SEARCH · PubMed Health

Results for “Stockings, Compression”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 379 records · Page 21Linked to original sources

PubMed2000

The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression.

BACKGROUND: The aim of this prospective study was to analyse a group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression and intensive mobilisation and to evaluate its feasibility, efficacy and safety from possible risks of pulmonary embolism. METHODS: From March 1997 to September 1999, 96 consecutive patients with diagnosed DVT were enrolled in a prospective study and treated at home with enoxaparin (Clexane Rh ne-Poulenc) administered subcutaneously at doses depending on body weight (1 mg/kg) b.i.d. for a minimum of seven days. Oral anticoagulants were started two days before discontinuing LMWH and given later for three months according to the haemocoagulation parameters. All patients wore elastic second degree compression stockings during the whole period of treatment and for 12 months there after. They were encouraged to walk 1-3 km daily. The sites of thrombosis were ilio-femoral vein--38 patients (40%), femoral or popliteal vein--32 patients (33%), crural veins--26 patients (27%). According to our surgical criteria two years ago 17 patients would have been operated on and trombectomy performed. The diagnosis was made by compression ultrasonography using a colour duplex scanner (Acuscan 125), by contrast phlebography, and platelet scintigraphy (Tromboscint test). Perfusion-ventilation scintigraphy of the lungs was performed only if there were clinical signs or even a suspicion of pulmonary embolism and on all patients with iliofemoral thrombosis. Perfusion gamagraphy of lungs was carried out on 51 patients where thrombosis was localised in proximal veins. RESULTS: In 27 patients there were signs of non-fatal pulmonary embolism (53%), but only seven patients (26%) suffered mild non-specific clinical signs; 20 patients with diagnosed pulmonary embolism (74%) were symptom-free. Out of 96 patients, three admitted to hospital (3%), 67 (70%) injected LMVH themselves and felt comfortable. Eight to 12 weeks after this treatment control sonography and phlebography were carried out in 70 patients to assess the localisation and progress of the thrombosis. In 51% (36 patients) partial and 31% (22 patients) total recanalisation was found. Five out of 96 complained of minor bleeding (5%). No thrombocytopenia was noticed. The first five days on home treatment were crucial. All patients were able to walk and live at home without difficulty. None of our patients with proximal deep vein thrombosis used a vena cava filter. CONCLUSIONS: Home treatment of DVT is possible and is effective, safe and less costly on average and per patient 40% in costs was saved compared with those of a hospital stay in spite of the greater expense of LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group.

Anticoagulants↗

PubMed2005

Continuous passive motion in the prevention of deep-vein thrombosis: a randomised comparison in trauma patients.

There is a high risk of venous thromboembolism when patients are immobilised following trauma. The combination of low-molecular-weight heparin (LMWH) with graduated compression stockings is frequently used in orthopaedic surgery to try and prevent this, but a relatively high incidence of thromboembolic events remains. Mechanical devices which perform continuous passive motion imitate contractions and increase the volume and velocity of venous flow. In this study 227 trauma patients were randomised to receive either treatment with the Arthroflow device and LMWH or only with the latter. The Arthroflow device passively extends and plantarflexes the feet. Patients were assessed initially by venous-occlusion plethysmography, compression ultrasonography and continuous wave Doppler, which were repeated weekly without knowledge of the category of randomisation. Those who showed evidence of deep-vein thrombosis underwent venography for confirmation. The incidence of deep-vein thrombosis was 25% in the LMWH group compared with 3.6% in those who had additional treatment with the Arthroflow device (p < 0.001). There were no substantial complications or problems of non-compliance with the Arthroflow device. Logistic regression analysis of the risk factors of deep-vein thrombosis showed high odds ratios for operation (4.1), immobilisation (4.3), older than 40 years of age (2.8) and obesity (2.2).

Adult↗

PubMed1993

Popliteal vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency.

