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PubMed2006

[Acute-phase reactants and markers of inflammation in venous thromboembolic disease: correlation with clinical and evolution parameters].

OBJECTIVE: To asses the association of acute reactants and interleukin 6 and 8 (IL-6 & IL-8) at diagnosis of venous thromboembolic disease (VTD) and clinical outcome. METHODS: 100 patients were diagnosed of VTD by image tests. Acute reactants (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen), D-dimer and IL-6 and IL-8 we measured at the moment of diagnosis. We made a 12 month follow-up of these patients to notice any clinical evolution outcomes (recurrences, bleeding, post-phlebitic syndrome, death). RESULTS: IL-6 was increased in 9 patients and IL-8 in 3. The risk factors, time to diagnosis and pulmonary embolism rate were similar in both interleukin groups (normal and high levels). Fibrinogen levels were significantly increased in high IL-6 group (585 +/- 179 vs. 485 +/- 154 mgr/dl; p = 0.05). During follow-up there were 5 deaths, 3 recurrences, 11 bleedings and 43 postphlebitic syndromes. Normal ESR level was associated to postphlebitic syndrome (17.8 +/- 14.5 vs. 31.4 +/- 27.4 mm/1st h; p = 0.016). Patients who had high levels of IL-6 had worse survival than these with normal levels (p = 0.015). CONCLUSION: IL-6, ESR, and CPR at diagnosis of VTD could be useful to identified patients with higher risks of death and postphlebitic syndrome during the first year after diagnosis.

Acute-Phase Proteins↗

PubMed1992

Contemporary treatment of venous lower limb ulcers.

The postphlebitic syndrome is a significant management problem that affects a large number of patients. Primary prophylaxis of deep-vein thrombophlebitis would reduce the risk of developing the postphlebitic syndrome and should be considered in high-risk patients. Patients who have had a phlebitis should be monitored with noninvasive tests of the deep venous circulation for the development of venous valve incompetence. Patients with venous hypertension should be placed in compression stockings to prevent the postphlebitic syndrome. In patients who progress to venous ulceration, several aggressive measures must be undertaken. Systemic treatment includes management of obesity, edema, immobility, poor nutrition, and comorbid illnesses. Some patients may require a short hospitalization of bed rest, lower limb elevation, and daily dressings and wound care. Outpatient therapy requires sustained compression of 35 to 40 mmHg at the ankle for many months to allow the ulcer to heal. The standard bandage material is Unna's boots, which is applied every one to two weeks by a trained nurse. Cadexomer iodide is an effective local treatment that helps debride the ulcer and accelerate healing. Finally, pentoxifylline therapy has also been shown to significantly improve the healing of venous ulcers.

Bandages↗

PubMed1994

A decision analysis of streptokinase plus heparin as compared with heparin alone for deep-vein thrombosis.

BACKGROUND: It is uncertain whether patients with proximal deep-vein thrombosis should be treated with streptokinase followed by intravenous heparin or with intravenous heparin alone. Published reports indicate that streptokinase plus heparin increases the risk of bleeding, including central nervous system bleeding and death, but decreases the risk of postphlebitic syndrome. Previous recommendations regarding these treatments have not considered patients' preferences or the values they attach to the possible outcomes of therapy. METHODS: We used decision analysis to combine published estimates of the probabilities of various adverse outcomes of treatment (bleeding, pulmonary embolism, postphlebitic syndrome, and death) with the values patients placed on these outcomes. We questioned 36 patients about the values they attached to each outcome. Sixteen patients had had deep-vein thrombosis, and 20 had not. RESULTS: By the values they attached to the outcomes, all 36 patients indicated that they were unwilling to accept an increased risk of death to avoid postphlebitic syndrome. According to the decision analysis, heparin alone was the better treatment for all 36 patients. As compared with streptokinase plus heparin, heparin alone provided 29 days of additional life expectancy over the predicted life expectancy of 20 years. Although the difference between the two treatments was small, heparin alone remained the better treatment in sensitivity analyses that examined the reasonable ranges of probabilities of the clinical outcomes. CONCLUSIONS: The values patients placed on the outcomes of treatment for deep-vein thrombosis support the use of heparin alone over the combined use of streptokinase and heparin.

