A haemodynamic concept in the management of superficial non-saphenous vein thrombosis

2019 ◽  
Vol 35 (4) ◽  
pp. 281-287
Author(s):  
Giovanni Solimeno ◽  
Pasquale Valitutti
Keyword(s):  
Saphenous Vein ◽  
Venous System ◽  
Lower Limbs ◽  
Vein System ◽  
Vein Thrombosis ◽  
Perforating Veins ◽  
Ultrasound Evaluation ◽  
Ultrasound Study ◽  
Deep Vein ◽  
Perforating Vein

Objective Through the analysis of the haemodynamic model in the development of superficial non-saphenous vein thrombosis, the authors propose a therapeutic approach which is based on an ultrasound study of the superficial and perforating venous system of the lower limbs. Methods The authors propose the development of a haemodynamic model in the evolution of superficial non-saphenous vein thrombosis. They analyse three cases to highlight the importance of venous haemodynamics in the development of this condition and its possible complications, such as the progression of thrombosis in the deep vein system through the perforating veins. Results The evolution of a thrombosis in the venous network of the lower limbs from the peripheral collateral veins to the deep vein can be haemodynamically explained through this model involving the perforating vein system. Conclusions In the management and treatment of superficial non-saphenous vein thrombosis, it is essential to perform an accurate ultrasound evaluation of the superficial venous system, the deep venous system and the perforator system, according to venous haemodynamic principles. This study proposes a new model to be used in the ultrasonic management and treatment of superficial non-saphenous vein thrombosis.

scholarly journals CHOICE OF TACTICS OF SURGICAL TREATMENT OF VARICOSE DISEASE DEPENDING ON THE VARIANT OF THE ANATOMICAL STRUCTURE OF SAPHENO-POPLITEAL ANASTOMOSIS IN DOPPLEROMETRY OF THE VENES OF THE LOWER LIMBS

2020 ◽  
pp. 31-35
Author(s):  
I. B. Babinkina ◽  
G. A. Novikova ◽  
G. P. Babinkina
Keyword(s):  
Saphenous Vein ◽  
Surgical Intervention ◽  
Varicose Veins ◽  
Disease Recurrence ◽  
Anatomical Structure ◽  
Venous System ◽  
Lower Limbs ◽  
Laser Coagulation ◽  
Perforating Veins ◽  
Below The Knee

Summary. The aim of the study is to determine the variants of the anatomical structure of the saphenopliteal anastomosis in ultrasound Doppler of the veins of the lower extremities, including as sources of pathological blood reflux in varicose veins of the small saphenous vein basin, and the importance of insolvent veins in the formation of insufficiency in the small saphenous vein basin to clarify the further protocol treatment. Materials and methods. The venous system of 2348 patients was studied, including both patients with various pathologies of the venous system, including those with varicose veins, and those in whom the pathology of the veins was not detected by USDG. Results and discussion. In patients with USDG, various anatomical variants of the structure of the sapheno-popliteal anastomosis were found. The anastomosis may look like a perforating vein and have a fairly sharp angle of deviation from the trunk. In these cases, it is recommended to conduct an open surgical intervention, namely: crossectomy — ligation and transection of the small saphenous vein, striping — removal of the trunk of the small saphenous vein, ligation of insolvent communicative veins, miniflebectomy - removal of varicose nodes through punctures. The smooth course of the sapheno-popliteal anastomosis was found in 58.0 % of the subjects and did not depend on the level of the anastomosis. In such cases, the option of choice for surgical intervention was minimally invasive technologies: laser coagulation, radiofrequency ablation, as well as combined phlebectomy, which includes the following stages - removal of varicose inflows of the small saphenous vein and elimination of incompetent perforating veins. Indirect variants of the anastomosis turned out to be frequent, for example, through the sural or nonsaphenic vein with the presence of additional venous vessels (up to 18.0 % of those studied). In these cases, the level of the anastomosis was also formed below the knee joint gap. According to the USDG data, the anatomical absence of the sapheno-popliteal anastomosis was found only in 142 patients, which is less than 1.0 %. In such patients, a search and elimination of pathological reflux is performed, which leads to the development of varicose veins in the system of the small saphenous vein. Its varicose inflows are removed and insolvent perforating veins are eliminated. Conclusion. The specialists’ understanding of the variants of the structure of the saphenopliteal anastomosis in normal and pathological conditions, as well as the observance of the full examination protocol for venous ultrasonography, allows providing detailed information in order to determine the most effective treatment tactics and prevention of disease recurrence.