PURPOSE: This report describes popliteal vein entrapment in three patients and demonstrates that it may present with manifestations of typical venous disease. METHODS: This report was compiled from a review of inpatient and outpatient records. RESULTS: In the first case, a 28-year-old woman was seen with left leg popliteal and calf deep vein thrombosis without obvious cause. She described long-standing calf discomfort, and passive dorsiflexion of the left foot caused disappearance of arterial pulsations at the pedal level. She was given the anticoagulants heparin and sodium warfarin (Coumadin) followed by surgical exploration. The popliteal vein and artery were entrapped by a fibrous extension of the medial head of the gastrocnemius muscle attaching to the lateral femoral condyle. After band lysis, the patient has been symptom free for 6 years. The second patient, a 37-year-old man, was seen with bilateral chronic venous insufficiency (CVI). Passive dorsiflexion and active plantar flexion of the feet did not diminish the pedal pulses; impedance plethysmography suggested mild outflow obstruction. Ascending venography demonstrated entrapment at the midportion of duplicated popliteal veins with no postthrombotic changes. He was treated with compression stockings and has done well during an 18-month follow-up. The third patient, a 17-year-old male, was seen with severe symptoms of right leg CVI and venous obstruction since 3 years of age. Air plethysmography revealed ambulatory venous hypertension, whereas venography demonstrated reflux down to the knee with an extrinsic narrowing at the midpopliteal vein. During operation, an abnormal origin of the lesser saphenous vein (LSV) from the popliteal vein was found; the LSV took a medial route, compressed the tibial nerve, and caused severe distortion and narrowing of the popliteal vein. Division of the LSV resulted in release of popliteal venous compression and immediate relief of symptoms. CONCLUSIONS: The three cases presented demonstrate that popliteal venous entrapment may begin with symptoms of deep vein thrombosis and CVI. Popliteal venous entrapment must be considered in the differential diagnosis of venous disease in younger patients in whom common predisposing factors are absent.

Adolescent↗

PubMed1991

Ambulatory care for ambulant patients with deep vein thrombosis.

A follow-up study is reported on 49 patients with acute deep vein thrombosis (DVT) treated on an ambulatory basis. Venography had shown crural DVT in 27 % and proximal extension in 73 %. The initial treatment consisted of heparin (7,500 U iv, 40,000 U sc), ethylbiscoumacetate (900 mg), phenprocoumon (9 mg), and a ready made compression stocking for the calf. The patients were advised to undertake frequent strolls, the first when leaving the office. Pain, swelling and incapacity for walking vanished within two days. The partial thromboplastintime was prolonged 2.4-times on the first day and the thromboplastintime was in the therapeutic range on the second day already. Until follow-up 4 patients died of other diseases. There was no clinical pulmonary embolism, no secondary hospitalisation and only one new DVT. Of 844 months of patients at risk of recurrence 50 % passed under anticoagulants and 70 % with compression therapy. At an average of 19 months, 82 % of patients were asymptomatic and 45 % showed mild chronic venous insufficiency. In contrast, impaired drainage function (by lightreflectionrheography) was found in 79 % overall and in 100 % after DVT of the proximal veins. The discrepancy is explained by the compliance with compression therapy.

Adult↗

PubMed2000

Practicability and quality of outpatient management of acute deep venous thrombosis.

PURPOSE: The purpose of this study was to review the practicability and quality of a standardized management approach of deep venous thrombosis (DVT) provided by private practices. METHODS: There were 152 consecutive patients and 156 episodes. We determined the patients' diagnoses with estimation of clinical probability, D-dimers, duplex ultrasound scan, and venography. Patients were treated on an outpatient basis on principle, with dalteparin, phenprocoumon, different modalities of external leg compression, and deliberate ambulation. We followed up at 4 weeks. RESULTS: Proximal DVT was diagnosed in 101 episodes (65%). Results of the D-dimer test were false-negative in 6%, and venography was indicated in 15%. Calf vein thrombosis was found in 55 patients. Results of the D-dimer test were false-negative in 30%, and venography was required in 37%. Eleven patients were hospitalized (9 for thrombectomy or thrombolysis), and 145 episodes (93%) were treated according to our standardized approach (provided by the referring physicians alone in 43%). For 5 days, dalteparin was injected by the patients themselves or their relatives, in 78% of the cases. The international normalized ratio values were more than 2 in 88% of the cases, with no difference between providers. In all but two cases, external leg compression was applied immediately: a modified Unna's boot in 28% and compressing stockings in 72% (Sigvaris 503 in 91%; calf length in 100% of distal DVT, and 83% of proximal DVT). During follow-up, there was no clinical evidence of recurrence or progression, 1 possible pulmonary embolism, 1 injection site hematoma, and 1 hospitalization unrelated to the DVT. CONCLUSION: Diagnosis of proximal DVT is straightforward, but calf DVT often requires venographic confirmation because of discrepancies among clinical probability, D-dimer estimation, and ultrasound scan. Outpatient treatment can be offered to patients who can comply with the regimen. The quality of anticoagulation is in accordance with published data, and compliance with external leg compression is almost perfect.

