ObjectiveTo evaluate the treatment effective of deep vein thrombosis (DVT) of low extremities. MethodsThe clinical data of 86 patients with DVT were analyzed retrospectively, which were divided into thromboectomy group (12 patients) and thrombolysis group (74 patients) according to the therapy methods. The thromboectomy group patients were treated by thromboectomy using Fogarty balloon catheter plus thrombolytie, thrombolysis group patients were treated by thrombolysis (urokinase or antithrombus enzyme of viper). ResultsThere were 8 cases healed, 4 cases relieved, 0 invalidated in the thromboectomy group and 15 cases healed, 50 cases relieved, 9 cases invalidated in the thrombolysis group at discharge. During 3-100 months of following up with an average 27 months, 10 cases and 62 cases were examined by Bultrasonic in the thromboectomy group and thrombolysis group, respectively, 6 cases were not damaged in the function of valves of the thromboectomy group, 9 cases were not damaged in the function of valves of the thrombolysis group. The rates of acute response, longtime patency, and normal valve in the thromboectomy group were higher than those in the thrombolysis group (Plt;0.05), the rate of post-thrombotic syndrome in the thromboectomy group was lower than that in the thrombolysis group (Plt;0.05). ConclusionsEarly thromboectomy is an effective way of restoring the fluency of deep vein and protecting the efficiency of the vein value organization, and reducing the sequela of DVT. Thrombolysis can only relieve the symptomation, but it can not protect the crawling and relapsing of thrombus.
Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
OBJECTIVE The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve. METHODS Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons. RESULTS In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted. CONCLUSION It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo analyze the causes of lower extremity varicose veins and assess the value of deep vein imaging in diagnosing and treating venous diseases, according to deep vein angiography examination results under digital subtraction angiography. MethodsDuring January 2012 to January 2013, 689 cases of lower limb varicose veins in 394 patients underwent lower extremity deep venous anterograde contrast examination, among which 87 patients also underwent left femoral venous trocar puncture angiography examination and 46 patients underwent femoral vein puncture inferior vena cava angiography examination at the same time. Then the results of imaging data were analyzed. ResultsThe causes of lower limb varicosity, according to its incidence, were as follows:primary deep venous valve incompetence (349 limbs of 184 patients) accounting for 50.7%, simple varicose veins of lower limbs (148 limbs of 95 patients) accounting for 21.5%, left iliac vein compression syndrome (121 limbs of 69 patients) accounting for 17.6%, cloth plus syndrome (54 limbs of 34 patients) accounting for 7.8%, post-thrombotic syndrome (16 limbs of 11 patients) accounting for 2.3%, and Klipple-Trenaunay syndrome (1 patient) accounting for 0.1%. ConclusionVaricose vein of lower limb is a common clinical manifestation of a variety of diseases, and the primary deep venous valve incompetence is the leading cause. Varicose veins of lower limb deep vein angiography is a reliable method for examination of lower extremity venous disease, and a basis for the choice of other treatments as well.
The tendons of semitendinosus and biceps femoris were transposed in front of the popliteal vein in a "U" shaped loop with the purpose to impede the venous back-flow. This type of operation was used in 10 cases with the aim to treat incompetence of deep vein of the lower extremity. Following the operation, patients were under clinical observation and undertaken retrograde venographie examination. It was proved that the results after operation were satisfactory with the disapperance of symptoms and subsequent healing of ulcers.
The way of intravenous drug abuse is to puncture the peripheral blood vessels and inject the drug directly into the blood. Therefore, this method has an impact on the peripheral artery and venous system of the users, and can cause a variety of peripheral vascular diseases, such as phlebitis, deep vein thrombosis, chronic venous insufficiency, phlebangioma, atherosclerosis, acute arterial ischemia, pseudoaneurysm, etc. However, due to the particularity of drug abusers, the vascular complications caused by intravenous drug abuse have not attracted enough attention. This paper reviewed the types and pathogenesis of peripheral vascular diseases caused by intravenous drug abuse, so as to improve the clinical understanding of peripheral vascular diseases caused by intravenous drug abuse, improve the prognosis of patients, reduce occupational exposure of medical staff, and play a certain role in social warning.
