Blood Vessels ; injuries ; Extremities ; blood supply ; injuries ; Humans ; Ligation ; Pulmonary Embolism ; etiology ; prevention & control ; Vascular Surgical Procedures ; methods ; Venous Thrombosis ; etiology ; prevention & control

PURPOSE: Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS. METHODS: A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference. RESULTS: In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy. CONCLUSION The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.
Humans ; Venous Thromboembolism/prevention & control* ; Venous Thrombosis/etiology* ; Retrospective Studies ; Pulmonary Embolism/complications* ; Lower Extremity ; Risk Factors

PURPOSE: The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in Korean patients who underwent hip fracture surgery (HFS). MATERIALS AND METHODS: Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. RESULTS: Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. CONCLUSION: The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.
Aged ; Anticoagulants/*therapeutic use ; Female ; Heparin, Low-Molecular-Weight/*therapeutic use ; Hip Fractures/classification/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Pulmonary Embolism/etiology/*prevention & control ; Republic of Korea ; Venous Thromboembolism/*prevention & control ; Venous Thrombosis/etiology/*prevention & control

We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3). Incidences of symptomatic deep vein thrombosis (DVT) and PE, and major or minor bleeding complications were evaluated. Majority of the patients (86%) were assessed to be with standard risks both for PE and bleeding. No patient experienced symptomatic DVT or PE and major bleeding. Eleven percent of the patients discontinued chemoprophylaxis because of bleeding-related wound complication. In conclusion, the 1st AAOS guideline functions successfully in Korean patients undergoing TKA in terms of prevention of symptomatic DVT and PE while avoiding major bleeding complications.
Aged ; Arthroplasty, Replacement, Knee/*adverse effects ; Aspirin/administration & dosage ; Cohort Studies ; Enoxaparin/administration & dosage ; Female ; Fibrinolytic Agents/administration & dosage ; Humans ; Male ; Middle Aged ; Orthopedics ; Postoperative Complications/etiology/*prevention & control ; Postoperative Hemorrhage/etiology/prevention & control ; *Practice Guidelines as Topic ; Pulmonary Embolism/etiology/*prevention & control ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Societies, Medical ; Stockings, Compression ; Venous Thrombosis/etiology/prevention & control

OBJECTIVETo evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism (PE) in lower limb bone fracture patients with deep venous thrombosis (DVT).

METHODSFrom January 2003 to December 2012, 2 248 cases of lower limb and pelvic fractures with DVT were retrospectively analyzed. Before the procedure of IVCF implantation began, January 2003 to December 2007, there were 1 052 cases of acute trauma patients with DVT were classified as the group of early none-IVCF. The IVCF implantation was began since January 2008. From that time to December 2012, 712 cases of bone fractures with DVT received filter implantation, which were classified as IVCF group. The other 484 patients who had not undergone filter deployment were divided as group of late none-IVCF. The baseline conditions of the three groups were significantly different in addition to the ages between group of early none-IVCF and IVCF group. The incidences of PE and mortality of PE in each group were recorded and analyzed by χ(2) test.

RESULTSThere were totally 31 cases of symptomatic PE, among which 12 cases died. Totally 712 filters were deployed successfully without any major complications. The incidences of symptomatic PE were 0.14% (1/712), 2.19% (23/1 052) and 1.45% (7/484) in IVCF group, group of early none-IVCF and group of late none-IVCF, respectively. The mortality of PE were 0 (0/712), 0.86% (9/1 052) and 0.62% (3/484) in these groups. The incidence of symptomatic PE in IVCF group was significantly different from that in the group of early and late none-IVCF (χ(2) = 11.762, P = 0.001; χ(2) = 7.395, P = 0.007, respectively). The mortality of IVCF group was also significantly lower compared with the other two groups (χ(2) = 6.122, P = 0.013; χ(2) = 4.424, P = 0.035, respectively).

CONCLUSIONIVCF implantation effectively prevents symptomatic and fatal PE of patients of lower limb and pelvic fractures with DVT in the peri-operative period.

Adult ; Aged ; Female ; Humans ; Leg Injuries ; complications ; Lower Extremity ; Male ; Middle Aged ; Pulmonary Embolism ; etiology ; prevention & control ; Retrospective Studies ; Vena Cava Filters ; Venous Thrombosis ; complications

INTRODUCTIONWith the increased use of filler and fat injections for aesthetic purposes, there has been a corresponding increase in the incidence of complications. Vision loss as an uncommon but devastating vascular side effect of filler injections was the focus of this paper.

METHODSA review committee, consisting of plastic surgeons, aesthetic medical practitioners, ophthalmologists and dermatologists from Singapore, was convened by the Society of Aesthetic Medicine (Singapore) to review and recommend methods for the prevention and management of vision loss secondary to filler injections.

RESULTSThe committee agreed that prevention through proper understanding of facial anatomy and good injection techniques was of foremost importance. The committee acknowledged that there is currently no standard management for these cases. Based on existing knowledge, injectors may follow a proposed course of action, which can be divided into immediate, definitive and supportive. The goals were to reduce intraocular pressure, dislodge the embolus to a more peripheral location, remove or reverse central ischaemia, preserve residual retinal function, and prevent the deterioration of vision. Dissolving a hyaluronic acid embolus remains a controversial option. It is proposed that injectors must be trained to recognise symptoms, institute immediate actions and refer patients without delay to dedicated specialists for definitive and supportive management.

CONCLUSIONSSteps to prevent and manage vision loss based on current evidence and best clinical practices are outlined in this paper. Empirical referral to any emergency department or untrained doctors may lead to inordinate delays and poor outcomes for the affected eye.

