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PubMed1988

[Prognosis of renal vein thrombosis in the adult: influence of treatment].

The medical histories of 27 patients with renal vein thrombosis were evaluated retrospectively. Short and long term evolution as well as prognostic factors were analysed. 24 of the patients were suffering from a nephrotic syndrome, 15 from renal failure. In the 20 biopsies performed we observed: 14 cases of extramembranous glomerulonephritis, 2 cases of minimal glomerular lesions, 3 cases of segmental focal glomerulosclerosis and 1 periarteritis nodosa. The renal vein thrombosis was bilateral (18), left (7) or right (2). In 7 patients this was associated with thrombosis of the inferior vena cava. 9 patients were treated with anticoagulants alone, 9 underwent thrombectomy, 7 were treated by thrombolysis and 2 received no treatment. Within the first six months 11 patients died as a result of complications due to hemorrhaging (5), septic infection (2) or embolism (1) and 3 patients died of undetermined causes. The progression of the remaining patients was followed up over a period of 6 months to 19 years. In 12 patients, the nephrotic syndrome regressed and renal function did not deteriorate in any of the cases. The main causes for poor prognosis are the existence of initial renal failure and glomerulonephritis which is not extramembranous. Since the evolution of the glomerulopathy does not appear to be affected by extramembranous glomerulonephritis, renal vein thrombosis associated with this complication should be treated with anticoagulants alone. The risk-benefit ratio of thrombectomy leads us to conclude that this technique should be abandoned. Thrombolysis could be considered in cases where renal vein thrombosis is associated with acute renal failure.

Acute Kidney Injury↗

PubMed1988

Late thrombosis of saphenous vein coronary bypass grafts related to risk factors.

In 72% of 143 patients undergoing a second coronary bypass grafting, mural or occlusive late thrombosis was observed histologically in 69% of 173 resected grafts. Late thrombosis was particularly prevalent in atherosclerotic grafts (80.2% vs. 40.4% in nonatherosclerotic grafts) and was always noted in 16 grafts with aneurysmal dilation. Multivariate analysis of risk factors contributing to late thrombosis indicated that graft atherosclerosis and smoking after graft surgery played important roles. Univariate analysis also showed significantly higher ratios of serum total cholesterol/HDL cholesterol and of serum LDL cholesterol/HDL cholesterol in patients whose grafts were affected by late thrombosis. To prevent late thrombosis of saphenous vein aortocoronary grafts, it appears reasonable that decreasing the ratios of total cholesterol/HDL cholesterol and of LDL cholesterol/HDL cholesterol, refraining from smoking, and controlling other risk factors for atherosclerosis should be advised.

Arteriosclerosis↗

PubMed1977

Collagen stimulates more platelet prostaglandin endoperoxides in thrombosis.

Platelets prostaglandin cyclic endoperoxides after collagen stimulation were measured in 7 patients with arterial thrombosis, 4 patients with recurrent deep venous thrombosis and 27 patients before undergoing total hip replacement. Patients with post-surgical D.V.T. synthetized more platelet cyclic-endoperoxides compared to those with no D.V.T. COULD BE DIVIDED INTO 2 SUBGROUPS : GROUP I with platelet cyclic endoperoxides and group II with higher cyclic-endoperoxides synthesis. Also, there was a higher ratio of platelet cyclic endoperoxides in patients with arterial thrombosis and in 2 patients with recurrent venous thrombosis and shortened platelet survival time. Thus, a greater synthesis of platelet prostaglandin cyclic, endoperoxides was formed in a number of patients with thrombosis.

Blood Platelets↗

PubMedDate not supplied

[Axillary-subclavian venous thrombosis. Therapeutic management].

24 cases of axillary-subclavian venous thrombosis were studied according to the etiology: "intrinsic" thrombosis secondary to alteration of the endothelium (7 cases), "extrinsic" thrombosis secondary to compression at the level of the thoracic outlet (4 cases), "combined" thrombosis following a complex treatment of breast cancer (3 cases). The frequency of these thromboses, undoubtedly underestimated, seems low as compared to that of venous thromboses of the lower extremities. The frequency of pulmonary emboli is 8%. The treatment is limited to anticoagulants in case of intrinsic or combined thrombosis. In the third type, decompressive surgery is necessary, especially if there are abnormalities of the cervico-dorsal junction or associated neurological or arterial disorders.

Adult↗

PubMed1986

Thrombosis, recurrent fetal loss, and thrombocytopenia. Predictive value of the anticardiolipin antibody test.

