An interesting case of an atraumatic painful swollen limb in a pregnant woman

2021 ◽  
Author(s):  
Debkumar Chowdhury
Keyword(s):  
Femoral Vein ◽  
Immunoglobulin Therapy ◽  
Interesting Case ◽  
Vein Thrombosis ◽  
History Of ◽  
The Common ◽  
Bedside Ultrasonography ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens ◽  
Inpatient Basis

Phlegmasia cerulea dolens is an uncommon complication of deep venous thrombosis. This is associated with high rates of morbidity if not treated effectively. We present a young lady 13 weeks pregnant with one-day history of left lower limb swelling with pain and discolouration. Bedside ultrasonography revealed thrombosis occluding the common femoral vein and collateral femoral vein. She had history of neonatal alloimmune thrombocytopaenia (NAIT), and had immunotherapy previously. The safest option was to give low molecular weight heparin (LMWH) on an inpatient basis. Anticoagulation with LMWH has been well established as thromboprophylaxis during pregnancy, however, the safety profile of systemic anticoagulation is matter of debate. As highlighted in this scenario the management needs to be tailored on an individual basis. The cause for the extensive deep vein thrombosis could be possibly due to the recent immunoglobulin therapy, undiagnosed prothrombotic state (outwith pregnancy) or the procoagulant state associated with pregnancy.

A murine model of deep vein thrombosis Characterization and validation in transgenic mice

2005 ◽  
Vol 94 (09) ◽  
pp. 498-503 ◽  
Author(s):  
Linda Szema ◽  
Chao-Ying Chen ◽  
Jeffrey P. Schwab ◽  
Gregory Schmeling ◽  
Brian C. Cooley
Keyword(s):  
Deep Vein Thrombosis ◽  
Murine Model ◽  
Femoral Vein ◽  
Previous History ◽  
Bed Rest ◽  
Major Surgery ◽  
Vein Thrombosis ◽  
Transgenic Lines ◽  
History Of ◽  
Deep Vein

SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.

Incidence of deep vein thrombosis in patients undergoing breast reconstruction with autologous tissue transfer

2016 ◽  
Vol 32 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Hisato Konoeda ◽  
Takashi Yamaki ◽  
Atsumori Hamahata ◽  
Masakazu Ochi ◽  
Atsuyoshi Osada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Breast Reconstruction ◽  
Femoral Vein ◽  
Pedicled Flap ◽  
Autologous Tissue ◽  
Vein Thrombosis ◽  
Tissue Transfer ◽  
The Common ◽  
Deep Vein

Background Breast reconstruction is associated with multiple risk factors for venous thromboembolism. However, the incidence of deep vein thrombosis in patients undergoing breast reconstruction is uncertain. Objective The aim of this study was to prospectively evaluate the incidence of deep vein thrombosis in patients undergoing breast reconstruction using autologous tissue transfer and to identify potential risk factors for deep vein thrombosis. Methods Thirty-five patients undergoing breast reconstruction were enrolled. We measured patients’ preoperative characteristics including age, body mass index (kg/m2), and risk factors for deep vein thrombosis. The preoperative diameter of each venous segment in the deep veins was measured using duplex ultrasound. All patients received intermittent pneumatic pump and elastic compression stockings for postoperative thromboprophylaxis. Results Among the 35 patients evaluated, 11 (31.4%) were found to have deep vein thrombosis postoperatively, and one patient was found to have pulmonary embolism postoperatively. All instances of deep vein thrombosis developed in the calf and were asymptomatic. Ten of 11 patients underwent free flap transfer, and the remaining one patient received a latissimus dorsi pedicled flap. Deep vein thrombosis incidence did not significantly differ between patients with a free flap or pedicled flap (P = 0.13). Documented risk factors for deep vein thrombosis demonstrated no significant differences between patients with and without deep vein thrombosis. The diameter of the common femoral vein was significantly larger in patients who developed postoperative deep vein thrombosis than in those who did not ( P < 0.05). Conclusions The morbidity of deep vein thrombosis in patients who underwent breast reconstruction using autologous tissue transfer was relatively high. Since only the diameter of the common femoral vein was predictive of developing postoperative deep vein thrombosis, postoperative pharmacological thromboprophylaxis should be considered for all patients undergoing breast reconstruction regardless of operative procedure.

scholarly journals Significance of Partial or Complete Thrombosis of the Common and Deep Femoral Vein in Patients With Deep Vein Thrombosis

2019 ◽  
Vol 58 (4) ◽  
pp. 570-575
Author(s):  
Rikke Broholm ◽  
Niels Bækgaard ◽  
Susanne Hansen ◽  
Charlotte Strandberg ◽  
Christina Kinnander ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Femoral Vein ◽  
Vein Thrombosis ◽  
The Common ◽  
Complete Thrombosis ◽  
Deep Vein

Feasibility of identifying deep vein thrombosis characteristics with contrast enhanced MR-Venography

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 119-124 ◽  
Author(s):  
CWKP Arnoldussen ◽  
RHW Strijkers ◽  
DMJ Lambregts ◽  
MJ Lahaye ◽  
R de Graaf ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Interobserver Agreement ◽  
Average Duration ◽  
Femoral Vein ◽  
Mr Venography ◽  
Common Femoral Vein ◽  
Vein Thrombosis ◽  
Contrast Enhanced ◽  
The Common ◽  
Deep Vein

