Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.
Diagnosis ; Humans ; Ischemia ; Lower Extremity* ; Postthrombotic Syndrome ; Pulmonary Embolism ; Thrombectomy ; Thrombosis ; Venous Thrombosis ; Venous Valves

PURPOSE: Deep vein thrombosis of the lower extremity is a frequent disorder which may either occur spontaneously or following a high-risk situation such as major surgical procedures or prolonged period of immobilization. Untreated deep vein thrombosis is associated with morbidity and mortality due to pulmonary embolism and the postthrombotic syndrome. Factors in predicting the risk of deep vein thrombosis can be influenced by the variations of the medical and surgical conditions associated with it. Within the last few years, the knowledge of hereditary and acquired risk factor for deep vein thrombosis have increased, but yet not justified. METHOD: We describe why certain individuals develop deep vein thrombosis at varying times despite of similar risk factors, and also assess risk stratification as well as the value of thromboprophylaxis in medical and surgical patients. From January 1990 to December 1998, 73 patients who have developed deep vein thrombosis were admitted to our hospital. The patients' charts were reviewed retrospectively about risk factors according to age, site, associated medical and surgical conditions. RESULT: The older patients who have developed deep vein thrombosis generally had systemic disease, however the younger patient who have developed deep vein thrombosis had trauma, operation, previous deep vein thrombosis. The duplex scan was sufficient and accurate modality for diagnosis of deep vein thrombosis. CONCLUSION: The patients with risk factor may need to be under close observation and when deep vein thrombosis is diagnosed, prophylactic anticoagulation therapy may be beneficiary for patient's prognosis and pulmonary embolism prevalence. Further clinical research may be needed to help develop accurate methods of risk stratification and to clarify the benefits of thromboprophylaxis in high risk group.
Diagnosis ; Humans ; Immobilization ; Lower Extremity* ; Mortality ; Postthrombotic Syndrome ; Prevalence ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors* ; Venous Thrombosis*

OBJECTIVETo screening out the indices for diagnosis of traditional blood stasis syndrome (BSS) by investigating experts'experiences, evaluating their significance, for providing reference to the quantitative diagnosis of BSS.

METHODSUsing Delphi method, some diagnostic indices that being considered as importance by experts was screened out, and applied in 108 patients to assess their specificity and sensitivity in double-blinded condition, taking the Chinese diagnostic standard as gold standard.

RESULTSTen indices were screened out from 50 items for traditional observing on BSS, which are considered essential by experts uniform, and showed a coincidence rate of 91.4% when applied for comprehensive diagnosis of BSS.

CONCLUSIONThe indices for BSS diagnosis screened out by Delphi method can serve as a reference to the BSS quantitative diagnosis.

Adolescent ; Adult ; Aged ; Delphi Technique ; Diagnosis, Differential ; Double-Blind Method ; Female ; Humans ; Male ; Middle Aged ; Postthrombotic Syndrome ; diagnosis ; Young Adult

PURPOSE: Left side deep venous thrombosis (DVT) is associated with May-Thurner's anatomical variation and is often instigated by invasive treatment. The aim of this study is to analyze the influence of left iliac vein narrowness on incidence of post thrombotic syndrome (PTS) that developed after left side DVT. METHODS: Forty-one left side DVT cases that were followed up for more than 1 year were enrolled. The iliac vein narrowness was measured by the shortest distance from the right iliac artery to the 5th lumbar vertebra overlying left iliac vein in computed tomography (CT) scan. The incidence of PTS was measured by phone-call history taking for specific symptoms of PTS. The means of the shortest distance were compared by independent t-test. RESULTS: The number of PTS cases was eleven (26.8%). The level of thrombus, demographic data and other risk factors were similar in both PTS and non-PTS groups except the mean risk factor score. The mean of the shortest distance of PTS group and non-PTS group were 5.56 mm and 5.89 mm, respectively. CONCLUSION: The degree of left iliac vein narrowness measured by the shortest distance from the right iliac artery and the 5th lumbar vertebral body was not a predictive factor for PTS.
Iliac Artery ; Iliac Vein ; Incidence ; Postthrombotic Syndrome ; Risk Factors ; Spine ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis

