can be used for the accurate measurement of intima-media thickness (IMT). The within-observer coefficient of variation of the IMT of two carotids measured seven times each on different days by two different observers was between 4% and 8%, and the mean absolute difference of the IMT of 68 carotids measured independently by two observers was 0.11 +/- 0.11 mm (mean value +/- SD). Seventy-five consecutive male patients who underwent coronary angiography for assessment of chest pain and 40 normal controls matched for age and sex, were examined with high resolution B-mode ultrasound. The IMT of the common carotid artery for the controls was 0.71 +/- 0.16 mm and for the patients 0.91 +/- 0.18 mm (P < 0.005). In patients with normal coronary angiogram the IMT was 0.73 +/- 0.1 mm, and this increased in each of the subgroups with coronary stenosis compared to patients who had a normal coronary angiogram. In the group with one-vessel disease it was 0.91 +/- 0.17 mm (P < 0.05, ANOVA), in the group with two-vessel disease it was 0.96 +/- 0.17 mm (P < 0.01), and in the group with three-vessel disease it was 0.99 +/- 0.21 mm (P < 0.01). There was a significant linear trend between IMT and the number of involved vessels (P < 0.0001, r = 0.44). An IMT > or = 0.85 mm was derived from the studied population of 75 patients as a criterion for the prediction of coronary artery disease (CAD).(ABSTRACT TRUNCATED AT 250 WORDS)
Carotid Artery Diseases↗
Risk factors associated with recurrent carotid stenosis.
The incidence of restenosis following carotid endarterectomy reported with duplex scanning has ranged from 6-19%. The aim of this study was to determine the importance of risk factors in the development of carotid stenosis following carotid endarterectomy. Two hundred-thirty patients who underwent carotid endarterectomy (nineteen bilateral carotid endarterectomies) and had complete follow-up with duplex scanning for at least one year have been studied between February 1983 and April 1989. Forty six patients developed restenosis (18.5% of carotid endarterectomies) whereas 184 patients did not restenose. All patients were studied for the following risk factors: age, sex, ischemic heart disease, smoking habit, family history of cardiovascular disease diabetes mellitus, hyperlipidemia and peripheral vascular disease. The incidence of ischemic heart disease, a positive family history of cardiovascular disease, hyperlipidemia and diabetes mellitus was significantly increased (p < 0.05) in patients with recurrent carotid stenosis (80.4%, 71.7%, 58.7%, 32.6% respectively) as compared to patients without a recurrent stenosis (55.7%, 33.5%, 31%, 10.5%). None of the above significant risk factors was strongly associated with early (< 2 years) carotid restenosis. There is an increased prevalence of clinical atherosclerotic risk factors such as family history of cardiovascular disease, diabetes mellitus, ischemic heart disease and hyperlipidemia in patients who develop carotid restenosis.
Aged↗
Detection of superior mesenteric and coeliac artery stenosis with colour flow Duplex imaging.
Measurements of blood velocity in the coeliac axis (CA) and the superior mesenteric artery (SMA) before and after a standard meal in normal people have been studied by several authors. However, information about the ability to detect stenotic lesions is lacking. The aim of our study was to determine the accuracy of Duplex scanning in detecting angiographically proven lesions. Twenty normal volunteers (13 males and seven females) and 24 patients (19 males and five females) with visceral artery stenosis on angiography were examined in the supine position (angle of insonation 60.5) with colour flow Duplex imaging (CFDI) (3.5 MHz probe), in the fasting state and after a standard meal at 15, 40, 60 and 90 min. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were determined in both CA and SMA. The PSV was the best indicator of stenosis. After the meal, there was an increase in both PSV and EDV but neither of the postprandial measurements improved the accuracy of the test. The results indicate that CFDI can detect the presence of significant stenosis (> 50% in the CA and SMA with a sensitivity and specificity of > 80%.
Arterial Occlusive Diseases↗
Duplex scanning in post-operative surgical patients.
The technique of duplex scanning for the diagnosis of deep venous thrombosis (DVT) has been developed in 3 stages. Initially B-mode imaging with compression was used. Subsequently interrogation of the venous lumen using the Doppler facility was introduced and finally the latter became simple and efficient with the introduction of colour flow imaging. Sensitivities and specificities in excess of 90% have been produced for thrombosis proximal to the calf by all methods in symptomatic patients. Colour flow imaging has given the best results for calf DVT in symptomatic patients with 86% sensitivity and 91% specificity. Before the introduction of colour flow imaging the accuracy for the detection of old thrombi in asymptomatic patients was poor. With the introduction of colour, sensitivities and specificities in excess of 90% have been obtained for proximal DVT; for calf DVT, sensitivity of 79% and specificity of 97% have been reported by 2 studies. If further studies substantiate these recent results duplex scanning will become the non-invasive method to be used in screening asymptomatic patients.
