Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center

Objective We set out to investigate the prevalence of May-Thurner syndrome (MTS) in a cohort of patients diagnosed with iliofemoral deep vein thrombosis at a large medical referral center. Materials and Methods We retrospectively analyzed a cohort of 496 patients who were referred to the emergency unit of a large medical referral center with suspected venous thromboembolism (VTE) and were diagnosed with deep vein thrombosis of the iliac veins and/or the thigh on ultrasound. We retrospectively assessed the presence of MTS in the primary ultrasound examination and on additional imaging (available in n = 193 patients). Results Across all 496 patients with iliofemoral deep vein thrombosis, the median age was 70 years. 238 patients (48 %) were female. The thrombosis was left-sided in 263 cases (53 %), right-sided in 208 cases (42 %) and bilateral in 24 cases (5 %). In the subgroup of patients with left-sided and bilateral thrombosis, the growth pattern was classified as ascending in 142 patients (50 %), descending in 104 patients (36 %) and unclear in 41 patients (14 %). Additional imaging tests were available in 193 patients: 119 patients (41 %) underwent CT, 18 patients (6 %) MRI and 30 patients (10 %) underwent phlebography. Within the subgroup of patients with left-sided and bilateral thrombosis, MTS was confirmed in 88 patients (31 %), and the imaging findings in 17 patients (6 %) were highly suspicious of MTS. Differentiation was not possible in 86 patients (30 %) and MTS was excluded in 96 patients (33 %). Conclusion Underlying MTS is not uncommon in the selected cohort of patients with deep iliofemoral vein thrombosis at a large referral center and should be excluded by imaging. Key Points: Citation Format

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Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis

Blood ◽

10.1182/blood-2018-03-836783 ◽

2018 ◽

Vol 132 (21) ◽

pp. 2298-2304 ◽

Cited By ~ 18

Author(s):

Elham E. Amin ◽

Ingrid M. Bistervels ◽

Karina Meijer ◽

Lidwine W. Tick ◽

Saskia Middeldorp ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Vein Occlusion ◽

Absolute Reduction ◽

Key Points ◽

Deep Vein

Key Points Immediate compression therapy after DVT is associated with a 20% absolute reduction of RVO. The reduction of residual thrombosis is associated with an 8% absolute reduction of postthrombotic syndrome at 24 months.

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Novel FV mutation (W1920R, FVNara) associated with serious deep vein thrombosis and more potent APC resistance relative to FVLeiden

Blood ◽

10.1182/blood-2013-10-530089 ◽

2014 ◽

Vol 123 (15) ◽

pp. 2420-2428 ◽

Cited By ~ 29

Author(s):

Keiji Nogami ◽

Keiko Shinozawa ◽

Kenichi Ogiwara ◽

Tomoko Matsumoto ◽

Kagehiro Amano ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Apc Resistance ◽

Key Points ◽

Cofactor Activity ◽

Deep Vein

Key Points FVNara (W1920R), associated with serious deep vein thrombosis, is more resistant to APC relative to FVLeiden (R506Q). This mechanism results from significant decreases in FVa susceptibility to APC and FV cofactor activity for APC.

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Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis

Blood ◽

10.1182/blood-2014-04-566380 ◽

2014 ◽

Vol 124 (4) ◽

pp. 623-627 ◽

Cited By ~ 54

Author(s):

Melanie Tan ◽

Gerben C. Mol ◽

Cornelis J. van Rooden ◽

Frederikus A. Klok ◽

Robin E. Westerbeek ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

Key Points ◽

Diagnostic Management ◽

Deep Vein

Key Points Diagnostic management of ipsilateral recurrent DVT of the leg is complicated because residual DVT is common and mimics acute DVT on CUS. MRDTI is able to reproducibly distinguish acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins.

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Deep Vein Thrombosis during Pregnancy in Double Homozygous Carrier of Factor V Leiden and Prothrombin G20210A.