PURPOSE: The aim of this study is to identify risk factors of postthrombotic syndrome (PTS) and evaluate the efficacy of catheter-directed thrombolysis (CDT) for preventing the development of PTS in patients with lower extremity deep vein thrombosis (DVT). MATERIALS AND METHODS: From 2005 January to 2013 December, 139 limbs of 126 patients were included in this study who had the first episode of proximal DVT at the affected limb and who had visited our out-patient clinic. CDT was performed on 55 limbs (39.6%). We achieved complete recanalization in 39 limbs (70.9%) and partial recanalization (residual thrombus < 50.0%) in 16 limbs (29.1%). We retrospectively reviewed medical records for possible predictors of PTS. RESULTS: Median follow-up duration was 83 months (range, 30–136 months). No differences were found between the CDT and non-CDT group in age, gender, duration of symptom, use of anticoagulation and recurrence of DVT. A significantly higher thrombotic burden was observed in the CDT group (P=0.009). In a binary logistic regression model, patients with PTS had significantly higher body mass index (BMI) (odds ratio [OR], 1.303; 95% confidence interval [CI], 1.079–1.574; P=0.006) and longer thrombotic burden involved in ilio-femoro-popliteal DVT (OR, 3.666; 95% CI, 1.093–12.296; P=0.035). CDT did not influence the risk of PTS (P>0.05). CONCLUSION: We suggest that CDT is not effective in preventing PTS, while higher BMI and longer thrombotic burden are associated with the development of PTS in patients with DVT.
Body Mass Index ; Extremities ; Follow-Up Studies ; Humans ; Logistic Models ; Lower Extremity ; Medical Records ; Outpatients ; Postthrombotic Syndrome ; Recurrence ; Retrospective Studies ; Risk Factors ; Thrombosis ; Venous Thrombosis

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.
Antibodies, Anticardiolipin ; Antiphospholipid Syndrome ; Humans ; Iliac Artery ; Iliac Vein ; Lower Extremity ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; May-Thurner Syndrome ; Obesity ; Postthrombotic Syndrome ; Pregnancy ; Smoke ; Smoking ; Stents ; Thrombectomy ; Venous Thrombosis

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.
Antibodies, Anticardiolipin ; Antiphospholipid Syndrome ; Humans ; Iliac Artery ; Iliac Vein ; Lower Extremity ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; May-Thurner Syndrome ; Obesity ; Postthrombotic Syndrome ; Pregnancy ; Smoke ; Smoking ; Stents ; Thrombectomy ; Venous Thrombosis

PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. METHODS: Between Jan. 1999 and Dec. 2002, 29 consecutive patients with DVT had received thrombolytic therapy. The male: female ratio was 6: 23 and the mean age was 50.3+/-13.5 years. The mean duration of symptom was 9.9+/-22.1 days. Catheter-directed infusions of urokinase were administrated via ipsilateral popliteal veins and the angioplasty and stent placement performed after the thrombolytic procedure. The mean dosage of urokinase and duration of thrombolysis were 2, 435, 000+/-887, 000 units and mean duration of thrombolysis was 36.8+/-17.9 hours. Oral medication of warfarin continued at least six months or more. To evaluate the venous patency, duplex ultrasonography or CT venography were performed. RESULTS: Lysis was complete in 17 patients (58.6%, all acute DVT), partial in 11 (37.9%), with only one patient failing. Iliac vein stenosis had shown in 16 patient after thrombdysis. Which were treated with balloon angioplasty and stent insertion. As a postprocedural complication, vaginal bleeding occurred in two patients; one was treated with transfusion but the other stopped without treatment. CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. However further study will be reguired to evaluate the relationship between the incidence of postthrombotic syndrome and thrombolytic therapy alone.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic ; Female ; Humans ; Iliac Vein ; Incidence ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Postthrombotic Syndrome ; Stents ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator* ; Uterine Hemorrhage ; Venous Thrombosis* ; Warfarin

OBJECTIVESTo confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment.

METHODSIFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS).

RESULTSThe positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05).

CONCLUSIONSThe present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

Adult ; Aged ; Animals ; Disease Models, Animal ; Female ; Femoral Vein ; Humans ; Iliac Vein ; Male ; Middle Aged ; Postthrombotic Syndrome ; metabolism ; pathology ; surgery ; Rats ; Rats, Sprague-Dawley ; Retrospective Studies ; Tissue Plasminogen Activator ; metabolism ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; metabolism