Massive Deep Venous Thrombosis and Venous Gangrene in a 29-year-old Case: Metastatic Epidermoid Carcinoma with an Unknown Primary

Venous gangrene represents the most severe manifestation following deep venous thrombosis (DVT), and presents as acral ischaemic necrosis. The pathophysiology is driven by an acquired coagulopathic state leading to microvascular thrombosis outcomes are generally poor. This study was aimed at analysing the outcomes in these rare group of patients who presented with venous gangrene at a single institution during a two year period.

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Evaluation of Catheter Directed Thrombolytic Therapy versus Systemic Anticoagulant Therapy of Acute Ilio-Femoral Deep Vein Thrombosis

QJM ◽

10.1093/qjmed/hcab097.049 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Samy Gamil Akhnoukh ◽

Ramez Monuir Wahba ◽

Nabil Gamal Abd Elnaser Mahmoud

Keyword(s):

Deep Vein Thrombosis ◽

Thrombolytic Therapy ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Anticoagulant Therapy ◽

Vein Thrombosis ◽

Phlegmasia Alba ◽

Venous Gangrene ◽

Deep Vein

Abstract Background Deep venous thrombosis (DVT) is a major cause of morbidity and mortality all-over the world. Complications include pulmonary embolism (PE), post-thrombotic syndrome (PTS), phlegmasia alba dolens, phlegmasia cerulea dolens and venous gangrene. The PTS is the most common cause of long-term morbidity and disability among the previous complications. Aim of the Work The aim of this work is evaluation of the regional catheter-directed thrombolytic therapy versus standard systemic anticoagulant therapy in cases of acute ilio-femoral deep vein thrombosis as regard to efficacy, safety as well as complications. Patients and Methods This study was conducted on 30 patients presented to the vascular surgery unit of Ahmed Maher Teaching Hospital between February, 2019 and August, 2019 with acute iliofemoral deep venous thrombosis (less than two weeks duration). Of the 30 patients, 18 were females and 12 were males. The age of the patients ranged between 22 and 55 years. Results The outcome results of early Follow up of the thrombolytic therapy was complete recanalization in 30.7% of the cases, partial re-canalization in 53.8% of the cases and poor recanalization in the remaining cases15.3%.While the follow up results of anticoagulant therapy was complete re-canalization in 6.7% of the cases, partial re-canalization in 60% of cases and poor recanalization in the remaining cases 33.3% Conclusion Catheter directed thrombolytic therapy using streptokinase, as a lytic agent in the treatment of acute ilio-femoral DVT is a safe and efficient technique.

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Gall bladder carcinoma associated with anticoagulation-resistant, progressive, multi-focal venous thrombosis and gangrene of all limbs: a case report and review of literature

International Surgery Journal ◽

10.18203/2349-2902.isj20211844 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1625

Author(s):

Manisha Aggarwal ◽

Janitta Kundaikar ◽

Dinesh Manchikanti ◽

Shaji Thomas ◽

Ashish Arsia ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Rare Case ◽

Thrombotic Event ◽

Locally Advanced ◽

Lower Limbs ◽

Hypercoagulable State ◽

Coagulation Cascade ◽

Dvt Prophylaxis ◽

Venous Gangrene

Cancer being a prothrombotic state, frequently has vascular complications, venous thrombosis, embolism, recurrent venous thromboembolism and a high frequency of anticoagulant failure. We present a rare case of anticoagulant-resistant, progressive, multifocal venous thrombosis and gangrene in all four limbs in a patient with carcinoma gallbladder. A 49 year old lady with locally advanced gallbladder cancer who had been on routine perioperative deep venous thrombosis (DVT) prophylaxis presented two months later with deep venous thrombosis of both lower limbs progressing to venous gangrene of both feet, despite being on anticoagulation. 7 days later, she presented with venous gangrene of both hands. Shortly thereafter, she developed right facial paralysis due to thrombus in the segmental branch of the left MCA despite being on anticoagulation. The hypercoagulable state in cancer involves procoagulant molecules produced by tumor cells, suppression of fibrinolytic activity and platelet activation and is contributed by interactions between the coagulation cascade, complement pathway and immune system. Upto 15% of patients with cancer will develop DVT following surgery, despite standard DVT prophylaxis. Extended DVT prophylaxis should be considered in high-risk patients. Patients with metastases should continue with indefinite anticoagulant therapy after a thrombotic event. In patients without metastasis, anticoagulant treatment is recommended for as long as the cancer is active and while the patient is receiving antitumor therapy. This rare case has been presented to highlight the hypercoagulable state of cancer, the importance of long-term anticoagulation in advanced and metastatic cancers and the high rate of anticoagulation failure associated with unfavourable tumor biology.