Color↗
The effect of elastic stockings on the elasticity of varicose veins.
The aim of this study was to establish the long-term effect of graduated elastic compression on venous elasticity in patients with superficial or deep venous disease and to determine the possible relationship between elasticity and the duration of the disease. The elastic modulus of 29 patients, 19 with superficial vein incompetence and 10 with deep vein incompetence was assessed by the simultaneous measurement of calf volume (determined using strain gauge) and venous pressure (obtained via a dorsal foot vein) during venous occlusion. The measurements were obtained before and after 4 weeks of elastic compression stockings. The elastic modulus K, was defined as stress/strain when the veins were full and was calculated from the pressure/volume relationship. The results show a clear difference in elasticity before and after elastic stockings. Two groups of patients were identified: group 1 with increased elasticity and group 2 with decreased elasticity. There was a negative linear relationship (r = 0.88) between increase in elasticity after treatment and duration of venous disease.
Bandages↗
The combination of liquid crystal thermography and duplex scanning in the diagnosis of deep vein thrombosis.
One hundred patients with clinically suspected deep vein thrombosis (DVT) were studied by liquid crystal thermography (LCT), duplex scanning and venography. Liquid crystal thermography was found to have a negative predictive value of 97% if performed within 1 week of the onset of symptoms. Duplex scanning had a sensitivity of 93% and specificity of 91% for all thrombi (proximal and calf). On the basis of these results a plan of investigation has been formulated that would avoid duplex scanning and venography in 39 of the 100 patients. Duplex scanning alone would be appropriate in 56 of the remaining 61 patients. Only six patients would be unsuitable for duplex scanning because of a very tense tender leg and require venography. The plan would miss one calf thrombus and result in treating three patients unnecessarily. This policy would be not only effective but also cost-effective.
Female↗
Popliteal vein entrapment in the normal population.
The aim of this study was to determine the incidence and severity of popliteal vein compression by full knee extension in the normal population. The popliteal veins in 100 healthy volunteers (200 limbs) with no history of previous deep vein thrombosis (DVT) or venous obstruction were examined using duplex scanning with the knee slightly flexed and then fully extended. Knee extension produced complete obstruction in 17 subjects and severe obstruction (< 50% decrease in diameter) in a further 10 subjects. Thirteen subjects had unilateral compression and 14 bilateral. The 27 subjects were tested for functional venous outflow obstruction with air plethysmography. In flexion, the outflow fraction was normal (> 40%) in all subjects. With the knee fully extended, severe or complete venous obstruction (outflow fraction < 10%) was found in eight subjects. Moderate obstruction (outflow fraction 10-40%) was found in all the remaining 19 subjects. When digital compression of the long saphenous vein was performed, these subjects also demonstrated severe outflow obstruction. Although the incidence of symptoms of functional venous obstruction is rare in the general population, these findings have important implications for venous stasis for patients on the operating table and in those having prolonged bed rest. Studies investigating the association between popliteal vein compression and postoperative deep venous thrombosis are needed.
Adult↗
Deep vein thrombosis: aetiology, prevention and management.
Explore the source record for details and available documents.
Heparin↗
Venous hypertensive microangiopathy in relation to clinical severity and effect of elastic compression.
Arterial inflow in mL/minute and perimalleolar skin blood flow were measured with venous occlusion air-plethysmography and laser-Doppler flowmetry in 20 normal limbs, 40 limbs with uncomplicated primary varicose veins, 32 limbs with primary varicose veins and skin changes, and 36 limbs with deep venous disease. Limbs with complicated varicose veins (skin changes) and deep venous disease showed a marked increase (2 to 4 times) in both arterial inflow and skin blood flow when compared with the normal controls and uncomplicated varicose veins. The measurements were repeated 30 minutes after the application of graduated elastic stockings. There was a 16% reduction in the mean arterial inflow (P less than .01) and a 45% decrease in skin blood flow (P less than .01). The results indicate that in limbs with chronic venous insufficiency and skin changes there is an increased blood flow which is mainly in the skin. This is irrespective of whether the venous problem is in the superficial or deep venous system. Elastic compression tends to reduce the hyperemia towards the normal range.
