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PubMed1978

The iliac compression syndrome.

The iliac compression syndrome is caused by impaired venous drainage of the left leg, secondary to compression or stricture of the left iliac vein at, or just before, its junction with inferior vena cava. Serious potential complications are deep vein thrombosis, pulmonary embolism, venous congestion, and the resultant incapacity. Nine patients in whom the diagnosis was confirmed by iliac phlebography are described. Iliac pressure determinations were made in 7 patients. Four patinets underwent resection, and retroplacement of the right iliac artery behind the left iliac vein. The operative results were good. This rare syndrome should always be considered in the differential diagnosis of peripheral venous disease, as it can be treated in the early stages. If it is left untreated, there is a risk of pulmonary embolism or incapacitating peripheral vascular disease.

Adolescent↗
PubMedDate not supplied

Some complications from surgery in varicose veins.

This paper deals with some selected complications of operation. The majority arise from technical faults and errors in judgement or documentation. My choice of topics here has been for their immediate treatment and the avoidance and aftercare of the others. Wrong technique. Combined operations resulting in damage to important adjacent structures: a) arteries: divisions, ligations, stripping; veins: ligation, tearing, avulsion of saphena femoral junction; b) nerves: division, femoral, lateral popliteal, cutaneous; c) lymphatics: particularly in recurrent operations, lymphoma and subsequent oedema; d) skin: particularly incisions through thickened skin, inflammatory skin, oedematous skin; e) connective tissues. Major complications. Haemorrhage, shock, problems with skin closure, methods of dressings, post-operative immediate, anaesthetic problems. Haemorrhage, haematoma, swelling, oedema, lymphatic deep vein thrombosis, pulmonary embolism (1 in 3000--fatal 1 in 30,000). Wound healing, skin necrosis, wound infection. Leg complications: persistent varicose veins, recurrent varicose veins, pain, nerve palsies, chronic oedema.

Humans↗
PubMed1993

Audit of start of anticoagulation treatment in inpatients.

AIMS: To develop a method for evaluating the start of anticoagulation treatment in inpatients. METHODS: One hundred case notes were audited using a proforma based on local guidelines in accordance with British Society for Haematology recommendations. RESULTS: Confirmatory investigations were done in 93% and 79% of patients with symptomatic deep venous thrombosis and pulmonary embolism, respectively. Identification of patients' risk factors for anticoagulation by history taking and laboratory tests was often inadequate: baseline coagulation screen, platelet count, liver function and renal function tests were done in 52%, 95%, 70% and 87% of cases, respectively. There was a tendency to undertreat patients: 33% of the activated partial thromboplastin times (APTT) and 58% of the International Normalised Ratios (INR) were subtherapeutic. The heparin-warfarin crossover period was particularly problematic: 37% stopped heparin without an INR that day, or had an INR of less than 2. Microscopic haematuria was monitored occasionally. Of the 62 patients continuing anticoagulation, 72% were discharged with the final INR in the therapeutic range. At discharge, only 74% of patients had documented appointments for the anticoagulant Clinic, the period between discharge and appointment ranging from 0 to 12 days. Of the 25 cases with an appointment exceeding four days after discharge, only six (24%) had arrangements for an interim INR check. CONCLUSIONS: The experience allowed the proforma to become streamlined to a more practical, reliable, and valid tool for use elsewhere. Findings will be fed back to the hospital staff to promote practice improvements before closing the audit loop by re-evaluating practice. Further studies are in progress to identify barriers experienced by doctors in implementing the guidelines and problems in the process of referral to the anticoagulant clinic.

Adult↗
PubMed1996

Sagittal sinus thrombosis in adult minimal change nephrotic syndrome.

