Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied. The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured, furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%, 66.7%, 97.0%, 100%, and 97.1%, and 98.4%, 83.3%, 98.4%, 83.3%, and 97.1%, respectively. The plasma D-dimer in acute phase 〔(6 451±4 012.22) μg/L〕 and subacute phase 〔(2 063±1831.35) μg/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310±66.70) μg/L〕, Plt;0.01 and Plt;0.05, which was not different from that in chronic phase 〔(466±350.52) μg/L〕. Meanwhile, the plasma D-dimer in mixed limb venous thrombosis group 〔(4 464±3 753.16) μg/L〕 and central limb venous thrombosis group 〔(2 149±1 911.53) μg/L〕 were significantly higher than that in control group (Plt;0.05 and Plt;0.01), which was not different from that in peripheral limb venous thrombosis group 〔(560±315.62) μg/L〕. Conclusion Color Doppler ultrasonography is an optimal method and the plasma D-dimer is a predictive index in diagnosis of lower limb DVT.
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
With the widespread promotion and application of the Enhanced Recovery After Surgery (ERAS) concept in the surgical fields, the implementation of the ERAS concept in the treatment of lower extremity deep venous thrombosis (DVT) was explored in the vascular surgery. The “Six-Step” comprehensive treatment protocol and the establishment of the ERAS system for lower extremity DVT developed by the Department of Vascular Surgery at the First Affiliated Hospital of Chongqing Medical University were elaborated. The protocol includes steps such as filter placement, thrombus clearance, relief of venous outflow obstruction, dissolution of residual thrombus, filter retrieval, and standardized post-discharge anticoagulation management, along with their respective advantages. Additionally, the training and dissemination efforts undertaken to promote the “Six-Step” comprehensive treatment protocol were described. A comparison was made between ERAS and traditional recovery surgery, highlighting the comprehensive clinical benefits of the former. The aim is to promote the standardized implementation of the ERAS system in lower extremity DVT treatment and to bring greater benefits to patients.
Venous thromboembolism (VTE), comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that contributes significantly to the global burden of disease. The American College of Chest Physicians (ACCP) published the 9th edition of antithrombotic treatment guidelines for VTE (AT9) in 2012, which was first updated in 2016. In October 2021, ACCP published the 2nd update to AT9, which addressed 17 clinical questions related to VTE and presented 29 guidance statements in total. In this paper we interpreted the recommendations proposed in this update of the guidelines.
目的探讨低分子肝素预防下肢静脉曲张术后深静脉血栓形成的临床效果。 方法将2011年1月至2013年12月期间于笔者所在医院行大隐静脉高位结扎＋分段剥脱术＋腔内激光闭合术的513例下肢静脉曲张患者随机分为2组：低分子肝素组238例，下肢静脉曲张术后采用低分子肝素预防性治疗；对照组275例，术后不采用任何抗凝药物。比较2组患者深静脉血栓形成和并发症发生情况。 结果低分子肝素组发生浸透敷料的出血14例（5.9%），切口出血或皮下血肿25例（10.5%），血小板减少1例（0.4%），肝功能异常2例（0.8%），无深静脉血栓形成发生；对照组发生浸透敷料的出血19例（6.9%），切口出血或皮下血肿27例（9.8%），肝功能异常2例（0.7%），深静脉血栓形成7例（2.5%），无血小板减少发生。2组患者浸透敷料的出血、切口出血或皮下血肿、血小板减少及肝功能异常发生率比较差异均无统计学意义（P＞0.05），但低分子肝素组深静脉血栓形成的发生率低于对照组（P＜0.05）。术后获访487例，随访时间为4～12个月，平均10个月。其中低分子肝素组获访225例，对照组获访262例。获访患者随访期间发生下肢静脉曲张复发9例（低分子肝素组4例，对照组5例），隐神经损伤11例（低分子肝素组5例，对照组6例），无远期下肢深静脉血栓形成病例。2组患者的下肢静脉曲张复发率和隐神经损伤发生率比较差异均无统计学意义（P＞0.05）。 结论采用低分子肝素预防下肢静脉曲张术后下肢深静脉血栓形成具有良好的临床效果和安全性，值得临床推广应用。
目的:评价综合康复措施对预防地震髋部骨折伤员深静脉血栓形成的作用。方法：按深静脉血栓形成的高危因素对195例地震髋部骨折伤员进行分级评估,并针对性实施综合康复措施,观察深静脉血栓的症状和体征,了解深静脉血栓的发生情况。结果：地震髋部骨折伤员应用综合康复措施后,尚未发现下肢深静脉血栓形成的病例。结论：综合康复措施能有效地预防地震髋部骨折伤员深静脉血栓的形成。
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.
Objective To explore the efficiency of artificial intelligence algorithm model using preoperative blood indexes on the prediction of deep vein thrombosis (DVT) in patients with lower limb fracture before operation. Methods Patients with lower limb fracture treated in the Department of Orthopedics of Deyang People’s Hospital between January 2018 and December 2022 were retrospectively selected. Their basic and clinical data such as age, gender, height and weight, and laboratory examination indicators at admission were collected, then the neutrophi to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR) were calculated. According to color Doppler ultrasound indication of DVT in lower extremities at admission, the patients were divided into DVT group and non-DVT group. After data preprocessing, grey relational analysis (GRA) was used to screen the combination model of important predictive features of DVT, and BP neural network prediction model was established using the selected features. Finally, the accuracy of BP neural network prediction model was evaluated, and was compared with those of different models in clinical prediction of DVT. Results A total of 4033 patients with lower limb fracture were enrolled, including 3127 cases in the DVT group and 906 cases in the non-DVT group. GRA selected seven important predictive features: absolute lymphocyte value, NLR, MLR, PLR, plasma D-dimer, direct bilirubin, and total bilirubin. The accuracies of logistic regression analysis, random forest, decision tree, BP neural network and GRA-BP neural network combination model were 74%, 76%, 75%, 84% and 87%, respectively. The GRA-BP neural network combination model had the highest accuracy. Conclusion The GRA-BP neural network selected in this paper has the highest accuracy in preoperative DVT risk prediction in patients with lower limb fracture, which can provide a reference for the formulation of DVT prevention strategies.
ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.