Cerebral Hemorrhage↗

PubMed1990

[Felder's intervention in the posphlebitic syndrome of the lower limbs].

Postphlebitic syndrome of the lower limbs is a consequence of chronic varices or the outcome of TVP leading to edema, eczema, stasis ulcers, etc. In these cases surgical treatment takes the form of ligating the perforating varices using a subfascial route according to Linton's technique, together with stripping the great and small saphenous vein. There are cases, however, in which the extent of cutaneous involvement does not allow a "safety incision" to be made. Felder's operation, using posterior surgical aggression in that area of the skin which generally remains healthy, therefore allows an easier ligation of the perforating varices and quicker cutaneous healing.

Adult↗

PubMed1985

Clinical-instrumental relationships in post-phlebitic syndrome.

981 lower limbs belonging to 829 subjects, 67.6% of which were females, have been examined. The average venous pressure at the tibial posterior vein was 101 +/- 12 mmHg and 102 +/- 13 mmHg on the internal saphenous vein. In 311 lower limbs with femoro-iliac thrombosis, venous pressures are slightly higher than in 670 lower limbs with calf veins occlusion. In the 44.4% of cases the phlebothrombosis was clearly dependent on traumas, deliveries, surgical operations or other conditions. The relationships between the supposed aetiopathogenesis of the affection and the pressure values have been examined. The 6.7% refers to phlebitis, which caused pulmonary embolism during their acute phase. The different objective and subjective symptoms have, furthermore, been taken into consideration. It has been noticed by the analysis of the diagrams of the pressure values in the time that the same values which are considerably high at the initial phase of the iliac postphlebitic syndrome, are always high in the following years. On the other hand, in postphlebitic syndrome of the leg those pressures whose value are not remarkably high in the initial phase, increase from the second to the fourth year after the arising of phlebitis and, finally become stable at fairly high values, but still lower than those of iliac syndrome. The venous orthostatic pressure of internal saphenous vein in the iliac postphlebitic syndrome was also found to exceed the deep pressures, likely because of the altered saphenous discharge at the cross level.

Adult↗

PubMed1990

Fibrinolytic therapy for idiopathic subclavian-axillary vein thrombosis.

We report our results in eight consecutive patients with idiopathic subclavian-axillary vein thrombosis treated at a community hospital with systemic streptokinase therapy. Seven of the eight patients were treated within 1 week of symptoms. All seven patients had partial or total recanalization documented by venography. One patient developed rethrombosis that did not respond to therapy with tPA and had mild persisting symptoms of postphlebitic syndrome. None of the other patients had symptoms of postphlebitic syndrome on follow-up up to 5 years' duration.

Adult↗

PubMed1983

[Fibrinolytic and defibrinogenation therapy].

Plasma fibrinogen is one of the main determinants of blood viscosity and is known to play an important role in the pathogenesis of venous and arterial thromboembolism. The pharmacological intervention on these factors can be achieved by lowering fibrinogen. Plasma fibrinogen concentrations can be lowered by fast-acting and slow-acting drugs. Among fast-acting drugs, fibrinolytic agents (such as streptokinase, urokinase, brinase and plasmin) act by cleaving FGN directly or indirectly through the formation of the proteolytic enzyme plasmin. Defibrinogenating agents (ancrod and batroxobin) are thrombin-like enzymes which induce the in vivo formation of fibrin microclots characterized by a peculiar physicochemical structure rendering them more easily cleared by the reticuloendothelial system. There is a clear-cut evidence for the clinical efficacy of fast-acting FGN-lowering drugs in the prevention and treatment of a number of clinical conditions associated with thromboembolic manifestations. However, it is not well established to which extent the effectiveness is due to their action on blood viscosity rather than to their fibrinolytic and anticoagulant properties. Slow-acting drugs (such as anabolic steroids, clofibrate, ticlopidine and pentoxifylline) decrease plasma FGN less rapidly and to a smaller extent than fast-acting drugs. Unlike these, they can be employed in long-term treatments. Clinical trials have clearly shown their clinical efficacy in a number of conditions associated with an altered microcirculation (Raynaud's syndrome, liposclerosis and postphlebitic syndrome). Their effect on blood viscosity is likely to be an important determinant of the clinical efficacy of these drugs.

