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PubMed2003

[Economy class syndrome].

Economy class syndrome is venous thromboembolism following air travel. This syndrome was firstly reported in 1946, and many cases have been reported since 1990s. Low air pressure and low humidity in the aircraft cabin may contribute to the mechanism of this syndrome. Risk factors for venous thrombosis in the plane were old age, small height, obesity, hormonal therapy, malignancy, smoking, pregnancy or recent parturition, recent trauma or operation, chronic disease and history of venous thrombosis. In Japan, the feminine gender is also risk factor though reason was not well known. For prophylaxis, adequate fluid intake and leg exercise are recommended to all passengers. For passengers with high risk, prophylactic measures such as compression stockings, aspirin or low molecular weight heparin should be considered.

Aircraft↗

PubMed2004

[Progressive lymphoedema in the legs of children and adolescents].

In three children, two girls aged 18 months and 15 years and a boy aged 16 years, lymphoedema of the legs was diagnosed. Investigation by dynamic lymphoscintigraphy showed no or diminished activity of lymph vessels in the lower extremities. The patients were treated by manual compression therapy and compression stockings, which controlled the oedema. Early recognition and diagnosis are important, as otherwise irreversible complications and reduced mobility may occur.

Adolescent↗

PubMedDate not supplied

[Prevention of deep vein thrombosis and preeclampsia. Therapeutic possibilities].

To prevent deep vein thrombosis during pregnancy and the puerperium, compression stockings and heparin have been proposed. These measures are safe for the mothers and their babies, however low molecular weight heparin (LMWH) must be preferred to unfractioned heparin if possible. The prevention of preeclampsia (PE) has been widely studied. Among nutrients, calcium supplementation is effective to prevent PE among women with a spontaneous low calcium intake, but fish oil supplementation is not. The effectiveness of folic acid is still controversial. Aspirin has been widely studied to prevent, and also treat, PE. The effectiveness of aspirin depends on an early administration during pregnancy and probably on the dose, while the best results have been observed with doses more than 60 mg/day. The association of aspirin and LMWH was used among patients with systemic pathologies, and no hemorrhagic complications were described. Oral anticoagulants are used only among patients with mechanical heart valves, the use between the 6th and the 12th week of pregnancy is controversial, because of an increased risk of fetal malformation, and near term because of an increased risk of neonatal hemorrhage.

Aspirin↗

PubMed2004

Travel as a risk factor for venous thromboembolic disease.

There is increasing evidence that prolonged travel may be associated with the development of venous thromboembolic disease: ie deep venous thrombosis and pulmonary embolism. The data from case reports, retrospective reviews and case control studies have been confirmed by prospective studies. There have been several prospective studies of subjects embarking on airline flights of greater than 4 hours duration aimed at determining the incidence of DVT as detected by ultrasonography. In unprotected subjects, the incidence of thrombosis in the calf veins or muscular veins ranged between 0% and 10%. There is evidence that the incidence of travel-related pulmonary embolism appears to be related to the distance travelled and immobility during the flights. Whether the imputed causation is merely due to immobility and venous compression or to other factors associated with the aircraft cabin requires further clarification. The use of below-knee graduated compression stockings appears to be highly effective. A 100 AXa U/kg single dose of a low molecular weight heparin, given 2-4 hours before the flight, have been reported to be more effective than aspirin and placebo. However, the benefit/risk ratio of such a strategy remains to be assessed.

Humans↗

PubMed2002

Horse chestnut:a multidisciplinary clinical review.

Horse chestnut seed extract (HCSE) is widely used in Europe for the management of chronic venous insufficiency (CVI). Although traditionally recommended for a variety of medical conditions, CVI is the only indication for which there is strong supportive scientific evidence. Review of the literature reveals 14 randomized controlled trials, of which seven are methodologically of high quality, albeit limited by small sample sizes and short durations. These studies support the superiority of HCSE over placebo, and suggest equivalence to compression stockings and to oral oxerutins. In the future, a longer and adequately powered randomized trial is warranted to compare HCSE to standard of care, and to further assess safety and long-term efficacy. There are no data to suggest that horse chestnut flower, raw seed, branch bark, or leaf are effective for any indication, and it is recommended that these products not be used, as they are known to be toxic when ingested.

