Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

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Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?

Blood Advances ◽

10.1182/bloodadvances.2020002268 ◽

2020 ◽

Vol 4 (21) ◽

pp. 5595-5606

Author(s):

Fionnuala Ní Áinle ◽

Barry Kevane

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Recurrence Risk ◽

Vein Thrombosis ◽

Recurrent Venous Thromboembolism ◽

Clinical Conditions ◽

Deep Vein

Abstract Recurrent venous thromboembolism (VTE, or deep vein thrombosis and pulmonary embolism) is associated with mortality and long-term morbidity. The circumstances in which an index VTE event occurred are crucial when personalized VTE recurrence risk is assessed. Patients who experience a VTE event in the setting of a transient major risk factor (such as surgery associated with general anesthesia for >30 minutes) are predicted to have a low VTE recurrence risk following discontinuation of anticoagulation, and limited-duration anticoagulation is generally recommended. In contrast, those patients whose VTE event occurred in the absence of risk factors or who have persistent risk factors have a higher VTE recurrence risk. Here, we review the literature surrounding VTE recurrence risk in a range of clinical conditions. We describe gender-specific risks, including VTE recurrence risk following hormone- and pregnancy-associated VTE events. Finally, we discuss how the competing impacts of VTE recurrence and bleeding have shaped international guideline recommendations.

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Ilio-Femoral Deep Vein Thrombosis Secondary to May-Thurner Syndrome With Ipsilateral Lower Limb Arterio-Venous Graft In-Situ

Vascular and Endovascular Surgery ◽

10.1177/1538574421994782 ◽

2021 ◽

pp. 153857442199478

Author(s):

Brjan Kaiji Betzler ◽

Li zhang ◽

Kai Siang Chan ◽

Enming Yong ◽

Ivan Kuang Hsin Huang ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Common Iliac Vein ◽

Arteriovenous Graft ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively.

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Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?

Hematology ◽

10.1182/hematology.2020002268 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 201-212

Author(s):

Fionnuala Ní Áinle ◽

Barry Kevane

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Recurrence Risk ◽

Vein Thrombosis ◽

Recurrent Venous Thromboembolism ◽

Clinical Conditions ◽

Deep Vein

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Standards for recanalisation of chronic venous outflow obstructions

VASA ◽

10.1024/0301-1526/a000696 ◽

2018 ◽

Vol 47 (4) ◽

pp. 259-266 ◽

Cited By ~ 3

Author(s):

Michael Lichtenberg ◽

Rick de Graaf ◽

Christian Erbel

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Symptoms ◽

Vena Cava ◽

Iliac Vein ◽

Venous Hypertension ◽

Postthrombotic Syndrome ◽

Venous Outflow ◽

Vein Thrombosis ◽

Technical Developments ◽

Deep Vein

Abstract. Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency. Recent technical developments and new stent techniques now allow recanalisation of even complex venous outflow obstructions within the iliac vein and the inferior vena cava. This manuscript gives an overview on the latest standards for venous recanalisation.

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Deep Vein Thrombosis in Obstetric Patients: Diagnosis and Risk Factors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648129 ◽

1992 ◽

Vol 67 (01) ◽

pp. 004-007 ◽

Cited By ~ 12

Author(s):

Karin de Boer ◽

Harry R Büller ◽

Jan W ten Cate ◽

Marcel Levi

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Diagnostic Method ◽

Clinical Symptoms ◽

Impedance Plethysmography ◽

Vein Thrombosis ◽

Deep Vein

SummaryThis study was performed to assess the prevalence of deep vein thrombosis (DVT) in consecutive obstetric patients with clinical symptoms of DVT, using impedance plethysmography (IPG) as the diagnostic method and to establish the safety of withholding anticoagulant therapy in patients with a repeatedly normal IPG. In addition, in patients with DVT the prevalence of coagulation and fibrinolytic disorders, which may explain the occurrence of venous thrombosis was investigated.Of the 77 obstetric patients with symptoms of DVT 32 (42%) had an abnormal IPG. The remaining 45 patients had a repeatedly normal IPG and showed no venous thromboembolism during a 6 months follow-up period. Twenty percent (six patients) of the patients with an abnormal IPG had a coagulation or fibrinolytic abnormality. These observations suggest that serial IPG can be used effectively in the management of obstetric patients with clinically suspected DVT and that hemostatic abnormalities are frequently found in those patients with DVT

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May–Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02730-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Joel Zhen Khang Hng ◽

Shu Su ◽

Noel Atkinson

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Endovascular Treatment ◽

Computer Tomography ◽

Lower Limb ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Left Lower Limb ◽

Deep Vein

Abstract Background May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required. Case presentation A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis. Conclusions Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.

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Clinical signs and risk factors of acute deep vein thrombosis of lower extremities in patients after abdominal surgery for cancer: efficiency and safety of different types of anticoagulant therapy

Critical Care ◽

10.1186/cc8593 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P361

Author(s):

O Tarabrin ◽

V Suslov ◽

S Kalinchuk ◽

S Tarasenko ◽

V Grubnik ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Abdominal Surgery ◽

Anticoagulant Therapy ◽

Clinical Signs ◽

Lower Extremities ◽

Vein Thrombosis ◽

Different Types ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661195 ◽

1984 ◽

Vol 52 (03) ◽

pp. 276-280 ◽

Cited By ~ 17

Author(s):

Sam Schulman ◽

Dieter Lockner ◽

Kurt Bergström ◽

Margareta Blombäck

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulation ◽

Dose Group ◽

Low Dose ◽

Clinical Signs ◽

Coagulation Factor ◽

High Dose ◽

Vein Thrombosis ◽

Heparin Treatment ◽

Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

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