Ancrod↗

PubMed1983

Hemodynamic assessment of venous problems.

Objective assessment of venous function based on venous refilling time recorded by photoplethysmography (PPG) was done in 89 patients with postphlebitic syndrome (47), primary varicose veins (29), and after an episode of acute deep vein thrombosis (13). Limbs with symptomatic postphlebitic changes had a shortened venous refilling time of 15.6 +/- 11 seconds (normal greater than 20 seconds). When venographic findings (ascending and descending) in 47 patients with postphlebitic syndrome were analyzed, it was noted that femoral valve incompetence demonstrated by descending venography was a common finding (81%), even in asymptomatic limbs (85%). Venous refilling time bore no relationship to the degree of femoral venous valve reflux. However, if there were associated diseased deep veins with incompetent perforating veins, the venous refilling time was much shorter (14 +/- 4 seconds) than in limbs without calf perforating veins (27 +/- 11.9 seconds, P less than 0.05). A tourniquet was used to impede saphenous flow, and changes in refilling time were recorded in 34 limbs with varicosities of the long saphenous vein. Refilling time normalized after tourniquet application in 31 limbs (14.43 +/- 4.34 to 30.64 +/- 11.9 seconds), and all patients underwent vein stripping. Postoperative recording confirmed the improvement in venous refilling time (29.52 +/- 27.8 seconds, P less than 0.05). Thirteen patients with acute deep vein thrombosis had serial PPG tests during a follow-up period of 27 months (mean 15.8 months). Seven had initial abnormal PPG results and persistently abnormal readings, and all developed postphlebitic changes. Venous refilling time is an useful test to determine the hemodynamic significance of femoral venous valve incompetence and to assess the effect of vein stripping on varicose veins. In acute deep vein thrombosis, follow-up study may help to identify patients at risk for development of postphlebitic changes.

Femoral Vein↗

PubMedDate not supplied

Indications and results of vein valve transplant.

Approximately 250,000 people are affected by postphlebitic syndrome each year in the U.S. Its pathogenesis is related to the incompetence of vein valves in the leg caused by thrombophlebitis and congenital redundancy. "Indications and results of vein valve transplant" discusses the correction of postphlebitic syndrome. Preliminary results of the vein valve transplant have been previously reported. This report updates the follow-up of 46 patients up to 3 years after the operation. The significance of muscle changes that occur with venous insufficiency is illustrated, and two new modalities of preoperative evaluation and postoperative follow-up are introduced.

Blood Pressure↗

PubMed1987

Radiological evaluation of the chronic venous stasis syndrome.

Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as "the postphlebitic syndrome," implying that thrombophlebitis is its sole etiology. To test this hypothesis, we performed ascending venography on 51 limbs of patients with the chronic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached.

Humans↗

PubMed1994

Venous function and clinical outcome following deep vein thrombosis.

The severity of post-thrombotic symptoms in 111 limbs (107 patients) with previous phlebographically proven deep vein thrombosis (DVT) was correlated with superficial and deep venous function as determined by foot volumetry (n = 90) and duplex ultrasonography (n = 62). The median delay between DVT and assessment was 8 (range 1-34) years. Symptoms were mild (group 1) in 31 limbs (28 per cent), moderate (group 2) in 41 (37 per cent) and severe (group 3) in 39 (35 per cent). There was no significant relationship between the site of DVT, or the time since DVT, and the severity of symptoms. Without tourniquet occlusion of superficial veins, limbs in group 3 had a significantly shorter half-refilling time than those in groups 1 and 2 (P = 0.01). Although a similar trend was observed after tourniquet occlusion of superficial veins, this was not statistically significant. There was no significant difference in the expelled volumes between the three clinical groups. On duplex scanning, deep and superficial venous reflux was detected in just over half of the limbs in each group. Eight patients had entirely normal scans and none of them had severe symptoms (P = 0.04). This study identifies a strong association between severe postphlebitic syndrome and venous reflux, such that it may be considered that venous reflux is necessary for the development of severe post-thrombotic symptoms. However, many patients with severe reflux have only mild symptoms and additional factors must therefore contribute to the development of severe postphlebitic syndrome.

