Popliteal vein compression with the limb extended

Background: The aim of this study was to assess the haemodynamic significance of popliteal vein compression by full knee extension. Patients and methods: We examined patients without a history of previous deep vein thrombosis with the knee slightly flexed and then fully extended. The popliteal vein diameters and venous pressures in 61 subjects (116 limbs) were examined using duplex ultrasonography and photoplethysmography. The venous outflow in 50 patients was assessed using photoplethysmography. Results: The diameter of the popliteal vein in semiflexion was 7.7 (+ 1,5) mm, in extension it was reduced to 4.3 (+ 1,7) mm (p < 0.001). Venous pressure in the big toe rose from 12.3 (+ 6,1) mmHg to 15.5 (+ 7,4) (p < 0.001). We have demonstrated the reduction of maximum venous outflow in 50 patients from 65.8 (+ 24) %/min to 60.1 (+ 23) %/min (p < 0.01) immediately after loosening the 2-minute venous occlusion, as well as outflow reduction during subsequent seconds. Conclusions: Our results provide evidence of haemodynamically significant popliteal vein compression in full extension of the limb. Clinically, the compression may play a role as a risk factor for venous thrombosis in immobilized patients, particularly during operations.

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Popliteal Valvular Construction Using a Silastic Sling (Technique II) for Deep Venous Insufficiency of the Lower Limb

Phlebology The Journal of Venous Disease ◽

10.1177/026835559200700408 ◽

1992 ◽

Vol 7 (4) ◽

pp. 158-165 ◽

Cited By ~ 1

Author(s):

D. Psathakis ◽

N. Psathakis

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Continuous Wave ◽

Venous Pressure ◽

Popliteal Vein ◽

Sling Procedure ◽

Vein Thrombosis ◽

Continuous Wave Doppler ◽

Deep Vein ◽

Vein Reflux

Objective: To establish the safety and efficacy of a silastic sling procedure for reconstructing popliteal vein. Design: Prospective survey of patients undergoing surgical treatment for popliteal vein reflux. Setting: Department of Surgery, County Hospital, Bad Karlshafen, Germany. Patients: 209 patients undergoing surgery for popliteal vein incompetence. Interventions: Silastic sling procedure (Technique II) for correction of popliteal vein incompetence. Main outcome measures: Continuous wave Doppler ultrasound examination of popliteal vein, ambulatory foot vein pressure measurements, lower limb venography. Results: One week following surgery 202 patients (of 209) reported relief of pain and reduction of limb oedema. 77 patients with ulcers (of 85) healed following the surgical procedure. Ambulatory venous pressure improved from 71 SD 11 mmHg to 36 SD 17 mmHg. There was prolongation of the venous refilling time from 9 SD 5 seconds to 27 SD 17 seconds. Postoperative phlebography in 92 patients was performed on the tenth post-operative day and in no patient was deep vein thrombosis observed. In 82 of these patients phlebography demonstrated that the constructed popliteal valve was patent. Conclusions: Construction of a popliteal valve using the author's silastic sling technique is a satisfactory method for managing patients with otherwise uncontrolled popliteal vein reflux due to either primary valvular failure or previous deep vein thrombosis.

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Hypofibrinolysis in Patients with a History of Idiopathic Deep Vein Thrombosis and/or Pulmonary Embolism

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648459 ◽

1992 ◽

Vol 67 (04) ◽

pp. 397-401 ◽

Cited By ~ 28

Author(s):