TRANSFASCIAL THROMBOSIS SURGERY IN THE GREAT SAPHENOUS VEIN BASIN

2021 ◽  
Vol 74 (10) ◽  
pp. 2620-2623
Author(s):  
Ivan I. Hadzheha
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Effective Prevention ◽  
Vein Thrombosis ◽  
Surgical Tactics ◽  
Deep Vein ◽  
Perforating Vein ◽  
Prevention Of Recurrence

The aim: To evaluate the effectiveness of surgical treatment of varicothrombophlebitis complicated by transfascial thrombosis. Materials and methods: The results of examination and treatment of 45 patients with varicothrombophlebitis of the great saphenous vein complicated by transfascial thrombosis. Results: The indications for surgical prophylaxis of pulmonary embolism in transfascial thrombosis in the basin of the great saphenous vein have been substantiated. In the postoperative period, all patients with transfascial thrombosis, regardless of the radical nature of the surgical intervention, were offered to prescribe treatment as in deep vein thrombosis. The introduction of active surgical tactics in transfascial thrombosis allows for effective prevention of pulmonary embolism. Conclusions: In varicothrombophlebitis complicated by transfascial thrombosis, thrombectomy with further prevention of recurrence of the disease and pulmonary embolism should be considered the main standard of treatment. For perforating vein thrombosis, subfascial thrombectomy followed by perforating ligation should be performed. All patients with transfascial thrombosis, regardless of the volume of surgery, should be treated as for deep vein thrombosis.

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

1996 ◽  
Vol 76 (04) ◽  
pp. 518-522 ◽  
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.

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

1982 ◽  
Vol 47 (02) ◽  
pp. 141-144 ◽  
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.

Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

2021 ◽  
pp. 1358863X2199467
Author(s):  
Jean-Eudes Trihan ◽  
Michael Adam ◽  
Sara Jidal ◽  
Isabelle Aichoun ◽  
Sarah Coudray ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Operating Characteristics ◽  
Vein Thrombosis ◽  
Ultrasound Study ◽  
Wells Score ◽  
Deep Vein ◽  
The Impact ◽  
Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

scholarly journals Isolated proximal greater saphenous vein thrombosis and the risk of propagation to deep vein thrombosis and pulmonary embolism

2018 ◽  
Vol Volume 14 ◽  
pp. 129-135 ◽  
Author(s):  
Samuel H Kim ◽  
Nimesh Patel ◽  
Kanika Thapar ◽  
Ananda V Pandurangadu ◽  
Amit Bahl
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Saphenous Vein ◽  
Vein Thrombosis ◽  
Deep Vein

Epidemiology and Pattern of Thromboembolism in Aseer Central Hospital, a Multispecialty Hospital in Aseer Region, Abha in Southern Saudi Arabia

2020 ◽  
Author(s):  
Aziz S
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Demographic Data ◽  
Venous Blood ◽  
Pulmonary Veins ◽  
Lower Limbs ◽  
Central Hospital ◽  
Vein Thrombosis ◽  
Hospitalization Period ◽  
Deep Vein

Background: Venous Thromboembolism (VTE) is a clinical disorder characterized by the pathological occurrence of single or many thrombi developing mainly in the deep veins of the lower limbs and pulmonary veins but also other parts of the venous circulation, albeit less. A frequently occurring venous thrombosis is a deep vein thrombosis (DVT), which is the presence of thrombus in deep veins of the lower extremity. Once this clot fragment is swept off (embolism), it moves along with the venous blood and flows to the pulmonary vessels, where it may result in a clinically significant disorder called pulmonary thromboembolism (PTE). Thrombosis occurring in the superficial veins would only cause discomfort but generally with insignificant consequences. Aim: This study aimed to assess patterns and risk factors of venous thromboembolism (VTE) among patients in the Aseer region. Methodology: A record-based descriptive analysis (retrospective) was used in this study. The clinical study targeted the patients with venous thromboembolism (VTE including PE & DVT) either admitted with the diagnosis or complicated during the hospitalization period in Aseer Central Hospital during the period from January 2010 to June 2019. Data extracted using pre-structured data collection sheet. The extracted data were patients' bio-demographic data, VTE related data, treatment received and relevant complications of treatment, and patient’s follow-up history. Results: The study included total of 207 patients with thromboembolism. The age of patients was between 15 - 100 years old with the average age being 57.3+12.9 years. Approximately 58% of the patients were female. Deep vein thrombosis (DVT) was recorded in 60.4% of the cases and 27.5% of them were diagnosed with pulmonary embolism (PE) while 12.1% had both PE and DVT. Exact of 59.6% of cases with PE had immobilization history for 24 to 72 hours as compared to 31.2% of DVT and 44% of patients with mixed thromboembolism. DM was recorded among 14% of PE cases and 21.6% of DVT. Warfarin with Enoxaparin was the most frequently given treatment in total (23.2%). Heparin followed by Warfarin was the second most common treatment. Conclusions and recommendation: The study revealed that VTE was commonly reported especially DVT and PE among the recorded cases and it was bilateral in a considerable number of cases. Immobilization with chronic disease and morbid obesity was noted as the most significant predictor for VTE.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

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