Adult↗
Reduced human peritoneal plasminogen activating activity: possible mechanism of adhesion formation.
A unifying pathophysiological hypothesis states that the plasminogen activating activity (PAA) of the peritoneal mesothelium determines whether the fibrin which forms after peritoneal injury is either lysed or organized into permanent fibrous adhesions. The PAA of human peritoneal biopsies was measured using a fibrin plate lysis technique to assess the changes that occur in inflammation and ischaemia, conditions which both produce fibrous adhesions. Activity was found in all biopsies from normal parietal and visceral (appendix, bowel and omentum) peritoneum with no significant site-to-site variation. Inflamed peritoneum (parietal, appendicular and mesenteric) had significantly less PAA compared with normal peritoneum; visceral ischaemia also resulted in a significant decrease of PAA. These reductions in human peritoneal PAA observed in inflammation and ischaemia support the view that mesothelial PAA plays a key part in the prevention of events leading to the production of fibrous adhesions.
Appendicitis↗
New information on the value of plaque characterisation--relation to symptoms.
This paper reviews the literature on the significance of carotid plaque echomorphology and degree of stenosis in relation to the different types of cerebrovascular symptomatology (amaurosis fugax, hemispheric transient ischaemic attacks, stroke) and the asymptomatic status. It provides evidence that amaurosis fugax is associated with hypoechoic and severely stenosed plaques, the hemispheric transient ischaemic attacks and stroke are associated with plaques of intermediate echodensity and stenosis while the asymptomatic status is associated with hyperechoic and moderately stenosed plaque. It lends support to the notion that plaque hypoechoicity is associated with embologenicity. It supports the view that the severe carotid stenosis facilitates the opening of the cerebral collateral circulation and that amaurosis fugax is associated with an "opened" cerebral collateral supply as contrasted to the cerebrovascular symptomatology. It proposes the inclusion of the cerebral collateral circulation as a stroke risk factor along with the plaque echomorphology and the degree of stenosis in the natural history studies of asymptomatic individuals with carotid bifurcation plaques.
Amaurosis Fugax↗
Combined carotid endarterectomy and coronary artery bypass grafting. A literature review.
This is a review article on the management of patients with both carotid and coronary artery lesions. Most authors agree that patients with symptomatic coronary and symptomatic carotid disease should be offered a combined operation (same anaesthetic) in the presence of unstable angina or left main stem coronary disease and staged operations in the presence of stable angina. Patients with symptomatic coronary disease and asymptomatic severe (greater than 80% stenosis) carotid disease should be offered the staged procedure not for preventing perioperative but late stroke. This statement is tentative and not supported by hard data. It should be revised when the results of the multicentre randomised studies of asymptomatic carotid stenosis become available. A prospective randomised study is required in patients with symptomatic coronary and asymptomatic severe unilateral and bilateral carotid stenosis (greater than 80%) in order to determine whether surgery in the carotid decreases the incidence of late stroke. It cannot be overemphasised that the team that does the carotid endarterectomy should have a good track record of combined mortality and morbidity of less than 5% for patients with TIA's and less than 3% for patients with asymptomatic carotid disease.
Carotid Stenosis↗
Natural history of chronic bilateral internal carotid artery occlusion.
Chronic bilateral ICA occlusion was found in 15 of 3200 patients studied with duplex scanning during a six years period. Ten of these patients had a history of stroke. Mean follow-up was 28.9 months. Six patients died during follow-up, coexisting cardiac ischaemia being the major cause of death. Two patients suffered a stroke (one fatal) resulting in an annual stroke rate of 5.5%, three patients continued to have TIAs and 5 remained asymptomatic. Chronic bilateral ICA occlusion is not always associated with neurological deficit. Coronary ischaemia, more than stroke is the leading cause of death in these patients.
Adult↗
Complement activation in atherosclerosis: effect of angiography and surgery.
Complement activation in the plasma of patients with severe atherosclerosis (arterial occlusive or aneurysmatic disease) was investigated in this study. The effects of angiography and reconstructive arterial surgery (RAS) were also assessed. Atherosclerosis was not found to be associated with systemic complement activation. Angiography resulted in high levels of C3 breakdown products. Surgery caused a significant degree of systemic complement activation in both patients with atherosclerosis and controls. Post-operative levels of C3 breakdown products were significantly higher in atheromatic patients than in controls, most likely due to the insertion of dacron arterial prostheses in the first group.
Angiography↗