Vito Grimaudo ◽

Fedor Bachmann ◽

Jacques Hauert ◽

Maria-Adele Christe ◽

Egbert K O Kruithof

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Plasminogen Activator ◽

Fibrinolytic Activity ◽

Venous Occlusion ◽

Vein Thrombosis ◽

Molar Excess ◽

History Of ◽

Deep Vein ◽

Pai 1

SummaryAn impaired fibrinolytic activity after a venous occlusion test is the most common abnormality associated with thomboembolic disease. To better characterize the causes of abnormal responses we have measured different fibrinolytic parameters, before and after 10 and 20 min of venous occlusion, in 77 patients with a history of idiopathic deep vein thrombosis and/or pulmonary embolism and in 38 healthy volunteers.The patients had a lower mean fibrinolytic response to venous occlusion than the controls and higher antigen levels of tissue-type plasminogen activator (t-PA: Ag) and plasminogen activator inhibitor type 1 (PAI-1:Ag). Before venous occlusion, PAI-1 levels were at a molar excess over those of t-PA in all patients and controls. After 20 min of venous occlusion, the release of t-PA from the vascular endothelium resulted in a molar excess of t-PA over PAI-1 in the majority of controls (72%) but only in a minority of patients (39%).To identify patients with fibrinolytic abnormalities, reference intervals (RI) for fibrinolytic activity, t-PA:Ag and PAI-1:Ag were established in healthy controls. None of the patients had low levels of t-PA:Ag, but 17 (22%) had elevated PAI-1:Ag levels before venous occlusion and 12 (16%) exhibited low fibrinolytic activity after 20 min of venous occlusion. Ten of these were among the 17 subjects with high PAI-1: Ag levels before venous occlusion. Thus, the measurement of PAI-1:Ag levels before venous occlusion (i.e. in samples taken without any stimulation) is a sensitive (83%) and specific (89%) assay for the detection of patients with an impaired fibrinolytic response to venous occlusion.

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INCIDENCE OF DEFECTIVE T-PA RELEASE IN 158 UNRELATED YOUNG PATIENTS WITH VENOUS THROMBOSIS IN COMPARISON TO PC-, PS-, AT III-, FIBRINOGEN- AND PLASMINOGENDEFICIENCY

10.1055/s-0038-1643047 ◽

1987 ◽

Author(s):

I Scharrer ◽

V Hach-Wunderle ◽

H Heyland ◽

C Kuhn

Keyword(s):

Young Patients ◽

Venous Occlusion ◽

Vein Thrombosis ◽

Occlusion Test ◽

At Iii ◽

Before And After ◽

History Of ◽

Time Periods ◽

Deep Vein ◽

Venous Occlusion Test

The incidence of defective T-PA release in 158 young unrelated patients (<45 years old) with deep vein thrombosis was studied and compared to that of PC-, PS-, AT III-, fibrinogen- and plasminogen deficiency. Thrombotic episodes were documented using venography with contrast medium. Venous occlusion test (VO) over 20 min. was performed in all patients, 8-12 weeks after thrombosis. T-PA antigen (Biopool kit) , T-PA activity (on fibimplates) and PAI (T-PA-inhibitor, Biopool kit) were measured before and after VO in the fasting morning samples. Furthermore we investigated the functional and immunologic levels of PC,PS,AT III, fibrinogen and plasminogen. We detected 28 patients (15 females, 13 males)= 17.7% with abnormal T-PA release. In these patients the VO test was repeated three times in an interval of 6-8 weeks. Release of T-PA activity and T-PA-Ag was diminished in all these patients. PAI levels were enhanced in 12 of these 28 patients. The rate of recurrency of thrombosis was 52%. A family history of thrombosis was reported only in 20%The incidence of PC def. was 9.4%, of PS def. 6.3%, of AT III def 5%, of dysfibrinogenemia 0.6% and of plasminogen def. 1.2%. No combined defect of abnormal T-PA release with other known hereditary coagulation or fibrinolysis disorders could be detected.In 11 healthy volunteers we investigated 4 different time periods of VO, 5, 10, 15 and 20 min. in an interval of 10 days in order to find the suitable time for VO. It was striking that T-PA activity (on fibrin plates) did not decrease to the same extent as T-PA-Ag. The different behaviour is demonstrated on table 1. Decrease in % is compared to the values of 20 min. VO.