Acute Disease↗

PubMed1999

Thromboembolic prophylaxis with use of aspirin, exercise, and graded elastic stockings or intermittent compression devices in patients managed with total hip arthroplasty.

BACKGROUND: Prophylaxis against pulmonary embolism as a complication of total hip arthroplasty remains controversial. Our experience suggests that an inexpensive protocol of prophylaxis that includes aspirin and exercise is effective. METHODS: We investigated the effectiveness of aspirin, a program of intraoperative and postoperative exercises, and graded elastic stockings or intermittent compression devices as prophylaxis against thromboembolic disease in a series of 1267 patients who had had 1492 total hip arthroplasties. All of the operations were done through a posterior approach. For the purpose of this review, the duration of follow-up was limited to a minimum of three months. No patient was lost to follow-up. Any thromboembolic complications that may have occurred after the third postoperative month were not considered to be related to the operation and were not recorded. RESULTS: A fatal pulmonary embolism occurred after two arthroplasties (0.13 percent), a nonfatal pulmonary embolism was diagnosed after fourteen (0.94 percent), and deep venous thrombosis developed after fifteen (1.01 percent). Regional (epidural) anesthesia was used for 1099 arthroplasties (73.7 percent), and general anesthesia was used for 393 procedures (26.3 percent). A fatal pulmonary embolism occurred after two (0.18 percent) of the 1099 arthroplasties that had been performed with regional anesthesia and after none that had been performed with general anesthesia (chi square = 0.22; p > 0.05). A nonfatal pulmonary embolism occurred after two procedures (0.18 percent) that had been done with regional anesthesia and after twelve (3.05 percent) that had been done with general anesthesia (chi square = 25.3; p < 0.001). Deep venous thrombosis was diagnosed after seven procedures (0.64 percent) that had been performed with regional anesthesia and after eight (2.04 percent) that had been performed with general anesthesia (chi square = 5.45; p < 0.025). We detected a significant difference between men and women with respect to the rate of nonfatal pulmonary embolism (chi square = 4.36; p < 0.05). With the numbers available, we found no significant differences between the 774 arthroplasties (51.9 percent) in patients who had worn graded elastic stockings and the 718 arthroplasties (48.1 percent) in patients who had used intermittent compression devices, between the 774 arthroplasties (51.9 percent) that had been performed in Florida and the 718 (48.1 percent) that had been done in California, or between the 1313 primary arthroplasties (88 percent) and the 179 revision arthroplasties (12 percent), with regard to the prevalence of fatal pulmonary embolism, nonfatal pulmonary embolism, or deep venous thrombosis (p > 0.05 for all comparisons). In summary, we found that the type of compression (graded elastic stockings or intermittent compression devices), the geographic location (California or Florida), and the type of operation (primary or revision) had no significant effect, with the numbers available, on the rate of thromboembolic complications. Compared with general anesthesia, the use of regional anesthesia was associated with a significantly lower rate of nonfatal pulmonary embolism (p < 0.001) and deep venous thrombosis (p < 0.025). Both patients who had a fatal pulmonary embolism had had regional anesthesia (p > 0.05). CONCLUSIONS: This inexpensive method of prophylaxis against thromboembolic disease after total hip arthroplasty, which was based primarily on the use of aspirin as the pharmacological agent and the performance of intraoperative and postoperative exercises, produced good clinical results.