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The mechanisms are as yet unclear, but numerous alterations in coagulant and anti-coagulant factors have been reported [Llach et al. 1985, Harris and Ismail 1994]. The most common clinical features in adults are renal vein thrombosis, femoral vein thrombosis and pulmonary embolism, although thrombosis in numerous other arterial and venous sites has been described [Cameron 1984, Llach et al. 1985]. Intracranial thrombosis is rare, although in adult nephrotic syndrome arterial thrombosis is well recognized [Fuh et al. 1991]. We report a patient with minimal change nephrotic syndrome who developed venous sinus thrombosis detected by magnetic resonance (MR) scanning.

Adult↗
PubMedDate not supplied

Comparison of a weight-based heparin nomogram with traditional heparin dosing to achieve therapeutic anticoagulation.

Optimum anticoagulation with heparin within the first 24 hours of a thrombotic event is critical in preventing a recurrence. We believed that traditional nonweight-based heparin dosing at our institution resulted in delayed anticoagulation. A weight-based heparin nomogram was therefore created and compared to traditional heparin dosing in patients with a diagnosis of acute deep vein thrombosis or pulmonary embolism. Fifty historical control patients were compared to 50 consecutive patients treated prospectively using the weight-based nomogram. The primary outcome assessed was time to achieve therapeutic anticoagulation, defined as an activated partial thromboplastin time (aPTT) of 46-70 seconds (1.5-2.5 times the control aPTT). The weight-based nomogram achieved an aPTT above the therapeutic threshold more rapidly than the control group (10.7 hrs nomogram vs 33.3 hrs control group, p < 0.004). Similarly, the proportion of patients who exceeded the therapeutic threshold at the first aPTT measurement, at 24 hours, and at 48 hours was significantly higher in the nomogram group. There was no difference in the frequency of bleeding complications or recurrent thrombotic events between the two groups. The initial nomogram was revised for patients weighing more than 80 kg owing to a greater frequency of excessive anticoagulation in these patients. Subsequent analysis of 29 patients using the modified nomogram revealed sustained efficacy and a reduced number of supratherapeutic aPTTs. We concluded that a weight-based heparin nomogram is superior to traditional therapy in achieving rapid therapeutic anticoagulation without an increase in adverse outcomes.

Anticoagulants↗
PubMed1996

[Thromboembolic complications in nephrotic syndrome].

Thromboembolic complications of nephrotic syndrome are very frequent. They can occur in the arterial or venous circulation. Venous thromboses are frequently asymptomatic and are manifested only by pulmonary embolism. Thrombosis of the renal vein may be dramatic and include renal failure. For the diagnosis various isotope, X-ray and ultrasound methods are used. Anticoagulation or thrombolytic treatment is used; in some instances also thrombectomy may be used. In patients with albumin levels lower than 20-25 g/l prophylactic administration of acetylsalicylic acid is useful. The clinical picture and therapeutic procedure are demonstrated on three brief case-histories.

Adult↗
PubMed1979

[Clinical significance of the radioimmunological determination of beta-thromboglobulin and platelet factor 4].

Recently new radioimmunoassay methods have been established to measure plasma concentrations of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), platelet release products which are set free when platelets aggregate. Plasma concentrations of beta-TG and PF4 were investigated in disorders with increased thromboembolic risk. Extremely high concentrations of these platelet proteins were found in patients with venous thrombosis, pulmonary embolism, polycythemia vera, and chronic renal failure. Moderately increased beta-TG and PF4 levels were observed in patients with peripheral vascular disease, coronary artery disease, chronic rheumatoid arthritis, multiple myeloma, and diabetes mellitus. These data indicate, that plasma concentrations of beta-TG and PF4 are useful parameters for the evaluation of the "in vivo" platelet activity. By using these new methods for clinical applications special blood sampling conditions have been taken into account; moreover one has to consider that the plasma levels of the platelet "release products" are dependent from renal function.

Arthritis, Rheumatoid↗
PubMed1970

Thromboembolic disease and the steroidal content of oral contraceptives. A report to the Committee on Safety of Drugs.