To determine the predictive value of the IgG anticardiolipin antibody (ACA) test for thrombosis, recurrent fetal loss, and thrombocytopenia, the clinical features of 121 patients with varying antibody levels were studied. When patients were grouped into high-positive, low-positive, and normal groups according to their ACA levels, there were strong statistical correlations with arterial thrombosis, venous thrombosis, fetal loss, thrombocytopenia, and a positive Coombs' test. At levels of 7 SD and above, the test was highly specific (greater than 80%) and predictive (greater than 70%) for thrombosis, thrombocytopenia, and recurrent fetal loss. This study suggests that the IgG ACA test may be a useful predictor for thrombosis, recurrent fetal loss, and thrombocytopenia in patients with autoimmune disorders.

Abortion, Habitual↗

PubMed1985

[Experimental and clinical studies on left ilio-femoral thrombosis, with reference to the significance of impaired venous return].

UNLABELLED: One hundred and eleven patients with venous thrombosis were studied with pelvic phlebography and 99mTc-MAA venous scintigram. Based upon the degree of iliac venous compression, they were classified into 4 types: Normal type (I), slightly compressed type (II), moderately compressed type (III) and severely compressed type (IV). Left ilio-femoral venous thrombosis frequently occurred in type III and type IV, which suggests that left ilio-femoral venous thrombosis tends to develop with the advance of impaired venous return. The amount of serotonin, one of the substances released from platelets, was measured after the ligation of iliac veins in 31 mongrel dogs. Thrombus formation was observed 3 days after the ligation, while the decline of intra-platelet serotonin and the rise of extra-platelet serotonin had already been seen 3 hours after the ligation. In all the 18 patients who had laparotomy, intra-platelet serotonin levels declined significantly 3 days after the operation, and left ilio-femoral venous thrombosis with iliac venous compression was detected in three of them without any symptoms. CONCLUSION: Iliac venous compression tends to produce left ilio-femoral venous thrombosis not only under impaired venous return but also from the releasing reaction of platelets, suggesting a strong possibility that platelets may play an important role in venous thrombogenesis.

Adult↗

PubMed1974

Platelet inhibition in the management of thrombosis.

The role of platelets in the initation of arterial thrombosis is clear. In venous thrombosis as well, platelets may in some circumstances play a significant role. For these reasons, and because of the complications and limitations of anticoagulant therapy, antithrombotic trials have been launched with several agents which inhibit platelet function. Regarding postoperative deep vein thrombosis, neither aspirin nor dipyridamole alone appears effective, although the combination offers promise. Results with dextrans are conflicting. In recurrent idiopathic deep vein thrombosis, sulfinpyrazone may be beneficial. On the arterial side, transient cerebral ischemic attacks may be favorably affected by either aspirin or sulfinpyrazone. Prevention of thromboembolism associated with prosthetic heart valves appears possible with combination warfarin-dipyridamole therapy, and the beneficial effect of sulfinpyrazone on shortened platelet survival in this group suggests that this agent may also be effective. Sulfinpyrazone may also be beneficial in preventing thrombosis in arteriovenous canulas. The issue which has attracted the greatest attention and about which no clear answer exists at present is whether antiplatelet agents can modify the course of acute myocardial infarction. Several trials with aspirin are currently underway, and it would be premature to recommend its use in this condition until the results of these trials are available, probably in 1975.

Aspirin↗

PubMed1979

[Post-traumatic cerebral artery thrombosis].

In the years 1965--1978 thrombosis of the intracranial vessels of different aetiology was diagnosed in 204 patients treated at the Department of Neurosurgery, Medical Academy in Warsaw. The authors selected from this group 8 cases described in greater detail in which there was an evident temporal relationship between trauma and the development of the disease. The severity of the sustained trauma was without a significant influence on the development of post-traumatic thrombosis. Clinical Manifestations increased in intensity usually within the first 48 hours and in only one case they appeared 2 weeks after trauma. In the clinical status of the patients of considerable interest was usually absence of disturbances of consciousness with presence of serious signs of focal central nervous system damage. Of decisive diagnostic significance was cerebral angiography which localized the site of thrombosis and excluded presence of post-traumatic intracerebral haematoma. In 7 cases thrombosis affected the main trunk or branches of the middle cerebral artery. The prognosis as to survival of such patients is generally good but in most cases disability of different degree developed following thrombosis.

Adult↗

PubMed1977

[Clinical picture and localization of foci of softening in the brain following vertebral artery thrombosis].