Arthroplasty, Replacement, Hip↗

PubMed1999

[Prospective 12-year follow-up study of clinical and hemodynamic sequelae of deep venous thromboses in patients with low risk (Zurich Study)].

No prospective study of the long-term sequelae of more than 10 years after acute deep vein thrombosis exists so far. Therefore, 28 patients with DVT were included in a prospective study to evaluate the natural history of postthrombotic syndrome. Clinical and hemodynamic examinations were performed at the time of admission; after 3, 6 and 12 months; after the 2nd, 3rd, 4th, 5th; and finally after the 12th year. All patients received unfractionated heparin initially and oral anticoagulants subsequently. After 12 years, 64% of the patients exhibited normal findings. Mild skin changes were found in 28%, marked trophic changes in 5%, and only 1 venous ulcer occurred. Regular use of compression stockings was reported by 54% of the patients with multilevel disease. Although mean maximum venous outflow was significantly reduced from the acute event to 2 years later (p < 0.003) compared with the contralateral leg, a significant (p < 0.05) improvement was observed 6 months later. Recanalization of calf vein thrombosis was detected by Doppler sonography after 3 months. 64% of the multilevel thromboses were recanalized completely or in part after 1 year; in 69%, valvular incompetence was found. In conclusion, in contrast to earlier reports, this prospective study up to 12 years after DVT demonstrates a low incidence of PTS by administration of initially unfractionated heparin, oral anticoagulation and compression therapy. However, the adverse clinical event rate (mortality 14%) and recurrency rate of 24% show that the prognosis after DVT does not appear favorable even in low-risk patients.

Adult↗

PubMed2006

[Effectiveness of compressive hosiery < > for therapy of chronic venous insufficiency].

Total 40 patients with III grade chronic venous insufficiency underwent conservative treatment with compressive hosiery < >. Patients were divided into 2 groups: the first group used compressive stockings, the second--tights. To objectivize the assessment, all patients underwent volumetry, radionuclide phlebography and regional blood volume measurements. It was shown that in the first group pain syndrome was coped in 73% of patients, edematous--in 60%. According to volumetry data, mean calf volume has reduced by 183+/-41 ml, phlebography has revealed an improvement of muscular-venous pump capacity in 11 patients; in 9 patients it remained unchanged. Blood filling in the affected limb decreased in 16 patients from 10.7% to 8.2% and from 7.5% to 5.3% for thigh and calf, respectively. In the second group an improvement of venous return parameters was more pronounced. Compressive tights relieved pain in lower extremities in 95%, decreased led edema--in 90% of patients. There was significant reduction in calf volume--by 259+/-31 ml to the end of treatment course. Radionuclide phlebography has shown significant improvement of muscular-venous pump evacuatory function and reduction of blood filling in all patients of the second group. In conclusion, results of the study evidenced the effectiveness of compressive hosiery for treatment of chronic venous insufficiency.

Adult↗

PubMed1998

[Physical therapy of venous diseases].

If physical therapy like compression stockings and supervised outpatient vascular exercise programmes are begun early, subjective complaints can be alleviated and ankle flexibility and venous drainage can be improved. Incapacitating congestive diseases such as dermatolipofasciitis and ulcus cruris can be avoided. Once chronic venous congestion has led to joint capsule atrophy, stiffening of the ankle and muscular atrophy in the lower leg, expensive therapeutic measures involving professional physiotherapeutic care become unavoidable. In our own experience physiotherapy is most effective in combination with biomechanical stimulation therapy. Once the patient's equine gait has been eliminated, conventional walking exercise can gradually restore a physiological gait. After successful physiotherapy, an outpatient vascular exercise programme combined with optimized compression therapy contribute decisively to long-term therapeutic success in patients with advanced chronic venous insufficiency. Like coronary sports, vascular exercise programmes are covered by public health insurance. Along with compression therapy, they represent an efficient, cost-effective basic therapy for chronic venous insufficiency.

Bandages↗

PubMed1996

Prospective 12-year follow-up study of clinical and hemodynamic sequelae after deep vein thrombosis in low-risk patients (Zürich study).