Reports of thromboembolism following the use of oral contraceptives received by drug safety committees in the United Kingdom, Sweden, and Denmark have been analysed to investigate possible differences in the risks associated with the various preparations. For this purpose the numbers of reports of thromboembolism attributed to each product were compared with the distribution that would have been expected from market research estimates of sales, assuming that all products carried the same risk.A positive correlation was found between the dose of oestrogen and the risk of pulmonary embolism, deep vein thrombosis, cerebral thrombosis, and coronary thrombosis in the United Kingdom. A similar association was found for venous thrombosis and pulmonary embolism in Sweden and Denmark. No significant differences could be detected between sequential and combined preparations containing the same doses of oestrogen, nor between the two oestrogens, ethinyloestradiol and mestranol.Certain discrepancies in the data suggest that the dose of oestrogen may not be the only factor related to the risk of thromboembolism; thus there was a significant deficit of reports associated with the combination of mestranol 100 mug. with norethynodrel 2.5 mg. and a significant excess of reports associated with the combination of ethinyloestradiol 50 mug. with megestrol acetate 4 mg. An excess of reports also occurred with other combined preparations containing megestrol acetate.The data obtained in earlier epidemiological studies were re-examined and, though no trend was obvious in any one of them, the combined results showed an excess of cases of thromboembolism at the highest dose of oestrogen.The finding of a positive correlation between the dose of oestrogen and the risk of coronary thrombosis is of special interest since previous studies have failed to provide clear evidence of a relationship between oral contraceptives and this condition.

Contraceptives, Oral↗
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↗
PubMed2002

[Clinically non-symptomatic pulmonary embolism in patients with deep vein thrombosis of the lower limb].

The pulmonary embolism (PE) is the common and severe complication of the deep vein thrombosis of the lower limbs. The lack of accurate diagnosis of PE is a cause of 5-10% of the hospital deaths. The aim of the study was to assess the incidence of the pulmonary embolism in patients with the deep vein thrombosis of the lower limbs with no clinical symptoms of pulmonary embolism. Pulmonary perfusion scintigraphy was performed in 25 patients with angiographic findings confirmative to the deep vein thrombosis of the lower limbs. The results of the study were analysed according to the PIOPED criteria. In the group of patients with common thrombosis of the deep vein a high probability of lung embolism was assessed in 70%, medium and low by 12% in each group, and very low in 6%. In the group of patients with femoral thrombosis of the deep vein a high probability of lung embolism was assessed in 60%, medium in 20% and very low in 20%. In the group of patients with calf thrombosis of the deep vein high, medium and very low probability of lung embolism was assessed by 25% in each group. Results of this study indicate the need of searching the pulmonary embolism in patients with thrombosis of the deep vein of the lower limbs despite the lack of clinical symptoms of the pulmonary embolism.

Adult↗
PubMed1999

Controversies in pulmonary embolism and deep venous thrombosis.

The diagnosis of venous thromboembolic disease, and pulmonary embolism in particular, remains problematic. Physicians should strongly consider empiric anticoagulation if the best available diagnostic tests are inconclusive, because treatment is usually safe and successful. Twice-daily subcutaneous low-molecular-weight heparin, dosed without monitoring, may eventually replace standard heparin for most treatment of venous thromboembolism, but it is not yet labeled for the treatment of pulmonary embolism. Deep venous thromboembolism and pulmonary embolism should be treated with anticoagulants rather than inferior vena cava filters, even in oncology patients, unless anticoagulation is contraindicated; if so, when the contraindication remits, anticoagulation should be employed. The most effective prophylaxis of venous thromboembolism in at-risk patients should be used, with prolonged duration if evidence from clinical trials supports efficacy and safety. Low-dose warfarin should be used to prevent venous thrombosis and indwelling central venous catheter thrombosis in patients with cancer.

Anticoagulants↗
PubMed1991

Pulmonary embolism from a venous thrombosis distal to the popliteal vein.