ObjectiveTo evaluate the safety and efficacy of rivaroxaban for prevention of deep vein thrombosis (DVT) in patients with preoperative abnormal D-dimer after total knee arthroplasty (TKA). MethodsBetween August and September 2013,60 consecutive patients with varus knee osteoarthritis undergoing unilateral TKA were enrolled in the study.According to the preoperative D-dimer level,the patients were divided into 2 groups:D-dimer normal group (control group,n=41) and D-dimer abnormal group (test group,n=19).No significant difference was found in gender,age,body mass index,and preoperative knee range of motion between 2 groups (P>0.05).All patients underwent conventional primary TKA and anticoagulation therapy with rivaroxaban to prevent DVT.The tourniquet use time,postoperative hospitalization time,and total hospitalization time were compared between 2 groups.At 1,3,and 5 days after operation,prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB),and D-dimer were measured.Wound complications and DVT were observed. ResultsThe postoperative hospitalization time of the test group was significantly longer than that of the control group (t=2.327,P=0.031),while the tourniquet use time and total hospitalization time showed no significant difference between 2 groups (P>0.05).All the patients were followed up 6-8 months (mean,7.2 months).Wound complications occurred in 3 cases (7.3%) of the control group and in 2 cases (10.5%) of the test group,showing no significant difference (χ2=0.175,P=0.676).Color ultrasonography showed no pulmonary embolism and DVT at 6 weeks after TKA.There were significant differences in PT,TT,and FIB between at pre- and post-TKA in the same group,but no significant difference was found between 2 groups.The APTT and D-dimer had significant differences between at pre- and post-TKA in the same group,and between groups.There was no significant interaction effect between time and group for each index. ConclusionPreoperative abnormal D-dimer level should not be regarded as a contraindication for TKA.The risks of DVT and wound complications in patients with abnormal D-dimer level are similar to patients with normal D-dimer level using rivaroxaban administration after TKA.It is unnecessary to conventional monitor D-dimer and other coagulation and hemorrhage laboratory tests in the patients after TKA.
Objective To investigate the pathogenesis of deep vein thrombosis (DVT) after total hip arthroplasty (THA) and the preventive effectiveness of low molecular weight heparin (LMWH). Methods The occurrence condition of DVT in 90 cases undergoing THA treated with LMWH between February 2003 and March 2004 was restrospectively analyzed. Among 90 cases, 39 were treated with LMWH at a dose of 5 000 U/day (high dose group) and 51 at a dose of 2 500 U/day (low dose group). Another 90 cases undergoing THA without LMWH treating between February 2002 and February 2003 were used as control group. There was no significant difference in gender, age, illness cause, course of disease, or the type of prosthesis among 3 groups (P gt; 0.05). Results DVT occurred in 19 cases (21.1%) of control group, in 2 cases (5.1%) of high dose group, and in 5cases (9.8%) of low dose group, showing significant differences between two treated groups and control group (P lt; 0.05), but no significant difference between two treated groups (P gt; 0.05). There was no significant difference in gender, age (gt; 65 years and ≤ 65 years), pathogen (trauma and bone disease) of each group, as well as of the same type patients within 3 groups (P gt; 0.05). The DVT incidence rate in the patients with bone cement artificial joint was significantly higher than that in the patients with non-bone cement artificial joint (P lt; 0.05), but there was no significant difference in the same type patients within 3 groups (P gt; 0.05). The postoperative blood loss in high dose group, low dose group, and control group was (463.5 ± 234.2), (342.4 ± 231.6), and (288.2 ± 141.6) mL; showing no significant difference between the high and low dose groups, between low dose and control groups (P gt; 0.05), while showing significant difference between high dose and control groups (P lt; 0.05). Conclusion The DVT incidence rate in THA patients with bone cement artificial joint is high; LMWH can reduce the DVT incidence rate and has good safety.