Adult↗

PubMed2000

Prevention of venous ulceration by use of compression after deep vein thrombosis.

Venous ulcers may result from damage to the lining of the veins after an occurrence of deep vein thrombosis (DVT). As the pressure in the damaged venous system remains pathologically high, a result of DVT, swelling develops, hemosiderin staining develops around the ankle area, and varicosities often develop. These symptoms are part of the postphlebitic syndrome and are a precursor to formation of the chronic venous ulcer. The mainstay of treatment or prevention for venous ulcers remains compression therapy. In spite of the evidence that compression is necessary to reduce edema and allow the ulcer to heal, many patients still are not using compression after DVT to prevent ulcer formation. This article describes the prevalence, cost, etiology, and pathophysiology of postphlebitic syndrome and presents the nursing intervention of compression therapy as an ulcer prevention strategy for the patient with DVT. A variety of compression strategies are discussed. A case study of a patient in need of compression therapy is presented.

Bandages↗

PubMed1984

[Strain-gauge plethysmography in the evaluation of the evolution of deep vein thrombosis of the legs].

Previous research has shown that MVO (Maximum Venous Outflow), VR (Venous Reflux), VE (Venous Emptying) and the respiratory waves recording are useful in differentiating occlusion and recanalization in postphlebitic syndrome. In the present work strain-gauge plethysmography was employed to quantitate the venous function after deep venous thrombosis of the legs. The studies were performed in a vascular laboratory with controlled temperature (23 to 25 C); records were obtained by a plethysmograph Parks mod. 270 connected to a Hewlett-Packard multi-channel mod. 7700. 17 patients (12 males, 5 females), mean age 55 years (range 24-75) that presented femoropopliteal thrombophlebitis documented by phlebography at the admission to the hospital were examined. MVO with and without superficial veins occlusion was measured by a mercury in silastic strain-gauge placed circumferentially about the calf. A pneumatic cuff thigh was inflated to 60 mm Hg. VE was measured in patients lying in inclined bed with the lower extremities 100 cm below the heart level compressing the calf with a pneumatic cuff 10 times for 5 seconds; the strain-gauge was placed on the foot level. VR after Valsalva's maneuver and the respiratory waves were recorded by a strain-gauge positioned at the maximum girth about the calf in patients lying on inclinated bed with the lower extremities 50 cm below the heart level. The result are here indicated: (Table: see text) There was differences in the evolution of venous function after deep venous thrombosis of the legs for each patient. Strain-gauge plethysmography may become evaluable non invasive technique in the evaluation of deep venous thrombosis evolution in the legs. The therapeutic assessment of postphlebitic syndrome.

Adult↗

PubMed2005

The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review.

BACKGROUND: Post-thrombotic syndrome is a chronic, potentially debilitating complication of deep vein thrombosis (DVT) of the lower extremity. Comparatively little is known about post-thrombotic syndrome after upper extremity DVT (UEDVT). OBJECTIVE: To perform a systematic review of clinical studies that have examined the incidence, clinical features, risk factors and management of post-thrombotic syndrome after UEDVT. METHODS: Using combinations of keywords venous thrombosis, postphlebitic syndrome, thrombophlebitis, arm swelling, post-thrombotic syndrome, UEDVT, Paget-Schroetter syndrome, thoracic outlet syndrome, axillary vein, subclavian vein, and central venous catheter, the MEDLINE database was searched for English language articles published between January 1967 and December 2004. Retrieval and review of articles were restricted to clinical studies in humans that described long-term outcomes after objectively confirmed UEDVT. RESULTS: Seven studies were reviewed. The frequency of PTS after UEDVT ranges from 7-46% (weighted mean 15%). Residual thrombosis and axillosubclavian vein thrombosis appear to be associated with an increased risk of PTS, whereas catheter-associated UEDVT may be associated with a decreased risk. There is currently no validated, standardized scale to assess upper extremity PTS, and little consensus regarding the optimal management of this condition. Quality of life is impaired in patients with upper extremity PTS, especially after DVT of the dominant arm. CONCLUSIONS: PTS is a frequent complication of UEDVT, yet little is known regarding risk factors and optimal management. A standardized means of diagnosis would help to establish better management protocols. The impact of upper extremity PTS on quality of life should be further quantified.