BACKGROUND: No prospective study of the long-term sequelae of more than 10 years after acute deep vein thrombosis exists so far. Therefore, 58 low-risk patients with DVT were included in a prospective study to evaluate the natural history of postthrombotic syndrome. METHODS AND RESULTS: Clinical and hemodynamic examinations were performed at the time of admission; after 3, 6, and 12 months; after the 2nd, 3rd, 4th, 5th years; and finally after the 12th year. All patients received heparin initially and oral anticoagulants subsequently. After 12 years, 64% of the patients exhibited normal findings. Mild skin changes were found in 28%, marked trophic changes in 5%, and only one venous ulcer occurred. Regular use of compression stockings was reported by 54% of the patients with multilevel thrombosis. Although mean maximum venous outflow was significantly reduced from the acute event to 12 years later (P<.003) compared with the contralateral leg, a significant (P<.05) improvement was observed 6 months later. Recanalization of calf vein thrombosis was detected by Doppler sonography after 3 months. Sixty-four percent of the multilevel thromboses were recanalized completely or in part after 1 year; in 69%, valvular incompetence was found. CONCLUSIONS: In contrast to earlier reports, this prospective study up to 12 years after deep vein thrombosis demonstrates a low incidence of postthrombotic syndrome by administration of oral anticoagulants and regular compression therapy. However, the adverse clinical event rate (mortality 14%) and a recurrence rate of 24% show that the prognosis after deep vein thrombosis does not appear favorable even in low-risk patients.

Administration, Oral↗

PubMed2006

Prophylaxis against venous thromboembolism in orthopedic surgery.

Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less likely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications.

Anticoagulants↗

PubMed2006

Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study.

OBJECTIVES: This study sought to assess the efficacy of compression bandage of legs and abdomen in preventing hypotension and symptoms. BACKGROUND: Progressive orthostatic hypotension can occur in elderly people during standing. METHODS: Twenty-one patients (70 +/- 11 years) affected by symptomatic progressive orthostatic hypotension underwent 2 tilt-test procedures, with and without elastic bandage of the legs (compression pressure 40 to 60 mm Hg) and of the abdomen (compression pressure 20 to 30 mm Hg) in a randomized crossover fashion. Leg bandage was administered for 10 min and was followed by an additional abdominal bandage for a further 10 min. Symptoms were evaluated by a 7-item Specific Symptom Score (SSS) questionnaire before and after 1 month of therapy with elastic compression stockings of the legs (prescribed in all patients irrespective of the results of the tilt study). RESULTS: In the control arm, systolic blood pressure decreased from 125 +/- 18 mm Hg immediately after tilting to 112 +/- 25 mm Hg after 10 min of sham leg bandage and to 106 +/- 25 mm Hg after 20 min despite the addition of sham abdominal bandage. The corresponding values with active therapy were 129 +/- 19 mm Hg, 127 +/- 17 mm Hg (p = 0.003 vs. control), and 127 +/- 21 mm Hg (p = 0.002 vs. control). In the active arm, 90% of patients remained asymptomatic, versus 53% in the control arm (p = 0.02). During the month before evaluation, the mean SSS score was 35.2 +/- 12.1 with dizziness, weakness, and palpitations accounting for 64% of the total score. The SSS score decreased to 22.5 +/- 11.3 after 1 month of therapy (p = 0.01). CONCLUSIONS: Lower limb compression bandage is effective in avoiding orthostatic systolic blood pressure decrease and in reducing symptoms in elderly patients affected by progressive orthostatic hypotension.

Abdomen↗

PubMed1996

Intermittent pneumatic compression prophylaxis for proximal deep venous thrombosis after total hip replacement.