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A murine model of deep vein thrombosis Characterization and validation in transgenic mice

Thrombosis and Haemostasis ◽

10.1160/th05-03-0170 ◽

2005 ◽

Vol 94 (09) ◽

pp. 498-503 ◽

Cited By ~ 25

Author(s):

Linda Szema ◽

Chao-Ying Chen ◽

Jeffrey P. Schwab ◽

Gregory Schmeling ◽

Brian C. Cooley

Keyword(s):

Deep Vein Thrombosis ◽

Murine Model ◽

Femoral Vein ◽

Previous History ◽

Bed Rest ◽

Major Surgery ◽

Vein Thrombosis ◽

Transgenic Lines ◽

History Of ◽

Deep Vein

SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.

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Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.86b4.0860621 ◽

2004 ◽

Vol 86-B (4) ◽

pp. 621-621 ◽

Cited By ~ 1

Author(s):

F. T. HOAGLUND

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Arthroplasty ◽

Natural History ◽

Hip Arthroplasty ◽

Total Hip ◽

Vein Thrombosis ◽

History Of ◽

Deep Vein

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History of COVID-19 infection is not associated with increased d-dimer levels and risk of deep-vein thrombosis in total joint arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04181-8 ◽

2021 ◽

Author(s):

Anna Jungwirth-Weinberger ◽

Ilya Bendich ◽

Carola Hanreich ◽

Alejandro Gonzalez Della Valle ◽

Jason L. Blevins ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Vein Thrombosis ◽

History Of ◽

Deep Vein ◽

D Dimer

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Acute Deep Vein Thrombosis and Association with Popliteal Fossa (Baker's) Cysts in Patients with Lower Extremity Duplex Ultrasound Examination

Blood ◽

10.1182/blood-2020-134231 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 9-10

Author(s):

Danielle Vlazny ◽

Damon E. Houghton ◽

Ryan Meverden ◽

Paul Daniels ◽

Matthew Bartlett ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Sensitivity And Specificity ◽

Mayo Clinic ◽

Duplex Ultrasound ◽

Popliteal Fossa ◽

Popliteal Vein ◽

Vein Thrombosis ◽

Radiology Reports ◽

Deep Vein

Background: Popliteal fossa cysts (PFCs aka Baker's cysts) are synovial cysts of the knee joint that can be symptomatic or asymptomatic and incidentally identified on ultrasound. Whether PFCs are associated with deep vein thrombosis (DVT) is unknown. Possible mechanisms for an association include direct compression of the popliteal vein, indirect compression on the popliteal vein with leg flexion, adjacent inflammation of the cyst, or relative immobility due to underlying joint disease itself. Methods: Lower extremity venous Duplex ultrasound radiology reports from the inception of electronic archiving through 11/14/2019 were evaluated across the Mayo Clinic Enterprise (Rochester MN, Jacksonville, FL, Scottsdale AZ, and Mayo Clinic Health System) in patients >18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute DVT (proximal or distal) and PFCs. A random sample of 1,752 ultrasound reports underwent manual review to calculate the sensitivity and specificity of the NLP algorithm. Cases (ultrasounds with acute DVT) were compared to controls (ultrasound without acute DVT) to examine the frequency of PFCs. IRB approval was obtained and patients lacking Minnesota research authorization were excluded. Results: A total of 332,016 lower extremity venous ultrasounds were performed in 223,035 patients; 156,846 unilateral and 175,170 bilateral lower extremities exams. The mean age at ultrasound was 63.3 (SD 16.5) and 54.7% were female. Ultrasound reports were available for analysis starting in 1992 with a significant increase in the number of ultrasounds performed over the study period across the enterprise (Figure 1). Overall, acute DVT was identified in 24,179 (7.3%) of ultrasounds, and PFCs were identified in 32,427 (9.8%) of ultrasounds. The sensitivity and specificity of the NLP algorithm in the full dataset to identify acute DVT was 86.0% and 97.2%, respectfully. The sensitivity and specificity of the NLP algorithm to identify PFCs was 97.8% and 99.5%, respectively. PFCs were present in 9.3% of ultrasounds with acute DVT and 9.8% of ultrasounds without acute DVT (p=0.007), OR 0.94 (95% CI 0.90-0.98). In a multivariate logistic regression model, after adjusting for age and sex, results remained significant (aOR 0.95, 95% CI 0.91-0.995). Comparing ultrasounds before and after 2010, there was a higher percentage of PFCs and acute DVT reported after 2010 (p<0.001 for both). Sensitivity analyses comparing results before or after 2010, by sex, and only in the first ultrasound performed per person, demonstrated similar results. Conclusions: PFCs are negatively associated with the presence of acute DVT on lower extremity venous Duplex ultrasound. This data does not support PFCs as a contributing or causative factor in the development of lower extremity DVT. Figure 1 Disclosures No relevant conflicts of interest to declare.

