A Prognostic Score to Identify Low-risk Outpatients with Acute Deep Vein Thrombosis in the Lower Limbs

Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease of varied etiology which usually originates around aorta and spreads caudally along Iliac vessels into adjacent retroperitoneum causing ureteral obstruction as the most frequent complication. A 53-year-old male patient presented with complaint of mild pain in both the legs off and on. On investigating further, we found that he had been struggling with intermittent relapses every 3-4 years for last 20 years since he was first diagnosed with Idiopathic Retroperitoneal Fibrosis. He was 33-year-old when he first developed the symptoms of anuria for 48 hours and was diagnosed with Idiopathic retroperitoneal fibrosis. This was followed by atrophy of left kidney and hypertension 6 years later, then hypothyroidism after another 3years and finally involvement of Inferior Vena Cava and acute Deep Vein Thrombosis of lower limbs after another 3-4 years. His deep vein thrombosis was well managed in time. He was put on glucocorticoids everytime he had a relapse and a complication. We did a review of literature to understand recent advances about its pathogenesis, diagnosis, investigations and management. We searched in PubMed using terms like retroperitoneal fibrosis alone and in combination with related terms such as Inferior Vena Cava thrombosis, Deep Vein Thrombosis, Tamoxifen, Methotrexate. This case is unique as it is very rare to find acute Deep Vein Thrombosis in Idiopathic retroperitoneal fibrosis without development of any collaterals when Inferior Vena Cava lumen is compromised to almost complete obstruction. After a follow up of 20 years patient is doing well in terms of physical activity and psychological wellbeing with anti-hypertensives, thyroxine and anti-coagulants. Is the disease-free interval actually free of the disease or it just subsided with immunosuppressants to become active after some time?

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Thrombolytic therapy of acute deep vein thrombosis of the lower limbs: Choices, indications and limits

La Ricerca in Clinica e in Laboratorio ◽

10.1007/bf02906298 ◽

1984 ◽

Vol 14 (4) ◽

Author(s):

Pier Mannuccio Mannucci

Keyword(s):

Deep Vein Thrombosis ◽

Thrombolytic Therapy ◽

Lower Limbs ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Recanalization after acute deep vein thrombosis

Jornal Vascular Brasileiro ◽

10.1590/jvb.2013.050 ◽

2013 ◽

Vol 12 (4) ◽

pp. 296-302 ◽

Cited By ~ 1

Author(s):

Gustavo Mucoucah Sampaio Brandao ◽

Marcone Lima Sobreira ◽

Hamilton Almeida Rollo

Keyword(s):

Deep Vein Thrombosis ◽

Vessel Wall ◽

Lower Limbs ◽

Venous Disease ◽

Natural Evolution ◽

Vein Thrombosis ◽

Complex Process ◽

History Of ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.

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Acute deep vein thrombosis (DVT) of the lower limbs in a 32-year-old man with chronic hypoplasia of the inferior vena cava (HIVC) without risk factors

Internal and Emergency Medicine ◽

10.1007/s11739-015-1279-4 ◽

2015 ◽

Vol 11 (2) ◽

pp. 273-275 ◽

Cited By ~ 4

Author(s):

Salvatore Santo Signorelli ◽

Valerio Fiore ◽

Martino Ruggieri ◽

Antonio Basile

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Lower Limbs ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Comparison of a Pocket-Sized Versus a Full-Sized Ultrasound System in the Diagnosis of Proximal Lower Limb Acute Deep Vein Thrombosis

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318759914 ◽

2018 ◽

Vol 34 (4) ◽

pp. 245-251

Author(s):

Hang Yee Lau ◽

Wing Hang Luk ◽

Dilys Choi Yu Lui ◽

Eliza Po Yan Fung

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Lower Limbs ◽

Vein Thrombosis ◽

Comparable Performance ◽

Acute Deep Vein Thrombosis ◽

Ultrasound System ◽

Sensitivity Specificity ◽

Deep Vein ◽

Proximal Lower Limb

This study assessed the performance of a pocket-sized ultrasound system for the diagnosis of proximal lower limb acute deep vein thrombosis (DVT) compared to a full-sized ultrasound system. Patients who needed urgent lower limb sonograms for acute DVT were invited for the study. In each examination, the investigator scanned the patient using the pocket-sized system and then repeated the scan using the full-sized system. The sensitivity, specificity, and accuracy of the pocket-sized system were determined in reference to the full-sized system. The venous segments that failed to be visualized using the two systems were compared. One hundred lower limbs comprising 500 venous segments were examined. There were four venous segments, including two mid and two lower femoral veins in two patients who failed to be visualized using both systems. The sensitivity, specificity, and accuracy for diagnosing proximal lower limb acute DVT were 100% (95% confidence interval [CI], 94.94%–100%), 100% (95% CI, 99.05%–100%), and 100% (95% CI, 99.19%–100%), respectively. The pocket-sized ultrasound system and the full sized-ultrasound system demonstrated a comparable performance in detecting acute DVT in the leg.

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Acute Deep Vein Thrombosis Treated with Porcine Plasmin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647715 ◽

1974 ◽

Vol 32 (02/03) ◽

pp. 468-482 ◽

Cited By ~ 2

Author(s):

O Storm ◽

P Ollendorff ◽

E Drewsen ◽

P Tang

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Initial Dose ◽

Treated Group ◽

Allergic Reactions ◽

Double Blind ◽

Vein Thrombosis ◽

Thrombolytic Effect ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650615 ◽

1996 ◽

Vol 76 (04) ◽

pp. 518-522 ◽

Cited By ~ 44

Author(s):

A Elias ◽

I Aptel ◽

B Huc ◽

J J Chale ◽

F Nguyen ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Latex Agglutination ◽

Lower Limbs ◽

First Episode ◽

Lower Sensitivity ◽

Vein Thrombosis ◽

Deep Vein ◽

D Dimer

SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

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Diagnosis of Deep Vein Thrombosis by Combination of Doppler Ultrasound Flow Examination and Strain Gauge Plethysmography

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657149 ◽

1982 ◽

Vol 47 (02) ◽

pp. 141-144 ◽

Cited By ~ 7

Author(s):

H Bounameaux ◽

B Krähenbühl ◽

S Vukanovic

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Doppler Ultrasound ◽

Strain Gauge ◽

Predictive Value ◽

Lower Limbs ◽

Vein Thrombosis ◽

Non Invasive ◽

Strain Gauge Plethysmography ◽

Deep Vein

SummaryDoppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method had an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive methods cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both.After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

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