The efficacy of intermittent pneumatic compression in the prevention of proximal deep venous thrombosis was determined in a consecutive series of patients who had primary or revision total hip replacement. Two hundred and eighty-nine patients (242 primary and eighty revision hip replacements) who were at least forty years old were managed intraoperatively and postoperatively with intermittent pneumatic compression with use of thigh-high sequential compression sleeves and thigh-high elastic compression stockings as the only form of prophylaxis. Venous ultrasonography of the ipsilateral lower extremity was performed, at an average of five days postoperatively, to determine the presence of a thrombus in the femoral and popliteal veins. The prevalence of proximal deep venous thrombosis was 6 per cent (twenty of 322 procedures), and no patient had a clinically detected pulmonary embolism. The prevalence of a proximal thrombus was 4 per cent (ten of 233 procedures) when a regional anesthetic had been used and 11 per cent (ten of eighty-nine procedures) when a general anesthetic had been used; this difference was significant (p = 0.02). The prevalence of a proximal thrombus was 3 per cent (eight of 245 procedures) for patients who were less than seventy-five years old and 16 per cent (twelve of seventy-seven procedures) for patients who were seventy-five years old or more (p < 0.0001). No patient had a major bleeding complication. Twenty-nine other patients who had an additional risk factor for thrombosis, such as a history of deep venous thrombosis, were managed with intermittent pneumatic compression and low-dose warfarin. The prevalence of proximal deep venous thrombosis in this group of patients was 19 per cent (six of thirty-one procedures). Intraoperative and postoperative intermittent pneumatic compression, combined with the use of a regional anesthetic, was found to be highly effective in the prevention of proximal deep venous thrombosis after total hip replacement. Despite the limitations inherent in comparisons among series, it is noteworthy that the prevalence of proximal thrombosis in our series was similar to the reported prevalences in several large series of patients who had a total hip replacement and were managed with either low-dose warfarin or low-molecular-weight heparin. However, there was no risk of major postoperative bleeding in the current study.

Adult↗

PubMed2004

Incidence of clinically evident deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Advanced age, major orthopedic surgery, neoplastic disease, prolonged operations, varicose veins, immobilization, estrogen-containing medications, and obesity are known risk factors for the development of postoperative thromboembolic complications. Perioperative heparin is useful for reducing the incidence of deep venous thrombosis (DVT), but it is associated with a discrete bleeding rate. The purpose of this study was to determine the incidence of clinically evident DVT in morbidly obese patients after laparoscopic Roux-en-Y gastric bypass when a pneumatic compression hose is used as the only prophylaxis against DVT instead of anticoagulants. METHODS: From April 2000 to April 2003, 380 patients underwent laparoscopic Roux-en-Y gastric bypass for morbid obesity by one surgeon (R.H.C.). Prospectively, each patient was clinically evaluated for the presence of DVT during the postoperative period. Calf-length pneumatic compression stockings were placed before the procedure began, and remained in place until the patient was ambulatory. Ambulation was encouraged on the evening of the operation. No pharmacologic anticoagulant was used as a prophylaxis against DVT. RESULTS: Of the 380 patients, 346 were women and 34 were men with a mean age of 39.3 +/- 9.4 years (range, 14-65 years). The mean weight of these patients was 299.5 +/- 53.6 lb (range, 188-483 lb), and their mean body mass index was 48.5 +/- 6.6 (range, 36-70). The mean operative time was 103. 3 +/- 24.3 min (range, 62-227 min), and mean American Society of Anesthesiology (ASA) score was 2.6. Nine patients had clinical evidence of severe, chronic venous disease preoperatively. One patient (0.26%) experienced a clinically evident DVT limited to the popliteal vein on duplex ultrasonography. The clot resolved completely, as evidenced by follow-up duplex ultrasonography after 2 weeks of subcutaneously injected fractionated heparin. No clinically evident pulmonary thromboembolism occurred in this study group. CONCLUSIONS: The incidence of clinically evident DVT after laparoscopic Roux-en-Y gastric bypass is low when the procedure is accomplished with a relatively short operative time, with the initiation of calf-length pneumatic compression hose before the induction of anesthesia, and with routine early ambulation. No form of heparin anticoagulation is mandatory when these conditions can be met.

Adolescent↗

PubMed2000

Microcirculatory dysfunction in chronic venous insufficiency (CVI).