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Venous Gangrene a Rare but Dreadful Complication of Deep Venous Thrombosis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029610376629 ◽

2010 ◽

Vol 17 (6) ◽

pp. E1-E3 ◽

Cited By ~ 2

Author(s):

Muzammil H. Musani ◽

Muhammad Anis Musani ◽

Mary A. Verardi

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Rare Complication ◽

Subcutaneous Fat ◽

Underlying Disease ◽

High Rate ◽

Review Of Literature ◽

National Hospital Discharge Survey ◽

Causative Relationship ◽

Venous Gangrene

Venous gangrene is a rare complication of deep venous thrombosis. It is certain from review of literature that there is a significant causative relationship between malignant disease and venous gangrene. Data from the National hospital discharge survey from 1979 to 2006 showed that 0.43% of patients with deep venous thrombosis had gangrene, while 1.39% patients with gangrene had deep venous thrombosis. Toes and fingers are frequent site of venous gangrene in patients with massive deep venous thrombosis, as evident by review of literature. A possible explanation for this occurrence can be the fact that because of the scarcity of subcutaneous fat and the small spaces of fingers and toes, massive edema can generate large compressive forces; these forces may have a compressive effect on the arterioles, which may contribute to the development of venous gangrene. Lower extremities develop venous gangrene more commonly than upper extremities. The condition has an extremely high rate of mortality either from pulmonary embolism or from the serious underlying disease, such as neoplasms.

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Proximal deep venous thrombosis following PTA of the superficial femoral artery – an obligation to disclose a complication that is rarely taken into account

VASA ◽

10.1024/0301-1526.35.1.41 ◽

2006 ◽

Vol 35 (1) ◽

pp. 41-44 ◽

Cited By ~ 5

Author(s):

Klein-Weigel ◽

Pillokat ◽

Klemens ◽

Köning ◽

Wolbergs ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Rare Complication ◽

Femoral Vein ◽

Vein Thrombosis ◽

Explicit Information ◽

Life Threatening ◽

Legal Consequences

We report two cases of femoral vein thrombosis after arterial PTA and subsequent pressure stasis. We discuss the legal consequences of these complications for information policies. Because venous thrombembolism following an arterial PTA might cause serious sequel or life threatening complications, there is a clear obligation for explicit information of the patients about this rare complication.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

Author(s):

Piecuch ◽

Wiewiora ◽

Nowowiejska-Wiewiora ◽

Szkodzinski ◽

Polonski

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Retroperitoneal Hematoma ◽

Ivc Filter ◽

Filter Placement ◽

Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

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Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽

10.1024/0301-1526/a000508 ◽

2016 ◽

Vol 45 (2) ◽

pp. 141-147 ◽

Cited By ~ 7

Author(s):

Jakob Martin Burgstaller ◽

Johann Steurer ◽

Ulrike Held ◽

Beatrice Amann-Vesti

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cochrane Library ◽

Compression Stockings ◽

Post Thrombotic Syndrome ◽

Study Results ◽

Preventive Efficacy ◽

One Year ◽

The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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Is Quantitative Determination of Fibrin(ogen) Degradation Products and Thrombin-Antithrombin III Complexes Useful to Diagnose Deep Venous Thrombosis in Outpatients?

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647113 ◽

1989 ◽

Vol 62 (04) ◽

pp. 1043-1045 ◽

Cited By ~ 12

Author(s):

Paul F M M van Bergen ◽

Eduard A R Knot ◽

Jan J C Jonker ◽

Auke C de Boer ◽

Moniek P M de Maat

Keyword(s):

Quantitative Determination ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Antithrombin Iii ◽