A case of pulmonary embolism from a venous thrombosis distal to the popliteal vein is reported. This occurred despite venographic and ultrasound verification that the thrombus had not extended to the popliteal vein. The medical literature supports expectant treatment of "calf-only" venous thrombi. Our case clearly demonstrates that clinically significant pulmonary emboli can arise from calf vein thrombi without popliteal involvement.

Adult↗
PubMed2005

Trends in the incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients.

Trends in the incidences of pulmonary embolism (PE), deep venous thrombosis (DVT), and venous thromboembolism (VTE) (PE or DVT, or both) in hospitalized adults (aged > or =20 years) were evaluated using data from the National Hospital Discharge Survey. From 1979 to 1999, the incidence of DVT in hospitalized patients increased from 0.8% of admissions to 1.3% of admissions. The incidence of PE was 0.4% of admissions and did not change over the 21-year period. Trends and incidences were similar or the same among men and women and whites and blacks.

Adult↗
PubMed2000

[Pulmonary embolism due to deep venous thrombosis of extremities].

OBJECTIVE: To study the relationship between pulmonary embolism and deep venous thrombosis of extremities. METHODS: The authors conducted a retrospective analysis of 100 patients with deep venous thrombosis to analyse the occurrence of pulmonary embolism during 1996 to and 1998 in their hospital. RESULTS: In the 100 patients with deep venous thrombosis, the complication of pulmonary embolism was 45%, fatal pulmonary embolism was 4%. CONCLUSION: The complication of pulmonary embolism in the patients with deep venous thrombosis frequently occurred and medical professionals should pay attention to them.

Adult↗
PubMed1997

Pulmonary embolism from axillosubclavian thrombosis on a rehabilitation unit: case report.

This report presents a case of angiogram-confirmed pulmonary emboli (PE) from upper extremity deep venous thrombosis (UE DVT) in a patient with Guillain-Barré syndrome. UE DVT has been rarely reported in the rehabilitation literature and it is not described in many standard references in the field. Risk factors for UE DVT include central venous catheterization (CVC), stasis, and hypercoagulability. Rehabilitation patients commonly demonstrate these risk factors, as well as unilateral limb swelling and pain. Although early reports emphasized the rarity of PE from UE DVT, it is now reported in roughly 12% of cases, and there may be an even higher incidence in CVC-related UE DVT. This report includes a review of etiologic, anatomic, diagnostic, and therapeutic considerations, and concludes with a discussion of the potential underrecognized significance of UE DVT in the general rehabilitation population.

Angiography↗
PubMed1995

[Temporary cava filter: effective prophylaxis of pulmonary embolism in venous thrombosis in the region of the pelvic vascular system and the inferior vena cava?].

PURPOSE: To assess the temporary Günther filter system concerning handling, complication rate and efficacy in respect to prophylaxis of pulmonary embolism. PATIENTS AND METHODS: 45 temporary Günther filters were placed in 44 patients (mean age 46 years) with deep venous thrombosis of the iliac and/or inferior vena cava. RESULTS: The mean time until filter retrieval was 6.1 +/- 4.1 days (maximum 14 days) dependent on the success of either thrombolytic therapy or thrombus consolidation. 27 patients underwent systemic thrombolytic therapy (61%), three patients (7%) received local thrombolysis. 14 patients (32%) were treated with heparin in a therapeutic dosage (PTT > 60 sec). We observed four complications (8.8%): one accidental arterial puncture (carotid artery on attempting an internal jugular vein approach), one infection located at the puncture site and one caval vein thrombosis in a patient with known heparin-associated thrombocytopenia. One patient died of pulmonary embolism despite correct filter positioning. CONCLUSION: Percutaneous placement of inferior vena cava filters is therefore an easy, safe and effective prophylaxis in respect of pulmonary embolism if combined with thrombolytic therapy or therapeutic heparinisation.

Adult↗