Journal Article↗

PubMed2005

Local and systemic thrombolytic therapy for acute deep venous thrombosis.

This article presents a review of the treatment of lower-extremity deep venous thrombosis (DVT) with systemic and catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). Standard treatment including anticoagulation therapy and compression stockings may not be entirely adequate, because a significant proportion of patients eventually develop post-thrombotic syndrome (PTS). Thrombolytic agents might offer a potential advantage because they cause faster and more complete clot resolution, which may reduce or prevent residual vein stenosis and valve damage. Thrombolytic therapy results in greater lysis, but also in higher complication rates than does anticoagulation alone. Major bleeding occurs in 11% of patients treated with thrombolytic therapy. The incidence of PTS tends to be lower in patients treated with thrombolytics. However, several methodological flaws limit the conclusions with respect to reduction in PTS. No adequate randomised controlled trials have been performed comparing CDT or PMT with conventional therapy. Given the current data, thrombolytic treatment, CDT or PMT should not be applied except in extraordinary cases. First, the long-term effectiveness in terms of reducing PTS, although possible, remains uncertain. Second, the risks of thrombolytic therapy and PMT are higher. Third, current conventional therapy is relatively inexpensive, convenient and safe.

Acute Disease↗

PubMed2005

Venous disease and ergonomics of female employment.

AIM: The aim of this study was to describe the employment conditions of women with chronic venous disorders of the lower limbs. METHODS: Cross sectional study conducted by general practitioners who describe the first 3 women, between 18 and 65 years of age, who were employed and who presented with at least CEAP stage I venous disorders. RESULTS: Occupations held by these women indicate significant departures from the general population with an over representation of industrial workers (18.6% vs 11.9%) and an under representation of intermediate professions (12.5% vs 26.6%), (P<0.001). At work, 78.2% (n=4,143) of the women remained standing for 6.2+/-2.4 hours per day and/or 52.3% (n=2,771) were seated for prolonged periods, 28.9% (n=1 503) were exposed to sources of high heat on the legs and 18.2% (n=947) wore garments that compressed the abdomen Conditions favorable to the ergonomic evolution of their workstation are limited: only 9.2% (n=397) thought it possible to reduce the time they spend standing; 10.1% (n=319) the time they spend sitting; 12.9% (n=189) their exposure to heat. Combating these factors appears difficult: 74.3% (n=3 883) state that they do not have sufficient breaks to rest their legs, 38.9% (n=2,053) that they do not have the opportunity to stretch their legs and 42.5% (n=1,395) that compression stockings would be permitted, but would be a hindrance in their work (85.6%, n=4,503). For 27% (n=1,424) of respondents, these problems significantly increase the arduousness of their work and 73.7% (n=3,870) think their working conditions have worsened their venous distress. CONCLUSIONS: Women who consult for venous problems are employed in work which are characterized by unavoidable conditions constituting undeniable venous risk factors for venous disease and occupational medicine does not pay enough attention to the ''ladies legs'' at work.

Adult↗

PubMed2005

Risk factors and prophylaxis for deep venous thrombosis in neurosurgery.

Acceptance is increasing for pharmacological prophylaxis against deep vein thrombosis (DVT) and pulmonary embolism (PE) for most types of surgery, but its use remains controversial in neurosurgical patients because of the threat of catastrophic hemorrhage. Consequently, mechanical measures such as sequential calf compression and graduated compression stockings are currently the preferred prophylaxis for neurosurgical patients. However, some patients remain at high risk despite these measures and may require prophylaxis with low molecular weight heparins or unfractionated heparin. In neurosurgical patients, known risk factors for DVT or PE include advanced age, malignancy, limb weakness, prolonged surgery, and cranial as opposed to spinal surgery. Using comprehensive neurosurgery databases, the authors identify more specific neurosurgical diagnoses and procedures as risk factors for DVT and PE, and show increases in the frequency of DVT and PE for the wider neurosurgery population and for glioma patients over time. DVT prophylaxis is compared in public and private hospital settings. This chapter contributes to the changing picture of DVT and PE in neurosurgical patients over the last two decades.