Adult↗

PubMedDate not supplied

Centella Asiatica Triterpenic Fraction (CATTF) reduces the number of circulating endothelial cells in subjects with post phlebitic syndrome.

Here we report a study performed in order to assess the number of circulating endothelial cells (EC) in normal subjects and in patients with postphlebitic syndrome (PPS), and the effect of treatment with Centella Asiatica Triterpenic Fraction (CATTF), a drug which has been demonstrated to be effective in promoting wound healing in vivo. EC counts were determined by means of differential centrifugation and phase contrast microscopy. Patients with PPS showed an increased number of circulating EC in comparison to normal subjects (3.8 +/- 1.2 cells versus 1.5 +/- 0.6 per counting chamber). Treatment for three weeks with CATTF caused a statistically significant reduction of circulating EC (1.80 +/- 0.6 cells per counting chamber).

Cell Count↗

PubMedDate not supplied

Heat conductivity and skin temperature at the treatment of ischemic heart disease with curantyl and isoptin.

Forty one patients with ischaemic heart disease (IHD) of the age 60 +/- 12.3 years were hospitalized and treated two weeks with Curantyl (Dipyridamol) which was applied per os in a dose of 75 mg 3 times, and after another two weeks 34 of them wass applied Isoptin (Verapamil) in a dose of 40 mg 3 times daily. The heat conductivity (J.m-1, sec-1.degree C.10(-2), HC) and skin temperature (degree C, ST) were examined at the isothermic level 2 cm above the inner ankle by the apparatus Fluvograph 2 of Hartmann and Braun A. G. (BRD). The HC after Isoptin application above the left and right ankle was in 34 patients increased significantly (p less than 0.001). In patients with IHD after Curantyl application the HC and ST was significantly decreased above the left and right ankle in 9 (21.9%) and in 12 (30.0%), respectively. Curantyl could deteriorate HC and so to worsen legs ulceration healing and to point ap ischemia in patients with associated chronic postphlebitic syndrome with ulcera crurium.

Body Temperature Regulation↗

PubMedDate not supplied

Venous thrombosis: an overview.

Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, 125I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention.

Fibrinogen↗

PubMed1990

Occult antithrombin III deficiency: a potentially lethal complication of the postphlebitic limb.

Chronic venous insufficiency is a frequent sequel to lower extremity venous thrombosis. A relatively uncommon, but potentially lethal, cause of the thrombosis is congenital antithrombin III deficiency. Recognition and treatment of this occult deficiency is critical. The following report describes a family treated by the authors for this problem. In one generation of nine siblings, three males had documentation of the disease with functional antithrombin III levels in the range of 50% to 60%. Before evaluation for the deficiency one female sibling died at the age of 20 years as a consequence of a proven pulmonary embolus. Antithrombin III levels in another female sibling, who was free of symptoms, were normal (80% to 120%). Four other siblings who were free of symptoms (one female, three males) refused evaluation. All three men with the deficiency had severe, chronic, bilateral, lower extremity, venous insufficiency manifested by pain, varicosities, edema, pigmentation, and ulceration. Despite chronic warfarin therapy, one experienced recurrent pulmonary embolization with eventual loss of perfusion of the entire right lung. Ascending venography in the symptomatic males with the deficiency revealed evidence of recurrent and diffuse venous thrombosis with partial recanalization. Recurrent lower extremity venous thrombosis consequent to antithrombin III deficiency causes a particularly fulminant postphlebitic syndrome with characteristic venographic findings. Although potentially lethal if unrecognized and treated simply as venous insufficiency, chronic therapy with warfarin offers palliation and prolongs life.

Adult↗