Blood ◽

10.1182/blood.v106.11.1633.1633 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1633-1633

Author(s):

Ida Martinelli ◽

Tullia Battaglioli ◽

Angelo L. Beretta ◽

Marina Bianchi ◽

Pier Mannuccio Mannucci

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Ultrasound Examination ◽

Factor V Leiden ◽

Prothrombin G20210a ◽

Factor V ◽

Her Family ◽

Vein Thrombosis ◽

Gestational Week ◽

Deep Vein

Abstract Background. Factor V Leiden and prothrombin G20210A are gain-of-function mutations leading to an increased risk of venous thrombosis. They are the most common causes of thrombophilia, being present in their heterozygous form in 15–20% for factor V Leiden and 6–15% for prothrombin G20210A of unselected patients with venous thrombosis. The prevalence of each mutation in the Italian general population is 3%. Homozygous carriers for each mutation are rare, and double homozygous carriers, expected in 1 in 1.200.000 individuals, has never been described in the literature so far. Patient. On March 3, 2005 a 30-year-old woman was admitted to the Unit of Internal Medicine, Valduce Hospital, Como, for swell and pain in the left leg. She was pregnant at the 25th gestational week. Ultrasound examination diagnosed a deep vein thrombosis of the left external and common iliac veins. She had no symptoms of pulmonary embolism. She was given nadroparin 6000 UI b.i.d. (her weight was 63 kg), elastic stockings, and was discharged on March 9, 2005. Because of worsening of the swell in the left leg, she was re-admitted on March 12, 2005 and the ultrasound examination showed an extension of the deep vein thrombosis to the left femoral-popliteal venous system. The dose of nadroparin was increased to 7000 UI b.i.d. Thrombophilia screening revealed a double homozygosity for factor V Leiden and prothrombin G20210A. Her past personal history was negative for thrombosis, but she was never exposed to high risk situations (surgery, bone fractures, prolonged immobilization, oral contraceptive use, long-haul flights) apart from a previous pregnancy which ended in miscarriage at the 6th gestational week. On June 14, 2004 she had an uneventful vaginal delivery after two hours of labour, with the last nadroparin injection in the evening before, The newborn was a female who weighted 3500 g. Her family history was also negative for thrombosis in first- and second-degree relatives despite both parents were double heterozygotes for factor V Leiden and prothrombin G20210A and brother and sister were homozygotes for factor V Leiden and heterozygotes for prothrombin G20210A. Conclusions. The relative risk of venous thrombosis in double homozygous for factor V Leiden and prothrombin G20210A is unknown but is predicted to be extremely high. However, the patient described here had her first episode during a trigger situation, i.e., pregnancy, and severe thrombophilia seems to run an uneventful cause in her family in spite of repeated exposures to high risk situations. Hence, we shall advise the patient to stop oral anticoagulant therapy, started soon after delivery, one year after the thrombotic event.

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Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613436 ◽

2003 ◽

Vol 89 (02) ◽

pp. 228-234 ◽

Cited By ~ 132

Author(s):

Thomas Schwarz ◽

Kai Halbritter ◽

Jan Beyer ◽

Gabriele Siegert ◽

Wolfram Oettler ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Failure Rate ◽

Ultrasound Examination ◽

Venous Thromboembolic Event ◽

Technical Failure ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Venous Thromboembolic ◽

Deep Vein

SummaryNoninvasive diagnosis of deep vein thrombosis (DVT) is based on ultrasound examination of the leg veins, usually restricted to only compression of the proximal veins (CUS). Patients with negative CUS findings require a second examination or a combination with other tests, which impairs clinical efficiency. In this prospective outcome study, 1646 consecutive patients with clinically suspected DVT were examined once by a standardized protocol of complete compression ultrasound comprising all proximal and distal veins (CCUS) as the only diagnostic test. The examination was equivocal in 15 patients (1% technical failure rate). Another 366 patients (22%) were tested positive for proximal DVT, distal DVT, muscle vein thrombosis, or phlebitis. Of 1265 patients in whom CCUS findings were negative, 242 met exclusion criteria for follow-up (age <18, life expectancy <3 months, other reasons for anticoagulation, postthrombotic lesions of the leg veins, or lack of informed consent). During the 3 months of follow-up, three of 1023 patients with negative CCUS findings experienced a symptomatic venous thromboembolic event (0.3% [95% CI 0.1%-0.8%]). We conclude that the CCUS protocol has a low technical failure rate and is safe with respect to excluding DVT, thereby reducing the diagnostic workup of patients with suspected DVT to a single ultrasound examination.