Anticoagulants↗

PubMed1991

Evaluation of venous flow by light reflection rheography (LRR) in athletes performing track race.

The venous flow physiology in the athletes represents an interesting research field of sports angiology. The frequent observation of phlebectasias and/or varicose veins in athletes incited us to investigate the venous pathophysiological mechanisms predisposing them to such diseases. The maximal venous outflow (Rmax in millivolts) and the 1/2 venous refilling time (1/2 VRT in seconds) were evaluated in track racers, at rest and after exercise, by means of the light reflexion rheography (LRR). Thirty-two athletes (16 males, 16 females; mean age 23.4 years, range 15-37) were studied, dividing them in three groups: (A) 100 m (13), (B) 2,000 m (13), (C) 6 x 100 m with 2 minute recovery time (6). Among them six athletes performed the test wearing elastic compression stockings (25-32 mmHg). The results demonstrated a significant post-exercise modification of LRR curves and parameters in all groups, testifying superficial venous flow augmentation and deep venous flow overloading.

Adolescent↗

PubMed1991

Audit of attitudes to and use of postoperative thromboembolic prophylaxis in a regional health authority.

A survey of usage and attitudes to thromboembolic prophylaxis among 46 general surgeons in the Mersey Region found that 87% use either low-dose heparin, graduated compression stockings or both on a regular basis for their major cases. However, there was a wide variation of usage: 9 (19.6%) always used heparin in combination with thromboembolic stockings, 4 (8.7%) always used heparin alone, no surgeon used thromboembolic stockings alone. A total of 18 (39%) used thromboembolic stockings in combination with heparin, one-half of them selectively. A further 24% of surgeons used either low-dose heparin or thromboembolic stockings or both on selected patients. Current literature beliefs concerning the efficacy of low-dose heparin and thromboembolic stockings showed a similar variation, with 13% of surgeons believing that the efficacy of low-dose heparin against postoperative deep vein thrombosis has not been shown, 22% believing that thromboembolic stockings were ineffective against postoperative deep vein thrombosis, and 24% believing that low-dose heparin was of no value as a prophylactic agent against postoperative pulmonary embolism. Published meta-analysis has shown these beliefs to be wrong.

Attitude of Health Personnel↗

PubMed1991

Iliofemoral venous thrombectomy followed by percutaneous closure of the temporary arteriovenous fistula.

Iliofemoral venous thrombosis treated by anticoagulants alone almost invariably results in postthrombotic sequelae with deep venous reflux alone or combined with an outflow obstruction. This study evaluates the result of iliofemoral venous thrombectomy with temporary proximal arteriovenous fistula (AVF) performed on 48 consecutive patients. In 10 patients the thrombus extended in the inferior vena cava, and the thrombectomy was combined with inferior vena cava interruption. The AVF closed spontaneously in 8 of 48 patients (patency rate, 84%). An attempt to close the AVF by placing a detachable balloon percutaneously under radiographic control was made 6 to 12 weeks later (success rate, 87%; complications, rare). A preclosure arteriovenography of the femoro-iliaco-caval segment revealed 34 of 38 segments open (patency rate, 89%). Four patients had severe stenosis of the iliac segment, and a transvenous percutaneous dilatation was successfully performed in three of the four patients, keeping the fistula. At AVF closure 4 weeks later the arteriovenography showed sustained dilatation in only two patients. Thirty-seven patients were followed for 3 to 48 months (median, 24 months) and 30 of 37 patients (81%) who had no symptoms were not using compression stockings. Doppler investigation revealed patent and competent femoral and popliteal veins and normal photoplethysmography in 56% of the patients. Four iliac veins were occluded (patency rate, 88%). No recurrence of fistula had occurred. Venous iliofemoral thrombectomy seems to better preserve valve function. The percutaneous balloon closure of the AVF has decreased the complication rate, facilitated venographic evaluation of the result, and made possible the performance of percutaneous interventions under the protection of the AVF.