Purpose To assess the feasibility of identifying deep vein thrombosis characteristics with contrast enhanced magnetic resonance venography. Materials and Methods A total of 53 cases of deep vein thrombosis extending in and/or above the common femoral vein were evaluated by 4 independent observers (2 expert, 2 novice) using pre-determined characteristics to determine the thrombosis present to be acute, sub-acute or old. If present, chronic remnants of a previous deep vein thrombosis were reported. Additionally these image qualifications were compared to the reported duration of complaints. Results In all cases all observers were able to qualify the thrombosis. The interobserver agreement between the experts was excellent (kappa 0.97) and good between expert and novice (kappa 0.82). Thrombosis identified as acute had an average duration of complaints of 6,5 (2–13) days, sub‐acute 13 (8–18) days and old 22 (15–32) days. Conclusion Qualification of thrombosis as acute, sub-acute or old and identification of chronic remnants of DVT with CE-MRV using routinely identifiable characteristics is feasible and reproducible with good to excellent interobserver agreement.

scholarly journals Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis

2016 ◽  
Vol 39 (3) ◽  
pp. 178-181 ◽  
Author(s):  
Young-Kyun Kim ◽  
Ho Jong Chun ◽  
Jeong Kye Hwang ◽  
Ji Il Kim ◽  
Sang Dong Kim ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Femoral Vein ◽  
Cystic Disease ◽  
Common Femoral Vein ◽  
Vein Thrombosis ◽  
Adventitial Cystic Disease ◽  
The Common ◽  
Deep Vein

Thrombolysis in Deep Vein Thrombosis: Is there still an Indication?

2001 ◽  
Vol 86 (07) ◽  
pp. 499-508 ◽  
Author(s):  
Alan Forster ◽  
Philip Wells
Keyword(s):  
Thrombolytic Therapy ◽  
Meta Analysis ◽  
Local Therapy ◽  
Therapeutic Modality ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

SummaryThe most accepted therapy for DVT consists of anticoagulation with unfractionated heparin or low molecular weight heparin, followed by variable duration oral anticoagulation but thrombolytic therapy has been proposed in addition to standard anticoagulation. This paper reviews the literature on post thrombotic syndrome, the natural history of vein patency after therapy, and we perform a systematic review, using accepted standards for meta-analysis, to determine the outcomes when thrombolytic therapy is used to treat DVT. We demonstrate that thrombolytic therapy for DVT results in a significant increase in the risk of major hemorrhage and a significant increase in the rate of vein patency. However, although thrombolytic therapy is advantageous over anticoagulation as measured by early vein patency, a benefit in terms of a reduction in PTS risk, is unproven. Our review also shows that there is no evidence that there is a difference in efficacy between thrombolytic agents or that local therapy differs from systemic therapy. Finally, the potential role of catheter directed therapy is unknown since appropriate trials have not been performed but it is reasonable to use catheter directed therapy in patients with phlegmasia cerulea dolens. We conclude that more work is needed to define the role of thrombolytic therapy but it is too early to abandon this therapeutic modality.

Phlegmasia cerulea dolens – an uncommon but alarming manifestation of deep vein thrombosis

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 422-426
Author(s):  
Manuela Nickler ◽  
Sebastian Haubitz ◽  
Adriana Méndez ◽  
Martin Gissler ◽  
Peter Stierli ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Bleeding Risk ◽  
Venous Intervention ◽  
Aggressive Treatment ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Surgical Thrombectomy ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Summary: In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient’s bleeding risk.

The Utility of Non-invasive Tests for Detection of Previous Proximal-vein Thrombosis

1995 ◽  
Vol 73 (04) ◽  
pp. 592-596 ◽  
Author(s):  
Sabina Villalta ◽  
Paolo Prandoni ◽  
Alberto Cogo ◽  
Paola Bagatella ◽  
Andrea Piccioli ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Femoral Vein ◽  
Clinical Score ◽  
Diagnostic Methods ◽  
Popliteal Vein ◽  
Venous Reflux ◽  
Study Objective ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
The Common

SummaryBackground. Despite the availability of several diagnostic methods for the detection of deep-vein thrombosis (DVT), the identification of previous episodes of DVT remains a diagnostic challenge.Study objective. To assess the reliability of a combination of a standardized clinical score with three non-invasive tests: compression ultrasonography (CUS), Doppler ultrasound (DUS), and photoplethysmography (PPG), in determining the presence or the absence of previous proximal DVT.Methods. One hundred consecutive unselected outpatients were identified, who had undergone contrast venography six to nine years previously because of the clinical suspicion of DVT (confirmed in 43). They were blindly reinvestigated by a panel of trained operators unaware of venography results. They underwent a clinical evaluation of the lower limb, by applying a standardized score to five symptoms and six signs (grading each item from 0 to 3); a PPG test to determine the venous refilling time; a DUS test to determine the venous reflux separately in the common femoral and the popliteal vein; and a CUS test to determine vein compressibility in the same regions.Results. An abnormal CUS test and/or the demonstration of venous reflux in the popliteal region and/or a high clinical score (≥ 8) identified twenty-four of the 43 (56%) DVT + patients with a specificity of 89%. The combination of normal CUS with the absence of venous reflux in both the common femoral and popliteal vein and a low clinical score excluded previous thrombosis in 45 (79%) of the 57 DVT- patients (negative predictive value, 78%). Abnormal venous reflux in the isolated common femoral vein did not reliably predict the presence or absence of previous DVT. However, this occurred in only 13 (13%) patients. The PPG determination of venous refilling time did not improve the results obtained with the other tests.Conclusions. The combination of a standardized clinical evaluation with the results of CUS and DUS can reliably diagnose or exclude previous proximal-vein thrombosis in almost 90% of patients with previous episodes of suspected DVT.

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