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Prediction of the Risk of Preoperative Deep Vein Thrombosis in Non-fractured Patients Awaiting Total Joint Arthroplasty Using a Support Vector Machine

10.21203/rs.3.rs-844532/v1 ◽

2021 ◽

Author(s):

Haosheng Wang ◽

Tingting Fan ◽

Yanhua Chen ◽

Wenle Li ◽

Fujiang Zhao ◽

...

Keyword(s):

Support Vector Machine ◽

Regression Analysis ◽

Deep Vein Thrombosis ◽

Prediction Model ◽

Total Joint Arthroplasty ◽

Ultrasound Examination ◽

Joint Arthroplasty ◽

Support Vector ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: We developed a potential useful alternative prediction model based on the support vector machine (SAM) algorithm to predict the risk of preoperative deep vein thrombosis (DVT) in non-fractured patients awaiting total joint arthroplasty (TJA). Methods: From March 2015 to August 2020, a retrospective review of the preoperative ultrasound examination findings of lower extremity venous vessels was performed on non-fractured patients of 369 elective TJA. Based on the ultrasound examination findings of preoperative lower extremely venous vessels, these patients were divided into two groups: the DVT group and the Non-DVT group. We collected the clinical, imaging, and laboratory findings from an electronic medical record system. These variables were imported into univariate, multivariate and logistic regression analysis to identify the risk factor for preoperative DVT. According to published literature and clinical experience, a series of variables were selected to construct a prediction model based on the SVM machine learning algorithm. Results: Among the 369 patients, preoperative DVT was observed in 21 patients (5.7%). The Multivariate regression analysis showed the following 5 independent factors associated with preoperative DVT: preoperative fibrinogen odds ratio [OR] = 7.306), age (OR = 1.133), history of hypertension (OR = 3.848), preoperative hematocrit (OR = 0.315), and D-dimer (OR = 2.032). The SVM model achieved a maximum and average area under the receiver operating characteristic curve (AUC) of 0.94 and 0.77 in the 10-fold cross-validation. Meanwhile, the accuracy, precision, and recall of the model were 0.98, 0.92, and 0.93, respectively. Additionally, the confusion matrix showed the classification results of the discriminant analysis.Conclusions: SVM machine modeling is a promising method for the prediction of the risk of DVT in non-fractured patients awaiting TJA. However, future external validation is needed.

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Can thrombophilia predict recurrent catheter-related deep vein thrombosis in children?

Blood ◽

10.1182/blood-2017-10-811216 ◽

2018 ◽

Vol 131 (24) ◽

pp. 2712-2719 ◽

Cited By ~ 3

Author(s):

M. Laura Avila ◽

Nour Amiri ◽

Sanja Stanojevic ◽

Trang T. Vu ◽

Katherine Barron ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Recurrent Events ◽

Young Age ◽

Catheter Insertion ◽

Vein Thrombosis ◽

Key Points ◽

Deep Vein

Key Points Thrombophilia was not predictive of recurrent catheter-related deep vein thrombosis in children. Young age at the time of catheter insertion and lack of administration of anticoagulation were predictive of recurrent events.

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Postthrombotic syndrome and other outcomes of lower extremity deep vein thrombosis in children

Blood ◽

10.1182/blood-2016-03-704585 ◽

2016 ◽

Vol 128 (14) ◽

pp. 1862-1869 ◽

Cited By ~ 20

Author(s):

Maria Laura Avila ◽

Eleanor Pullenayegum ◽

Suzan Williams ◽

Natasha Yue ◽

Peter Krol ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Key Points ◽

Deep Vein

Key Points The frequency of PTS, PE, and DVT recurrence was higher in children with Non-LR DVT than in children with LR DVT. Thrombus resolution, DVT triggering event, and sex were predictors of LE PTS in children.