Blindness ; etiology ; prevention & control ; Dermal Fillers ; adverse effects ; Embolism ; Esthetics ; Humans ; Hyaluronic Acid ; adverse effects ; Iatrogenic Disease ; Incidence ; Injections ; adverse effects ; Ophthalmology ; Singapore ; Societies, Medical

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

OBJECTIVESTo study the efficacy of proximal embolic protection device in preventing intracranial artery embolization during carotid artery stenting (CAS) and to evaluate its security and maneuverability.

METHODSFrom October 2007 to July 2008, 23 patients with carotid artery stenosis who were suitable for surgical therapy according to the standards of NASCET or ACAS were enrolled in this clinical research. Among them 19 patients (82.6%) were symptomatic, 6 patients (26.1%) with 50%-70% stenosis and 17 cases (73.9%) with > 70% stenosis. All the patients received carotid angioplasty and stenting under the protection of MO. MA system (one kind of proximal embolic protection device). We recorded the cerebral ischemic time during the procedure and observed neurologic events within 30 days.

RESULTSAll the procedures were performed successfully, the mean carotid artery blocking time was (5.3 +/- 1.2) min. No death or stroke occurred during perioperative period. Two cases of patients developed transient loss of consciousness combined with contralateral limb convulsion, while the common carotid artery was occluded by balloon. Two cases of patients developed bradycardia, sustained 6 hours and 1 week. Plaque debris in the withdrawal blood from carotid artery were found in 9 cases. At 30-day follow-up after CAS, TIA occurred in 1 case, new contralateral stroke occurred in 1 case, the incidence of 30-day stroke and death rate was 4.3%.

CONCLUSIONThe application of proximal embolic protection device in CAS procedure for preventing neurologic complications is safe and effective, especially for severe stenosis and unstable plaque in carotid artery stenting.

Aged ; Aged, 80 and over ; Angioplasty, Balloon ; instrumentation ; methods ; Carotid Stenosis ; surgery ; Embolic Protection Devices ; Female ; Follow-Up Studies ; Humans ; Intracranial Embolism ; etiology ; prevention & control ; Male ; Postoperative Complications ; prevention & control ; Stents ; Treatment Outcome

PURPOSE: To compare the effectiveness of device closure and medical therapy in prevention of recurrent embolic event in the Korean population with cryptogenic stroke and patent foramen ovale (PFO). MATERIALS AND METHODS: Consecutive 164 patients (men: 126 patients, mean age: 48.1 years, closure group: 72 patients, medical group: 92 patients) were enrolled. The primary end point was a composite of death, stroke, transient ischemic attack (TIA), or peripheral embolism. RESULTS: Baseline characteristics were similar in the two groups, except age, which was higher in the medical group (45.3±9.8 vs. 50.2±6.1, p<0.0001), and risk of paradoxical embolism score, which was higher in the closure group (6.2±1.6 vs. 5.7±1.3, p=0.026). On echocardiography, large right-to-left shunt (81.9% vs. 63.0%, p=0.009) and shunt at rest/septal hypermobility (61.1% vs. 23.9%, p<0.0001) were more common in the closure group. The device was successfully implanted in 71 (98.6%) patients. The primary end point occurred in 2 patients (2 TIA, 2.8%) in the closure group and in 2 (1 death, 1 stroke, 2.2%) in the medical group. Event-free survival rate did not differ between the two groups. CONCLUSION: Compared to medical therapy, device closure of PFO in patients with cryptogenic stroke did not show difference in reduction of recurrent embolic events in the real world's setting. However, considering high risk of echocardiographic findings in the closure group, further investigation of the role of PFO closure in the Asian population is needed.
Adult ; Aged ; Aged, 80 and over ; Cardiac Catheterization/adverse effects ; Disease-Free Survival ; Embolism/etiology/*prevention & control ; Female ; Fibrinolytic Agents/adverse effects/*therapeutic use ; Foramen Ovale, Patent/complications/*drug therapy/mortality/*surgery ; Humans ; Ischemic Attack, Transient/*drug therapy/mortality/*surgery ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk ; Secondary Prevention/methods ; *Septal Occluder Device/adverse effects ; Stroke/etiology/prevention & control ; Treatment Outcome

OBJECTIVETo discuss the efficacy of anticoagulation on patency post-permanent inferior vena caval filter (IVCF) placements.

METHODSThe patients with deep vein thrombosis (DVT) of the lower extremity who were accepted permanent IVCF placement from December 2001 to December 2007 were reviewed retrospectively. Data on vital status, filter thromboembolism, anticoagulation time, and so on were obtained through follow-up. One hundred and thirty eight patients (75 male and 63 female) with a mean age of 65 years were enrolled in the study. All the patients were divided into non-anticoagulation group, anticoagulation group A with taking warfarin less than 6 months, or anticoagulation group B with taking warfarin more than 6 months. chi(2) test, t test, Kaplan-Meier survival curve, Log-rank test were used for statistics analysis.

RESULTSSixteen patients died, and 1 of them died of pulmonary embolism. Including the 1 patient mentioned before, there were 19 patients (13.8%) suffered from filter thromboembolism. Upon chi(2) test, there were no significant differences (P = 0.288) on the patency rates between non-anticoagulation, anticoagulation group A and anticoagulation group B (87.8%, 75.0%, and 88.3% respectively). Upon Kaplan-Meier survival analysis, there were still no significant differences (P = 0.227) on the mean patency time and the cumulate rates of patency at the 1st or 3rd year between the 3 groups (87.1%, 80.0%, 94.8% and 87.1%, 74.3%, 85.4% respectively).

CONCLUSIONAnticoagulation has no efficacy on patency post-permanent IVCF placements.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Equipment Failure ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pulmonary Embolism ; etiology ; prevention & control ; Retrospective Studies ; Vena Cava Filters ; Venous Thrombosis ; complications ; Warfarin ; therapeutic use