Adolescent↗

PubMed1991

Stasis ulcers: the role of compliance in healing.

The goal in treating a stasis ulcer is rapid and permanent reepithelialization of the ulcer bed. The patient can reach this goal by strict compliance with a program taught and continually reinforced by the physician. The program teaches about the effects of the force of gravity on the flow of blood and lymph in the lower extremities in various positions. The program consists of three rules for the patient to follow: (1) Never sit with legs below heart level. (2) Never stand still. Walk in place or even while sitting (if sitting is necessary). (3) Always wear compressive stockings or pneumatic leggings when walking. I present four case histories demonstrating the different rates of healing of stasis ulcers during noncompliance and during compliance with the physiologic methods of controlling edema and venous stasis in the legs.

Adult↗

PubMed1990

[Surgical thrombectomy versus conservative treatment of ileo-femoral phlebothrombosis. Functional comparison of long-term results].

The results of a retrospective study comparing two equally large groups of patients treated either surgically for restoration of venous patency and valvular function (24 patients) or medically with heparine, oral anticoagulants and compression stockings (25 patients) are presented. Follow-up time was 7.6 and 7.9 years respectively, operative mortality nil. Assessment of venous function was based on clinical observations as well as on measurements of haemodynamic parameters. Non-fatal pulmonary embolism after onset of treatment occurred in both cohorts with an equal frequency of 13%. Patients operated on for ilio-femoral deep venous thrombosis (DVT) were with few exceptions totally independent of any form of adjunctive hosiery which was in sharp contrast to the conservatively managed group. If onset of DVT had occurred more than three days earlier and extended from the ilio-femoral axis to the popliteo-crural level, surgery usually failed and patients were no better off than in the comparable medical subgroup. The same pattern of late outcome was found for all other clinical and haemodynamic parameters; i.e. clinical signs of venous hypertension, valvular competence as judged by sonography, patient's self-assessment and the expelled volume and refilling time measured by dynamic plethysmography after standardized leg-work. The mean expelled volume was 1.1 +/- 0.5 ml/100 g/min for the surgical subgroup treated early for ilio-femoral DVT and 0.7 +/- 0.5/100 g/min for the corresponding medical group (p = 0.05). Recovery or refilling time was 50 +/- 21 sec for the surgical group and 28 +/- 26 sec for the medical group (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Bandages↗

PubMed1990

Mechanical measures in the prophylaxis of postoperative thromboembolism in total knee arthroplasty.

Total knee arthroplasty patients are at high risk for deep venous thrombosis and pulmonary embolism. Prophylaxis against deep venous thrombosis and pulmonary embolism in these patients seems mandatory. Pharmacologic agents such as dextran 40, aspirin, and warfarin are effective but may be associated with significant complications such as drug reaction, bleeding, hematoma, and hemarthrosis. Heparin was not effective and was associated with significant bleeding complications. Mechanical methods such as continuous passive motion and sequential pneumatic compression stockings were without complications and seemed equal to or more effective than pharmacologic agents. Adding warfarin to mechanical methods did not seem to augment the antithromboembolic effect of the mechanical methods.

Anticoagulants↗

PubMed1990

The effects of elastic tights on the post-exercise response.

It has previously been demonstrated that graduated compression stockings will affect the post-exercise venous lactate profile. To determine the effects of elastic tights on venous lactate levels and the post-exercise response, eight males completed three exercise bouts on a motor driven treadmill. Each subject ran on the treadmill for up to three minutes at 110% of his VO2max. The conditions for the three exercise bouts were: elastic tights worn during exercise and recovery, elastic tights worn only during exercise, and no elastic tights worn during exercise or recovery. Oxygen consumption, heart rates and venous blood samples, for lactate and hematocrit determination, were obtained at rest and at 5, 15 and 30 min post-exercise. Analysis revealed no significant differences (p greater than 0.05) in any of the above variables between the three trials at any of the measurement times. These results indicate that the use of elastic tights will not significantly affect the post-exercise response or circulating lactate levels.