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Accuracy of Magnetic Resonance Direct Thrombus Imaging (MRDTI) As a Novel Tool in the Diagnosis of Acute Ipsilateral Recurrent Deep Vein Thrombosis

Blood ◽

10.1182/blood.v120.21.395.395 ◽

2012 ◽

Vol 120 (21) ◽

pp. 395-395

Author(s):

Melanie Tan ◽

Gerben C Mol ◽

Marcel A Van de Ree ◽

Cornelis J Van Rooden ◽

Robin E Westerbeek ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Ultrasound Examination ◽

Kappa Statistics ◽

Acute Thrombosis ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

Recurrent Deep Vein Thrombosis ◽

Deep Vein ◽

D Dimer

Abstract Abstract 395 Background Accurate diagnostic assessment of suspected acute ipsilateral recurrent deep vein thrombosis (DVT) is of high clinical importance, however discriminating residual thrombosis from acute recurrent DVT may be challenging. It is known that in 32% of the patients with a suspected acute ipsilateral recurrent DVT the ultrasound examination are non-conclusive. Despite this, patients were treated with indefinite anticoagulant therapy, indicating overtreatment in this group of patients (Tan M et al. J Thromb Haemost 2010). A non-invasive MR technique (Magnetic Resonance Direct Thrombus Imaging (MRDTI), without need for intravenous contrast agent, showed high sensitivity and specificity for diagnosing a first acute DVT (Fraser et al Ann Intern Med 2002). Furthermore the high signal associated with acute thrombosis was not detected 6 months after the initial acute thrombosis, making MRDTI potential relevant for distinguishing a recurrent DVT from a residual thrombosis (Westerbeek RE et al J Thromb Haemost 2008). This study evaluated the accuracy of MRDTI in patients with an acute ipsilateral recurrent DVT and patients with residual thrombosis. Patients/Methods In total 84 patients were enrolled. Of these, 42 consecutive patients had an acute ipsilateral recurrent DVT according to the current ultrasound examination standards in combination with a positive D-dimer test (≥ 500 μg/L); all patients were treated with anticoagulants. Furthermore, 42 patients were without acute signs and symptoms, however had a residual thrombosis on ultrasound examination in combination with a negative D-dimer test (< 500 μg/L). All patients received a MR examination within 48 hours of presentation. MR images were assessed in a blinded fashion by two radiologists. Sensitivity, specificity and interobserver variability were calculated. Results The images of two patients with ipsilateral recurrent DVT were not interpretable, one patient had a knee prosthesis that gave artifacts and in the other patient not the venous system of interest was imaged. The images of 40 patients with an ipsilateral recurrent DVT and of 42 patients with residual thrombosis were fully interpretable. Sensitivity was 86% (95% CI, 71 –94%) and specificity was 100% (95% CI, 89–100%) for MRDTI by the first observer; sensitivity was 88% (95% CI, 74–96%) and specificity was 100% (89–100%) by the second observer. The interobserver agreement between both observers was excellent, with a kappa statistics of 0.97 (95% CI, 0.92 – 1.0). Conclusion Our study shows reasonable sensitivity and very good specificity figures with an excellent observer agreement for imaging an ipsilateral recurrent DVT and residual thrombosis with MRDTI. The sensitivity is somewhat lower than expected; a reason could be that patients with inconclusive ultrasounds were considered as acute recurrent thrombosis by the attending physician, while in fact they had a residual thrombosis. We conclude that MRDTI has good potential in distinguishing a residual thrombosis from an acute recurrent DVT and could therefore be of high value for the diagnosis of patients with suspected acute ipsilateral recurrent DVT. This should however be further evaluated in a management outcome study in which treatment decisions are based on the results of MR. Acknowledgment This study was supported by the Netherlands Heart Foundation (grant no. 2007B146) Disclosures: No relevant conflicts of interest to declare.

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