The authors conducted a clinico-anatomical analysis of 45 observations with thrombosis of the vertebral arteries. In the majority of cases thrombosis of the vertebral arteries was isolated. In 5 observations it was combined--with thrombosis of the carotid artery (2 cases), with the middle brain artery (2 cases) and with the posterior cerebellum artery (1 case). In one observation thrombosis of the right innominate, subclavian, general carotid and vertebral arteries was diagnosed clinically and angiographically. Thrombosis of the vertebral arteries occurs in the presence of expressed atherosclerotic changes in the brain vessels with acute stenosis.

Aged↗

PubMed1984

Portal venous thrombosis: correlative analysis of sonography, CT and angiography.

In 17 patients with portal venous thrombosis; nine due to venous invasion by liver tumors, and eight due to benign causes, sonograms and CT scans were reviewed, and the results were correlated with angiography. Sonography detected portal venous thrombosis in 94% and CT in 76%. Sonography was better than CT in the demonstration of the extent of thrombosis. By the detection of solid masses in the liver, and contiguous thrombosis of the segmental portal veins, both sonography and CT were accurate in the differentiation of venous invasion by tumor from benign thrombosis. Angiography was 91% accurate and was unique in the demonstration of arterioportal shunting and detailed vascular anatomy of the portal venous system.

Angiography↗

PubMed1984

[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature].

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.

Adult↗

PubMedDate not supplied

Noninvasive detection of axillary and subclavian venous thrombosis by impedance plethysmography.

Venous occlusion impedance plethysmography (IPG) is an objective noninvasive test which is widely employed for the detection of deep venous thrombosis (DVT) in the lower extremities. The IPG technique is easily adapted to the evaluation of upper extremity venous thrombosis, as demonstrated in 46 patients with symptoms of axillary and subclavian venous thrombosis (88 limbs) and 26 normal volunteers (52 limbs). Venograms were obtained in 18 patients (22 limbs) and correlated in all cases with the previous IPG interpretation. The test procedure and interpretation criteria for the noninvasive detection of upper extremity deep venous thrombosis are similar to those previously developed for the lower extremities, but with more emphasis on comparison with the contralateral limb. Vascular laboratories performing IPG for lower extremity DVT should be able to employ this test for the detection of upper extremity venous thrombosis as well.

Adolescent↗

PubMed1982

[Spontaneous thrombosis of an azygos anterior cerebral artery aneurysm--report of a case (author's transl)].

A case of spontaneous thrombosis of azygos anterior cerebral artery aneurysm was reported. A 39-year-old man was admitted to our hospital on April 23, 1979, 5 days following an apparent attack of subarachnoid hemorrhage. On admission, he complained a headache and left hemiparesthesia. Neurologic examination revealed a very slight nuchal rigidity, left hemihypesthesia and hypalgesia. Routine laboratory studies were noncontributory. Left and right carotid angiograms showed an azygos anterior cerebral artery aneurysm. Twelve days after the attack, a left carotid angiogram demonstrated a segmental narrowing and widening of an azygos anterior cerebral artery, and then the aneurysm was filled incompletely. Nineteen days after the attack, the aneurysm was not visualized on right carotid angiogram. Neck clipping and resection of the aneurysm was performed on May 8, 1979. Cross section of the aneurysm exposed a thrombus. He showed postoperatively a slight hypesthesia in the left lower limb. Complete thrombosis of intracranial aneurysm occurring spontaneously is rare. We collected 42 such cases including the present case from the literature and discussed some factors facilitating intraluminal thrombosis. Although the shortest previous period of thrombosis is noted to be over a course of 5 days, the thrombosis in our case in 19 days after subarachnoid hemorrhage was certainly a relative rapid event.

Adult↗

PubMed1981

[Traumatic renal vein thrombosis].

Two female patients with left renal vein thrombosis are reported. In one case, the thrombosis was induced by preoperative selective renal vein phlebography for diagnosis of a perirenal tumor. The thrombosis was then detected intraoperatively. In the other case, the thrombosis was caused by traumatic avulsion. Predominantly, left renal vein thrombosis is treated conservatively. Both patients were operated, however. The operation of the first patient was indicated because of the operative tumor therapy. Relaparotomy of the second patient led to nephrectomy due to kidney contusion.

Adult↗

PubMed1994

Aprotinin could promote arterial thrombosis in pigs: a prospective randomized, blind study.

