Definition of post-thrombotic syndrome following lower extremity deep venous thrombosis and standardization of outcome measurement in pediatric clinical investigations

Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.

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Incidence and Risk Factors of the Post-thrombotic Syndrome

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.012s06 ◽

2012 ◽

Vol 27 (1_suppl) ◽

pp. 85-94 ◽

Cited By ~ 18

Author(s):

M A F De Wolf ◽

C H A Wittens ◽

S R Kahn

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Risk Stratification ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inflammatory Markers ◽

Patient Characteristics ◽

Venous Occlusion ◽

Post Thrombotic Syndrome

Annually 1–2 in every 1000 adults will develop a deep venous thrombosis of the lower extremity. A third to half of these patients will develop the post-thrombotic syndrome (PTS). However, predicting which patients will develop the PTS remains elusive. Ipsilateral thrombosis recurrence seems to be the most important risk factor. Moreover, residual venous occlusion and valvular reflux seem to predict PTS incidence to some degree. Laboratory parameters, including D-dimers and inflammatory markers, have shown promise in predicting development of the PTS in patients and are currently under investigation. Creating a model based on all combined risk factors and patient characteristics might aid in risk stratification in individual patients.

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Assessment of the Probability of Post-thrombotic Syndrome in Patients with Lower Extremity Deep Venous Thrombosis

Scientific Reports ◽

10.1038/s41598-018-30645-w ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Hao Huang ◽

Jian-Ping Gu ◽

Hao-Fan Shi ◽

Wan-Yin Shi ◽

Jing-Yuan Lu ◽

...

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Post Thrombotic Syndrome

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Successful Treatment of Post Thrombotic Syndrome with Sequential Lumbar Sympathetic Block

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e65 ◽

2015 ◽

Vol 18;1 (1;1) ◽

pp. E65-E69

Author(s):

Anita Gupta

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Blood Clot ◽

Key Words Pain ◽

Post Thrombotic Syndrome ◽

History Of ◽

Sympathetic Blocks

An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. Thus far there has been a paucity in the medical literature in how to treat post thrombotic pain. Post thrombotic syndrome (PTS) can cause a significant decrease in quality of life in individuals who have had a history of a DVT. Symptoms will typically include edema, pain, heaviness of the affected limb, skin changes, ulcers, varicosities, and gait abnormality. An underappreciated approach to treating PTS is the utilization of lumbar sympathetic blocks (LSB). A 68-year-old male who had a history of recurrent right lower extremity deep venous thrombosis presented with complaints of excruciating pain, discomfort, and erythema in his right lower extremity, which was negatively affecting his quality of life and prohibiting him from mobility. The patient attributed his lack of mobility secondary to the thrombotic pain. Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient’s pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient’s symptoms and improved the patient’s ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS. Key words: Pain, edema, lumbar, sympathetic, thrombosis, venous

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Successful Treatment of Post Thrombotic Syndrome with Sequential Lumbar Sympathetic Block

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e66 ◽

2015 ◽

Vol 18;1 (1;1) ◽

pp. E65-E69

Author(s):

Anita Gupta

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Blood Clot ◽

Nerve Blocks ◽

Post Thrombotic Syndrome ◽

History Of ◽

Sympathetic Blocks

An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. Thus far there has been a paucity in the medical literature in how to treat post thrombotic pain. Post thrombotic syndrome (PTS) can cause a significant decrease in quality of life in individuals who have had a history of a DVT. Symptoms will typically include edema, pain, heaviness of the affected limb, skin changes, ulcers, varicosities, and gait abnormality. An underappreciated approach to treating PTS is the utilization of lumbar sympathetic blocks (LSB). A 68-year-old male who had a history of recurrent right lower extremity deep venous thrombosis presented with complaints of excruciating pain, discomfort, and erythema in his right lower extremity, which was negatively affecting his quality of life and prohibiting him from mobility. The patient attributed his lack of mobility secondary to the thrombotic pain. Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient’s pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient’s symptoms and improved the patient’s ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS.

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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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Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients With Severe COVID-19 in Wuhan

Circulation ◽

10.1161/circulationaha.120.047407 ◽

2020 ◽

Vol 142 (2) ◽

pp. 181-183 ◽

Cited By ~ 61

Author(s):

Bin Ren ◽

Feifei Yan ◽

Zhouming Deng ◽

Sheng Zhang ◽

Lingfei Xiao ◽

...

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

High Incidence

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Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.06.023 ◽

2021 ◽

Author(s):

Xinrui Yang ◽

Xing Zhang ◽

Minyi Yin ◽

Ruihua Wang ◽

Xinwu Lu ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Compression Stockings ◽

Elastic Compression ◽

Post Thrombotic Syndrome ◽

Thrombus Removal

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Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02240-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhanchao Tan ◽

Hongzhi Hu ◽

Xiangtian Deng ◽

Jian Zhu ◽

Yanbin Zhu ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Medical Data ◽

Limited Information ◽

Related Factors ◽

Patella Fractures ◽

Independent Risk Factors ◽

Associated Risk Factors

Abstract Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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