Degradation Products ◽

Family Doctor ◽

Diagnostic Value ◽

Impedance Plethysmography ◽

Fibrin Degradation Products

SummaryWe studied the diagnostic value of recently introduced ELISA’s for the determination of thrombin-antithrombin III (TAT) complexes, fibrin degradation products (FbDP), fibrinogen degradation products (FgDP) and total degradation products (TDP) for deep venous thrombosis (DVT) in plasma of 239 consecutive outpatients, suspected for DVT by their family doctor. DVT was confirmed by impedance plethysmography in 60 patients. Using the 95th percentile range of 42 healthy volunteers the sensitivity for the detection of DVT was: 37% for TAT, 95% for TDP, 92% for FbDP and 90% for FgDP. Specificity was: 88% for TAT, 16% for TDP, 20% for FbDP and 25% for FgDP.We conclude that these assays are of little value in the diagnosis of DVT in outpatients.

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Platelet Adhesiveness and Fibrinolysis after Recent Cerebro-Vascular Accidents and their Relationship with Subsequent Deep Venous Thrombosis of the Legs

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648016 ◽

1976 ◽

Vol 36 (01) ◽

pp. 127-132 ◽

Cited By ~ 11

Author(s):

C. P Warlow ◽

J. A. N Rennie ◽

D Ogston ◽

A. S Douglas

Keyword(s):

Platelet Count ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasminogen Activator ◽

Fibrinogen Level ◽

Plasma Fibrinogen ◽

Platelet Adhesiveness ◽

Plasma Fibrinogen Level ◽

Vascular Accidents ◽

Subsequent Rise

SummaryIn fifteen patients with a cerebro-vascular accident resulting in an acute hemiplegia there was a subsequent rise in the platelet count and plasma fibrinogen level. There were no significant alterations in platelet adhesiveness, plasminogen activator, plasminogen, FR-antigen and haematocrit. Patients diagnosed as developing deep venous thrombosis with the 125I-fibrinogen technique had a significantly lower platelet adhesiveness and plasminogen level than those who were not.

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Markers of Hemostatic System Activation in Acute Deep Venous Thrombosis-Evolution during the First Days of Heparin Treatment

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649698 ◽

1993 ◽

Vol 70 (06) ◽

pp. 0909-0914 ◽

Cited By ~ 45

Author(s):

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Low Molecular Weight ◽

Dose Adaptation ◽

Heparin Treatment ◽

Lung Scan

SummaryFibrin D-Dimer (D-Di), prothrombin activation fragment (F 1+2) and thrombin-antithrombin III complexes (TAT) were measured using ELISA procedures in the plasma of patients with an acute deep venous thrombosis (DVT), at presentation and on days 2, 6 and 10 after initiation of heparin treatment. Patients were randomly allocated into two treatment groups: 44 patients received adapted doses of continuous intravenous unfractionated heparin (UH) whereas 47 received 1 mg/kg every twelve hours of a low molecular weight heparin (enoxaparin) subcutaneously. A phlebography and a perfusion lung scan were performed before inclusion and on day 10. Failure of therapy (n = 9) was defined by venogram worsening or confirmed pulmonary embolism. Improvement (n = 44) or stationary state (n = 38) were defined by venogram evolution in the absence of new leg scan defects.At presentation, D-Di, F 1 + 2 and TAT were above cut-off values in 97, 66 and 89% of patients respectively. D-Di levels correlated with the extent of venous thrombosis whereas TAT and F 1 + 2 did not. Mean levels of D-Di decreased sharply during the first days of treatment but were still abnormal on day 10. A secondary increase of D-Di on days 6 or 10 by more than 3 μg/ml occurred in 4 of the 9 patients who developed a thromboembolic recurrence but in none of the 72 patients who had a more favorable outcome. F 1 + 2 and TAT time-courses were not related to clinical evolution. In the Enoxaparin group, there was no relationship between antifactor Xa activities and any biological markers. TAT and F 1 + 2 levels fell on day 2 and remained stable until day 10. In contrast, in the UH group, TAT and F 1 + 2 did not significantly decrease on day 2, probably due to a delay in dose adaptation, but they declined slowly until day 10.In conclusion, D-Di displays a higher sensitivity than F 1 + 2 or TAT for the diagnosis of D\T. D-Di, but not TAT or F 1 + 2, follow-up seems to be of potential value for early detection of recurrency. Hemostatic activation is controlled earlier by fixed doses of a low molecular weight heparin, irrespective of the plasma anti-factor Xa activities, than by unfractionated heparin at adapted doses.

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