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Improvement of Medical Treatment Options of Proximal Deep Vein Thrombosis of Low Extremities Associated with Phlegmasia Alba Dolens

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2021-14-3-193-198 ◽

2021 ◽

Vol 14 (3) ◽

pp. 193-198

Author(s):

Boris Sukovatykh ◽

Aleksey Viktorovich Sereditsky ◽

Andrey Mikhailovich Azarov ◽

Vadim Feliksovich Muradyan ◽

Mikhail Borisovich Sukovatykh ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Conservative Treatment ◽

Treatment Options ◽

Proximal Deep Vein Thrombosis ◽

Venous Outflow ◽

Partial Restoration ◽

Vein Thrombosis ◽

Phlegmasia Alba ◽

Anti Inflammatory ◽

Deep Vein

The aim of the study was to improve the conservative treatment options for proximal deep vein thrombosis of low extremities associated with phlegmasia alba dolens optimization of anticoagulant therapy and paravascular injection of the anti-inflammatory medical mixture in areas of the most intense inflammatory process.Materials and methods. The results of treatment of two statistically homogeneous groups of patients with proximal deep vein thrombosis of the lower extremities associated with white phlegmasia were compared. In the first group (n = 30), standard conservative treatment was carried out using rivaroxaban as an anticoagulant; in the second group (n = 30), initial heparin therapy was first performed and, additionally, the following mixture was administered in the places of the greatest severity of inflammatory process under ultrasound control: dexamethasone 16 mg, heparin 5 thousand units, 0.25% novocaine solution 20.0 ml. During treatment the incidence of hemorrhagic syndrome was recorded. The results were assessed after one year according to the degree of deep vein lumen restoration and the severity of venous outflow impairment according to the Villalta scale. Results. In patients of both groups, every tenth patient developed some minor manifestations of hemorrhagic syndrome during treatment with rivaroxaban that was corrected by a decrease in the dose of anticoagulant.Complete restoration of the lumen of the veins occurred in 20.0%, patients of the first group and in 40.0%, patients of the second group; partial, in 63.3% and 56.7% of patients, respectively, minimal - in 16.7% and 3.3% of patients, respectively.In the first group, clinical disorders of venous outflow were absent in 20.0% of patients, a weak degree of severity was registered in 23.3%, an average - in 40.0%, and a strong one in 16.7% of patients, and in the second group, in 40 %, 26.7%, 30% and 3.3% of patients, respectively.Different minor hemorrhagic complications after Rivaroxaban intake occurred equally in both groups in each of ten patients. These complications were treated by the reduction of the anticoagulants dose.Complete restoration of the vein lumen occurred in the first group in 20.0%, and in the second group in 40.0% of patients, partial restoration, in 63.3% and 56.7% of patients, minimal - in 16.7% and 3.3% of patients respectively.In patients of the first group clinical venous congestion was absent in 20,0% of patients, mild congestion was manifested in 23,3% of patients, moderate - in 40,0% of patients, and severe was in 16,7% of cases. In the second group, the obtained data was 40%, 26,7%, 30%, and 3,3% of patients, respectively. Conclusion. Starting therapy with heparin and paravascular injection of anti-inflammatory mixture helps improve treatment outcomes.

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