Prevention and management of postoperative deep vein thrombosis in lower extremities of patients with gastrointestinal tumor.

The background of our research was to conduct a retrospective analysis of clinical signs and risk factors for acute deep vein thrombosis (ADVT) of lower extremities, and to compare the effectiveness and safety of therapy of LMWH bemiparin and UFH in patients after abdominal surgery for cancer.

To investigate the effect of different use time of intermittent pneumatic compression (IPC) on the incidence of deep vein thrombosis (DVT) of lower extremities after arthroplasty. Between October 2018 and February 2019, 94 patients who planned to undergo unilateral total hip or knee arthroplsty and met the selection criteria were randomly divided into a control group (47 cases) and a trial group (47 cases). There was no significant difference in gender, age, surgical site, and surgical reason between the two groups ( P>0.05). After returning to the ward, all patients were treated with IPC. And the IPC was used until 9:00 pm on the day after operation in the trial group and until 8:00 am the next day after operation in the control group. The levels of hemoglobin, platelet count, D-dimer, hospital stay, treatment costs, patients' satisfaction with IPC, the parameters of thromboelastrography [kinetics (K value), freezing angle (α angle), reaction time (R value), maximum amplitude (MA value)], visual analogue scale (VAS) score, circumference difference of calf before and after operation, Pittsburgh sleep assessment score, and the incidence of DVT of lower limbs were recorded and compared between the two groups. The K value and D-dimer before operation were significant different between the two groups ( P<0.05). There was no significant difference in pre- and post-operative hemoglobin, platelet count, and the other parameters of thromboelastography between the two groups ( P>0.05). There was no significant difference in pre- and post-operative VAS scores and post-operative circumference difference of calf between the two groups ( P>0.05). The sleep assessment score of the trial group at 1 day after operation was significant lower than that of the control group ( t=2.107, P=0.038). There was no significant difference in the hospital stay and treatment costs between the two groups ( P>0.05). There was 1 case (2.1%) of DVT, 3 cases (6.4%) of intermuscular venous thrombosis, and 1 case (2.1%) of infection in the trial group, and 2 cases (4.3%), 4 cases (8.5%), and 0 (0) in the control group. The differences were not significant ( P>0.05). After the completion of postoperative IPC treatment, the satisfaction rates of using IPC were 89.4%(42/47) in the trial group and 70.2% (33/47) in the control group, and the difference was not significant ( χ 2=0.097, P=0.104). IPC using for a short period of time after arthroplasty do not increase the degrees of the pain and the swelling of calf; it can effectively prevent DVT of the lower extremity, improve the quality of sleep in patients, and is good for the limbs rehabilitation.

To assess the performance of magnetic resonance venography (MRV) for pelvis and deep vein thrombosis in the lower extremities before surgical interventions for varicose veins. We enrolled 72 patients who underwent MRV and ultrasonography before stripping for varicose veins of lower extremities. All images of the deep venous systems were evaluated by time-of-flight MRV. Forty-six patients (63.9%) of all were female. Mean age was 65.2 ± 10.2 years (37-81 years). There were forty patients (55.6%) with varicose veins in both legs. Two deep vein thrombosis (2.8%) and three iliac vein thrombosis (4.2%) were diagnosed. All patients without deep vein thrombosis underwent the stripping of saphenous veins, and post-thrombotic change was avoided in all cases. MRV, without contrast medium, is considered clinically useful for the lower extremity venous system.

A prospective study comparing duplex scan and venography for diagnosis of lower-extremity deep vein thrombosis

This study was to investigate the incidences of DVT in lower extremities after pelvic fracture before and after operation, and explore the risk factors. The records of patients with pelvic fractures receiving operation were collected. The patients were examined by preoperative and postoperative ultrasonography, and divided into thrombosis group and non-thrombosis group according to the preoperative and postoperative ultrasonographic results. Totally, 128 patients with pelvic fractures were included in this study. The incidence of DVT was 21.09% preoperatively, and increased to 35.16% postoperatively. Peripheral DVT constituted 92.60% and 86.67% of preoperative and postoperative DVTs, respectively. The results showed that age (odds ratio [OR] = 1.07; 95% CI: 1.01-1.12; P = 0.013), fracture classification (OR = 3.80; 95% CI: 1.31-11.00; P = 0.014) and D-dimer at admission (OR = 1.04; 95% CI: 1.00-1.08; P = 0.029) were independent risk factors of preoperative DVT, and female (OR = 0.21; 95% CI: 0.06-0.81; P = 0.023) was independent protective factor. In addition, age (OR, 1.06; 95% CI, 1.00-1.11; P = 0.026), operative blood transfusion (OR, 1.34; 95% CI, 1.05-1.72; P = 0.020) were independent risk factors of postoperative DVT. In conclusion, the DVT prevention strategy has not changed the high incidence of DVT in pelvic fractures, and orthopedic surgeons should pay more attention to perioperative DVT. When a male or patient with Tile-C type pelvic fracture is at admission, it is should be reminded that the screening the DVT in lower extremities. In addition, the surgeon should stanch bleeding completely, to reduce the blood transfusion and formation of DVT.