The elevated ambulatory pressure in the peripheral venous system of chronic venous insufficiency (CVI) patients manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. For this reason, it is closely correlated with trophic disorders of the skin and can ultimately lead to ulceration. Using microcirculation research techniques, we are able to provide clear evidence of a typical microangiopathy in chronic venous insufficiency. Fifty CVI in Widmer stages I, II, and III were examined with fluorescence video microscopy, intravital video capillaroscopy, transcutaneous oxygen partial pressure measurement, TcpO2 and laser Doppler flowmetry. The effects of compression therapy with individually fitted compression stockings on capillary morphology were studied over a period of 4 weeks in 20 CVI patients in Widmer stages I and II. The capillary pressure was measured during simulated muscle contraction using a servo-null micropressure system. We periodically drew blood from the dorsalis pedis vein and a brachial vein of 11 healthy test persons and 8 patients with stage III CVI during experimental venous hypertension in order to evaluate the expression pattern of leukocyte adhesion molecules involved in inflammation: LFA-1 (CD11a), Mac-1 (CD11b), p150,95 (CD11c), CD18, VLA-4 (CD49d), and L-selectin (CD62L). In the same patients, we used immunohistochemical methods to examine clinically unaffected skin and the skin near an ulcer, focusing on the adhesion molecules ICAM-1, VCAM-1, and E-selectin. The microangiopathic changes observed with worsening clinical symptoms include a decrease in the number of capillaries, glomerulus-like changes in capillary morphology, a drop in the oxygen content (tcpO2) of the skin, increased permeability of the capillaries to low-molecular-weight substances, increased laser Doppler flux reflecting elevated subcutaneous flow, and diminished vascular reserve. These microangiopathic changes worsen in linear proportion to the clinical severity of chronic venous insufficiency. In patients with venous ulcerations, the baseline expression of LFA-1 and VLA-4 on lymphocytes, Mac-1 expression on the myeloid cell line, and L-selectin expression on all three cell lines was not significantly different form that in healthy controls. During orthostatic stress, there was a significant reduction in the expression of L-selectin in blood cells collected at foot level in the controls (p=0.002), but not in the patients. Clinical improvement by compression therapy was accompanied by an increase in the number of nutritive capillaries, while the diameter of the capillaries and the dermal papillae was reduced. When ulcers healed in a short period (<6 weeks), we observed a concomitant increase in the number of capillaries (p<0.05). Microangiopathy appears before tropic disorders of the skin develop. Even trophically normal skin areas may have dilated nutritive capillaries, an early sign of disturbed skin perfusion. These changes represent a plausible explanation for the development and to recurrency tendency of venous ulcers. The reduced expression of lymphocytic L-selectin in healthy controls during the orthostatic stress test may be an indication that the cells are activated by venous stasis. Clinically effective therapeutic measures improve the impaired microcirculation of the skin in the ankle area.

Bandages↗

PubMed2001

Deep vein thrombosis and its prevention in critically ill adults.

BACKGROUND: Our objective was to systematically review the incidence of deep vein thrombosis (DVT) and the efficacy of thromboprophylaxis in critically ill adults, including patients admitted to intensive care units and following trauma, neurosurgery, or spinal cord injury. METHODS: Two authors independently searched MEDLINE, EMBASE, abstract databases, and the Cochrane database. Data were extracted independently in triplicate. RESULTS: Ten percent to 30% of medical and surgical intensive care unit patients develop DVT within the first week of intensive care unit admission. The use of subcutaneous low-dose heparin reduced the rate by 50% compared with no prophylaxis. Approximately 60% of trauma patients developed DVT within the first 2 weeks of admission. Use of unfractionated heparin appears to decrease the incidence of DVT by only 20%, whereas low-molecular-weight heparin decreases the incidence by a further 30%. The estimated prevalence of DVT in neurosurgical patients not given prophylaxis is 22% to 35%. Mechanical prophylaxis is efficacious, with a pooled odds ratio in 5 randomized trials of 0.28. Use of low-molecular-weight heparin has been investigated as an adjunct to mechanical prophylaxis with a pooled odds ratio of 0.59 compared with graduated compression stockings alone. The incidence of DVT without prophylaxis in acute spinal cord injury patients is likely in excess of 50% to 80%. Studies of prophylaxis in these patients are too sparse to come to any definitive conclusion. CONCLUSIONS: Critically ill patients commonly develop DVT, with rates that vary from 22% to almost 80%, depending on patient characteristics. Methods of prophylaxis proven in one group do not necessarily generalize to other critically ill patient groups. More potent prophylactic regimens other than unfractionated or low-molecular-weight heparins alone may be needed with higher-risk groups.

