Variant Anatomy of Popliteal Vessels- A Cadaveric Study

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 designed to compare duplex scanning with contrast venography for the diagnosis of acute deep vein thrombosis of the lower extremity, both at the femoropopliteal (above-knee) and tibioperoneal (below-knee) levels. A total of 216 patients with 220 limbs suspected of acute deep vein thrombosis underwent duplex scanning followed within 24 h by ascending venography. The two studies were interpreted independently by two physicians who were blinded to the results of the corresponding alternative study. Venography was positive for deep vein thrombosis in 44.5% of cases (98/220). Duplex scanning was inadequate at the above-knee level in two cases (0.9%) and at the below-knee level in 17 cases (7.7%). Sensitivity and specificity of duplex scanning at above-knee level were 98.7% and 100% respectively while corresponding values were 85.2% and 99.2% at below-knee level. By excluding technically inadequate duplex studies, the sensitivity at below-knee level was clearly improved (93.8%). It is concluded that with meticulous technique, duplex scanning is highly accurate in diagnosing acute deep vein thrombosis of symptomatic lower extremities, avoiding contrast venography in over 90% of the cases, even at the tibioperoneal level.

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 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.

Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal

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.

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.

Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal

The natural history of calf vein thrombosis: Lysis of thrombi and development of reflux

To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis. The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22. Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all. There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

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.

Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity

The surgical management of venous injuries in the popliteal fossa is a contested issue. The basic options are ligation or repair. Most anatomy textbooks briefly describe a single popliteal vein, and the literature contains few references on venous patterns in this region. Although the primary objective of this study was to analyze venous variability in 52 dissected cadaveric popliteal fossae and 63 venograms, data were also collected on the popliteal artery. Nine groups (A-I) were designated regarding the manner of formation of the popliteal vein. These groupings were based primarily on differences in the union of the anterior tibial, posterior tibial, and fibular (peroneal) veins to form medial and lateral (popliteal) veins, and whether these two veins fused to form a singular popliteal vein proximal or distal to the transverse plane at the level of the distal edge of the femoral condyles (FC). In the majority of the dissections and venograms, multiple veins crossed the FC, and the medial vein was larger in diameter than the lateral vein. Two patterns of popliteal artery termination were observed based on differences in the site of origin of the fibular artery. The results were compared with anatomy and vascular surgery textbook descriptions and sparse literature reports on vascular variations in the popliteal fossa. It is hoped that these data will benefit surgeons performing procedures in this region.