Adult↗

PubMed1990

How long after surgery does the risk of thromboembolism persist?

Many of the risk factors which occur immediately after major general surgical operations persist for several weeks, and therefore a study was undertaken to assess the incidence of deep vein thrombosis in the 6 week period following surgery. Fifty seven patients who had undergone major surgery were studied, most of whom received deep vein thrombosis prophylaxis in the form of graduated compression stocking and subcutaneous heparin. Only four patients did not receive prophylaxis. Patients were studied for 6 weeks using Doppler ultrasound. 125I-fibrinogen scanning, strain gauge plethysmography and venography. Thirteen of the 51 patients who had not developed a deep vein thrombosis at the time of discharge did so during the 6 week period. It was concluded that the risk factors may persist in many patients and that deep vein thrombosis prophylaxis should be continued for longer than the hospital stay.

Bandages↗

PubMedDate not supplied

[Long-term sequelae of deep venous thrombosis of the legs. Experience with mesoglycan].

Ninety consecutive patients, affected by venographically proven deep-vein thrombosis (DVT) of the lower limbs, were given full-dose heparin followed by oral anticoagulants for 12 weeks, and then selected randomly to receive, for one year, either mesoglycan (72 mg/day orally) or placebo with a double-blind protocol. All patients wore elastic graduated compression stockings, and were prospectively followed for a period ranging from 5 to 48 months. In each scheduled examination programmed every three months for one year and then twice per year, an accurate clinical evaluation was performed and a predetermined objective score was applied. Furthermore, impedance plethysmography and Doppler ultrasound tests were executed serially to assess the persistence of venous obstruction and/or the development of valve incompetence. After a mean follow-up of 3 years, 80% of the patients were totally asymptomatic, and severe post-thrombotic sequelae (ulcer and/or edema associated with skin induration) were recorded in only 6 patients (6.6%). We failed to identify any correlation between post-thrombotic sequelae and persistence of venous obstruction (as shown by impedance plethysmography) or development of valve incompetence (as shown by Doppler ultrasound test). The behaviour of patients treated with mesoglycan did not differ from that of patients treated with placebo. However, objectively documented recurrences of DVT and/or pulmonary embolism were less frequent in patients treated with mesoglycan (6.6 vs 11.1%, non-significant difference), and the only two deaths attributable to pulmonary embolism occurred among the patients treated with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Treatment of chronic leg ulcers with a hydrocolloid dressing.

The effects of a hydrocolloid dressing (Comfeel Ulcus) on the physical environment of chronic leg ulcers in 58 consecutive out-patients were investigated. Patients were subdivided into two groups of which Group 1 included 31 (53.4%) and Group 2, 27 (46.6%) patients. Twenty-three (39.7%) patients healed within 7 weeks (study period) and 49 (84.5%) within 1 year (follow-up period). Aerobic and anaerobic bacterial cultures as well as mycotic cultures were performed from ulcer bases of both groups of patients. In Group 1 a 3 mm punch biopsy was taken from the ulcer margins for histopathological examination. In Group 2 serum levels of iron, zinc, copper and selenium were measured and in these latter patients a mean temperature difference of 2.8 degrees C between the ulcer base and the skin surrounding the ulcer was found. There was no difference in ulcer pH in patients belonging to Group 2, independent of bacterial or fungal contamination. Low serum iron was found in 74.1% and anaemia in 40.7% of the patients in Group 2. No differences in ulcer healing were seen in these patients compared with those without iron-deficiency or anaemia. No differences were seen in serum iron, zinc, copper or selenium levels between good and poor healers. There were 22.2% ulcer relapses in Group 1 within a year of the start of the study, with no relapses in those 15 patients of Group 2 who used specially designed compression stockings.

Adult↗