Anticoagulants↗

PubMed2001

Prevention and treatment of postphlebitic syndrome: results of a 3-part study.

BACKGROUND: The true incidence of postphlebitic syndrome (PPS) following proximal deep venous thrombosis (DVT) and the efficacy of graduated compression stockings in preventing and treating PPS are unknown. METHODS: A 3-part study of 202 patients evaluated 1 year after proximal DVT: 2 randomized placebo-controlled trials of stockings and 1 prospective cohort of untreated patients. Patients were evaluated for PPS, using a standardized questionnaire, and for venous valvular incompetence, using photoplethysmography and venous Doppler. They were enrolled in study 1 or study 2 if they did not have symptomatic PPS and did not have or had venous valvular incompetence, respectively, and into study 3 if they had symptomatic PPS. Study 1 patients were left untreated and followed up for development of PPS every 6 months for a mean of 55 months. Study 2 patients were randomized to a below-knee stocking (20-30 mm Hg) or a matched placebo stocking, and followed up for development of PPS every 6 months for a mean of 57 months. Study 3 patients were randomized to an active stocking (30-40 mm Hg) or a matched placebo stocking and followed up every 3 months for treatment failure, defined a priori. RESULTS: In study 1, 6 (5.0%) of 120 patients were categorized as treatment failures, a rate similar to placebo-treated study 2 patients (P =.10). In study 2, 0 (0%) of 24 active and 1 (4.3%) of 23 placebo-treated patients were categorized as treatment failures (P =.49). In study 3, 11 (61.1%) of 18 active and 10 (58.8%) of 17 placebo-treated patients were categorized as treatment failures (P>.99). CONCLUSIONS: Most patients do not have PPS 1 year after proximal DVT, and do not require stockings. We failed to show a benefit of stockings in patients with PPS, but the small numbers preclude definitive conclusions.

Adolescent↗

PubMedDate not supplied

Venous thrombosis after long-haul flights.

BACKGROUND: The risk for venous thromboembolism after long-haul flights represents a controversial issue. The aim of our study was to assess the incidence of venous thrombosis associated with long-haul flights in a prospective, controlled cohort study. METHODS: We included 964 passengers returning from long-haul flights (flight duration, > or =8 hours) and 1213 nontraveling control subjects. We excluded participants who were being treated with anticoagulant drugs or who used compression stockings. Main outcome measures were the incidence of ultrasonographically diagnosed thrombosis in the calf muscle and deep veins, symptomatic pulmonary embolism, and death. RESULTS: We diagnosed venous thrombotic events in 27 passengers (2.8%) and 12 controls (1.0%) (risk ratio [RR], 2.83; 95% confidence interval [CI], 1.46-5.49). Of these, 20 passengers (2.1%) and 10 controls (0.8%) presented with isolated calf muscle venous thrombosis (RR, 2.52; 95% CI, 1.20-5.26), whereas 7 passengers (0.7%) and 2 controls (0.2%) presented with deep venous thrombosis (RR, 4.40; 95% CI, 1.04-18.62). Symptomatic pulmonary embolism was diagnosed in 1 passenger with deep venous thrombosis (P =.44). All of these individuals had normal findings at baseline ultrasonography. Passengers with isolated calf muscle venous thrombosis or deep venous thrombosis had at least 1 risk factor for venous thrombosis (>45 years of age or elevated body mass index in 21 of 27 passengers). The follow-up after 4 weeks revealed no further venous thromboembolic event. CONCLUSIONS: Long-haul flights of 8 hours and longer double the risk for isolated calf muscle venous thrombosis. This translates into an increased risk for deep venous thrombosis as well. In our study, flight-associated thrombosis occurred exclusively in passengers with well-established risk factors for venous thrombosis.

Adolescent↗