Haemostatic properties of aprotinin could be associated with an increased risk of thrombosis. A randomized, blinded study was conducted to consider the potential thrombogenicity of aprotinin, using the Folts' model on femoral arteries in 12 pigs. The flow variations were measured by a pulsed Doppler in anaesthetised animals. Ear immersion bleeding time was performed. During the first part of the study, a stenosis was performed successively on both femoral arteries, each for a period of 30 min, without prior injury, to assess the integrity of the vessel, and to check that the arteries did not develop cyclic flow reductions (CFR), permanent cessation of flow (PCF) or partial thrombosis, when a stenosis is applied. Then the clamp was released and a bolus of placebo (saline), or aprotinin (4 millions KIU, followed by a continuous infusion of 1 million KIU.h-1), was administered. At the end of the bolus, the second part of the study began. Stenosis was applied to the arteries. If CRF, PCF, or partial thrombosis were observed without prior injury then the infused drug (aprotinin or saline) was considered a prothrombotic drug, and the opposite artery was studied. For each animal, right and left femoral artery segments were fixed and studied (morphologic study). Eighteen arteries were studied. In the aprotinin group, 6 arteries out of 8 developed an unexpected thrombosis, as compared with only 2 out of 10 arteries in the control group (p = 0.02). The morphologic study confirmed the occurrence of thrombosis in 4 out of 7 arteries in the aprotinin group, as compared with only 1 out of 9 in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1995

[Chemotherapy through selective pelvic artery catheterization complicated by mural thrombosis].

Through catheter on uterine artery digital subtractive angiography (DSA) intraarterial infusion of chemotherapeutic agents for the treatment of malignant trophoblastic diseases can raise local drug concentration, improve therapeutic results and reduce general side-effects. But mural thrombosis, a possible complication of intra arterial catheterization, should not be overlooked. This study reports 2 cases of mural thrombosis complication in selective pelvic artery catheterization for chemotherapy. The incidence, relevant factors to its occurrence such as technique of catheterization and the duration of catheter retention, as well as measures of prevention and treatment of mural thrombosis are discussed together with review of literature. With regards to prevention of mural thrombosis, stress is being laid on the importance of the technique of catheterization. Preliminary comments on the problem of heparin administration as a preventive measure of mural thrombosis are made.

Adult↗

PubMed1994

[Use of tissue plasminogen activator in the treatment of aortic thrombosis in newborn infants].

BACKGROUND--Aortic thrombosis is more frequent since the use of umbilical artery catheters in neonatal intensive care units. Some drugs or surgery are proposed to prevent complications; experience with tissue plasminogen activator (tPA) is still limited. CASE REPORT NO 1--A neonate, weighing 2400 g, developed respiratory distress requiring insertion of a catheter into her umbilical artery at H12. Ultrasonography on day 3 showed aortic thrombosis extending to the right renal artery which was confirmed by angiography. tPA 0.1 mg/kg was administered through the catheter, followed by 0.3 mg/kg/h for 3 hours and heparin, 100 IU/kg/hour for 54 hours. Angiography, performed 18 hours later, showed complete disappearance of the thrombosis. CASE REPORT NO 2--A neonate, weighing 2520 g suffered at 12 hours of life from seizures, apnea and bradycardia which required insertion of a catheter into her umbilical artery. Cyanosis of the right leg with weakening of femoral pulsations, 14 hours later, lead to the diagnosis of aortic thrombosis which was confirmed by aortography. The patient was given tPA 0.1 mg/kg followed by 0.3 mg/kg/h for 3 hours and heparin 100 IU/kg/hour for 6 hours. Amplitude of femoral pulsations strikingly increased within 6 hours with the disappearance of cyanosis. CONCLUSION--These results suggest that tPA can be useful in neonates presenting with aortic thrombosis.

Aorta↗

PubMed1995

[Diagnostic tomodensitometry of acute basilar thrombosis].

Basilar artery thrombosis is a potentially treatable neurologic disease whose initial symptoms are sometimes difficult to recognize. The basilar artery is hyperdense on computed tomography in cases with basilar artery thrombosis. We have studied computed tomography attenuation values before and after contrast administration in a total population of 117 patients, 12 of whom were diagnosed angiographically as having basilar artery thrombosis. While it is not always possible to detect basilar artery thrombosis simply by evaluation of the tomodensitometric values before or after contrast, the differential values obtained by subtracting them (after contrast/before), or by an attenuation ratio corresponding to the differential value divided by the value before contrast, are more helpful. Indeed, the differential values and attenuation ratios in the normal population have a mean value of 51.1 and 1.37 compared with 14.47 and 0.33 in patients with basilar artery thrombosis.

Aged↗