To make preliminary cross-sectional study on epidemiology of deep vein thrombosis of lower extremity of inpatients with high risk in Zhongshan hospital, and analyze risk factors in these patients. From Sep 2008 and Feb 2009, we performed compressed ultrasound to detect deep vein thrombosis of lower extremity of in-patients with high-risk in Zhongshan hospital, including bedrid stroke patients, post-surgery bedrid patients from department of orthopaedics, gynecology, general surgery and vascular surgery and patients of surgical intensive care unit. Prevalence rate of DVT of the whole study group as well as each department were calculated and analyzed. We collected detailed clinical information of each recruited patient. We made statistical single-factor and then Logistic regression multiple-factor analysis of these data with SPSS 16.0, to determine high risks of deep vein thrombosis of in-patients. (1) Totally 372 patients were enrolled in our study with 38 patients detected with DVT of lower extremity, so the prevalence rate of whole series was 10.2% (38/372). (2) High risks of lower extremity deep vein thrombosis for the whole series were bedrid time (30 day boundary) (P = 0.000), thrombin time (P = 0.007) and history of vascular surgery (P = 0.009). (3) The prevalence rate of DVT of lower extremity of department of neurology, orthopaedics and gynecology were 12.7% (13/102), of 10.0% (10/100) and 6.3% (7/111) respectively. (4) High risk for DVT in post-surgery gynecological patients was resection of uterus and both attachments (P = 0.032). In our study, the prevalence rate of DVT of lower extremity for high-risk in-patients was high, most of whom were asymptomatic and left-sided. High risk factors were bedrid time (30 day boundary), thrombin time and history of vascular surgery. It is necessary to strengthen prophylactic anticoagulation in these patients.

Objective To evaluate the value of color Doppler ultrasonography combined with coagulation test in the diagnosis of postpartum thrombosis and the prediction of thrombosis in pregnant women. Methods Color Doppler ultrasonography and blood coagulation examination were performed at 1 weeks before and 1 weeks after delivery respectively.Two or more abnormalities in both examinations were defined as positive thrombus combined diagnosis, two ultrasound tests that showedsnowstormsign were cdefined aspositive ultrasonic diagnosis.Thrombus formation in 30d after delivery was followed up.Three-dimensional χ2 test was used to compare the sensitivity and specificity of the combined diagnosis group and the ultrasonic diagnosis group. Results 238 cases were included in the study, including 76 positive cases and 162 negative cases in combined diagnosis group, 103 positive cases and 135 negative cases in ultrasonic diagnosis group.At the end of the follow-up period, there were 28 cases (36.84%) of the deep venous thrombosis of the lower extremities occurred in the combined diagnosis positive group and 21 cases (20.39%) in ultrasound diagnosis positive group.Kaplan-Meier method was used to analyze the lower extremity deep vein thrombosis of the positive subjects in the two diagnostic methods.Log Rank showed that the difference between the two groups was statistically significant (χ2=5.952, P=0.015). The sensitivity and specificity of the combined diagnosis positive group were higher than those of ultrasound diagnosis positive group, the difference was statistically significant(90.32% vs.67.74%; 76.81% vs.60.39%) (χ2=4.00, χ2=22.69, P<0.05). Conclusion Color Doppler ultrasonography combined with blood coagulation function can be used to diagnose prethrombotic state in pregnant women, and have high sensitivity and specificity for predicting deep vein thrombosis of lower extremities in pregnant women. Key words: Lower extremity deep vein thrombosis; Prethrombotic state; Color Doppler ultrasonography; Maternal value

A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.

To investigate how many critically ill patients developed deep vein thrombosis (DVT) during their admission to intensive care units (ICU) and to compare the characteristics of patients with and without deep vein thrombosis. Critically ill patients are a high-risk group for deep vein thrombosis because they typically have multiple risk factors, such as prolonged immobility, mechanical ventilation and old age. A prospective observational study was employed. The subjects were 90 patients who were older than 18 years of age, who were admitted to an intensive care unit for more than five days and were not provided any prophylactic measures. Data were collected at a university hospital for five months. A duplex scan was performed on day 2.4 on average and repeated between days 5-7 to diagnose deep vein thrombosis. The iliac, femoral, popliteal and tibial veins were examined by compression and colour Doppler methods of the duplex scan by one technician. Age, gender and body mass index were significant factors for deep vein thrombosis development (p < 0.05). Ten patients (11.1%) developed deep vein thrombosis during their stay in the intensive care units. The incidence was lower than in Western studies in which patients were not provided prophylaxis, but may increase with an extended observation period as in previous studies. The results of this study could allow ICU nurses to recognise the DVT incidence in critically ill patients. This result could lead to more active prevention and monitoring of DVT by ICU nurses, especially for high-risk patients, such as older or obese patients.

The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. The mean age was 62.24 (±17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(±2.94) and they had on average 4.01(±1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and <0 as low probability. Results: There were 68 patients with a history suggestive of DVT. Doppler ultrasonography being considered as gold standard for diagnosis confirmed 65 cases as DVT (95.6%) on the 1st day and remaining 3 cases were confirmed on the 3rd day in repeat Doppler ultrasonography. Mean age was 55.5 years (range: 34–75, standard deviation [SD] 11.3 years). Mean days of history was 3 days (range 1–10 days, SD 2.2 days). Pitting edema was present in 95.6% of cases which was the most common clinical characteristic in patients with DVT. This was followed by swelling of entire leg (67.6%), followed by localized tenderness along the distribution of deep venous system (64.7%). In 51 cases (75%), Wells' score was ≥3 (high probability), while in 14 cases (20.6), it was 1–2 (moderate probability) and in 3 cases (4.4%) it was <0 (low probability). In terms of positive Wells' score (≥2), there were 55 cases (80.9%). Conclusion: Wells' scoring can be used for diagnosis of DVT in lower extremities, but for further accuracy, it needs to be reconfirmed by Doppler ultrasonography.

Introduction: The popliteal fossa is a narrow intermuscular space posterior to knee joint. This area is vulnerable during knee arthroplasty or high tibial osteotomy. Therefore, awareness of anatomical variations in the popliteal fossa is important for anatomists, radiologists and surgeons. Popliteal Artery (PA) is frequently affected by penetrating and blunt trauma involving the lower extremity. Therefore, exposure of this artery is often required in both emergency and elective vascular procedures. The Popliteal Vein (PV) is formed at the distal border of popliteus. Pulmonary embolisms originate in deep vein thrombosis in lower extremities. The thrombus forms in the calf veins and subsequently embolize to the lungs. With continued increase of interventional procedures, the anatomical variations in the region of popliteal fossa may have an influence on the success of surgical reconstruction, transluminal angioplasty or embolectomy. Aim: To study the morphology and variations in popliteal vessels by dissection. Materials and Methods: The present study was a cadaveric study which was conducted on 30 lower limbs belonging to 15 formalin fixed adult human cadavers. Properly embalmed adult human cadavers were included in the study. Cadavers with any lower limb deformity or with history of surgery in popliteal fossa were excluded from the study. The data was entered in Microsoft excel sheet and expressed in percentage. Results: According to the classification given by Kim D et al., 96.6% cases were classified as Type IA. Higher bifurcation of PA into posterior tibial and common trunk of anterior tibial and peroneal was described as Type IIB. In addition, the PV was seen to be formed at the lower border of popliteus in 28 specimens (93.33%). Two specimens (6.67%) showed a variable level of formation. Conclusion: Considering such variable morphology of structures in the popliteal fossa, the surgeons operating around the knee joint should be aware of the possible variations in order to avoid undue complications.

The present meta-analysis was designed to systematically evaluate the effect of cemented and uncemented hemiarthroplasty on femoral neck fractures in the elderly and its effect on intraoperative bleeding and postoperative complications. Pubmed, Embase, the Cochrane Library, CNKI and WANFANG databases were retrieved and retrieval time was from inception to February 2019. Operative time, intraoperative blood loss, length of hospital stay, postoperative complications and postoperative mortality were compared between cemented and uncemented hemiarthroplasty. RevMan 5.3 statistical software was used for analysis. A total of 16 randomized controlled trials were included, with a total of 2,384 patients undergoing hemiarthroplasty. The cemented group had a longer operation time [weighted mean difference (WMD)=7.07, 95% confidence interval (CI)=3.91-10.23, P<0.0001], but it had lower incidence of intraoperative and postoperative fracture around the prosthesis (OR=0.25, 95% CI=0.13-0.47, P<0.0001) and shorter length of hospital stay (WMD=-1.78, 95% CI=-13.38--0.17, P=0.03). There was no significant difference in pulmonary embolism, mortality, lower extremity deep vein thrombosis rate, joint dislocation rate, intraoperative blood loss and postoperative incidence of lung, urinary system and incision infection between the two groups. To summarize, compared with the uncemented group, the cemented group had long operation time and a high incidence of pulmonary embolism, but had an advantage in reducing the risk of periprosthetic fractures. In addition, cemented hemiarthroplasty did not increase the mortality rate, the rate of deep vein thrombosis in lower extremities, the rate of joint dislocation, intraoperative blood loss, and the incidence of postoperative pulmonary, urinary, and incision infections.

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiari's network.

BackgroundThe purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.MethodsThis was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.ResultsUnivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.ConclusionsPICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.