Acute Phlebitis Research Articles

Patients with Acute Phlebitis Can be Treated Safely with Great Saphenous Vein Ablation

Patients with Acute Phlebitis Can be Treated Safely with Great Saphenous Vein Ablation

Budd-Chiari syndrome, review and illustration

Budd-Chiari syndrome is a rare vascular disorder characterized by obstruction of the hepatic venous outflow. Various diseases causing coagulopathy play a role in aetiology, such as myeloproliferative disorders. Acute vascular occlusion may lead to acute phlebitis with fever. The classic triad of acute liver failure may be present with ascites, hepatomegaly, and abdominal pain. However, subacute courses of disease were also observed. Because of the variable symptoms and severity extent, depending on the acuity of the course and the extent of the affected vessels, diagnosis is often difficult. Sonography, as a ubiquitously available and cost-effective diagnostic tool, plays a leading role. Doppler ultrasonography can be used to visualize hemodynamics in particular. In acute thrombotic occlusion, the affected hepatic veins usually cannot or only partially be visualized. In non-occluding thrombi, turbulent flow patterns may develop in the area of venous outflow obstruction, and flow velocity is then increased in the area of stenosis. Contrast enhanced ultrasound offers even better specificity of diagnosis. Computed tomography and magnetic resonance imaging can directly visualize thrombi and the cause of obstruction. Once the diagnosis is confirmed, anticoagulation must be initiated, but therapy of the underlying disease must also be started. If symptom-controlling measures are not sufficient, angioplasty/stenting to reopen short-segment stenoses or implantation of a TIPSS device may be considered. Liver transplantation remains ultima ratio. As studies on the precision of diagnostic methods are controversial, the characteristics of imaging for BCS are therefore summarized in this review on the basis of several illustrating case reports.

Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: A retrospective study.

Acute phlebitis due to peripheral vein catheter use is frequently observed in clinical practice, and requires surgical therapy in severe cases. In this retrospective study, we aimed to increase awareness, evaluate current treatment options, and develop recommendations to optimize treatment outcomes. A total of 240 hospitalized patients with a diagnosis of upper extremity phlebitis from 2006 to 2011 were evaluated in terms of initial clinical features, parameters, co-morbidities and treatment regimes. Severity of phlebitis was graded according to the Baxter scale by assessing clinical symptoms such as pain, erythema, induration, swelling, or palpable venous cord (grade 0-5). Patients were divided in two subgroups: conservative (n = 132) and operative (n = 108) treatment. Surgical intervention rates and severity were higher for cannula insertion in the cubital fossa region than for cannula insertion in the forearm and hand region (p < 0.05). Baxter scale grades were higher in the surgical treatment group than in the conservative treatment group (4.47 vs. 2.67, respectively). The cubital fossa region is vulnerable to severe phlebitis and is not recommended as the first site of choice for cannulation. Phlebitis of Baxter scale grade 4 or 5 should be considered for early surgical intervention.

Studies in phlebitis: detection and quantitation using a thermographic camera.

A new method for the detection of acute phlebitis in superficial veins is investigated. A thermographic camera is utilized for the quantitation of temperature changes in a rabbit ear model. A control group receiving no injection is compared against each of five treatment groups receiving these commercially available parenterals: amiodarone hydrochloride, phenytoin sodium, mechlorethamine hydrochloride, cephalothin sodium, and diazepam. The vehicles of the above-mentioned drugs as well as several commonly used organic cosolvents are also investigated. Local tissue responses to the parenteral challenges are measured and a good correlation between the visual and the thermographic data was seen.

Acute postoperative graft phlebitis: A rare cause of saphenous vein-coronary artery bypass failure

Most graft occlusions occurring early after saphenous vein coronary artery bypass procedures result from technical problems at the graft to coronary artery anastomosis site. This report describes an unusual cause of graft occlusion in a 67-year-old man who died three weeks after operation—a postoperative acute phlebitis of an implanted saphenous vein graft. Infection in the graft wall resulted in isolated graft thrombosis in the setting of a patent anastomosis. Graft phlebitis in this patient was associated with a purulent pericarditis and mediastinitis which failed to respond to surgical débridement and antibiotic therapy. Although mediastinitis is not infrequent, infection of an implanted saphenous vein coronary artery bypass graft in association with mediastinitis has never been reported. The findings in our case show that such graft infection may occur, and may result in graft thrombosis and occlusion.

Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities

A prospective study of fifty-two consecutive patients with thrombophlebitis of the lower extremity was carried out utilizing objective examinations to diagnose both the phlebitis and pulmonary embolism. Venography was an accurate means of identifying acute phlebitis. Fifty-two per cent of the patients with proved thrombophlebitis showed objective evidence of pulmonary embolism by lung scan technics including perfusion and ventilation scans. Serial perfusion lung scans materially improved the diagnostic accuracy of scanning technics. By utilizing all of the available lung scan technics the need for pulmonary angiography was decreased. Pulmonary emboli occurred frequently from clots at all sites in the lower extremity, including the tibial veins. The evidence suggests that the untreated clot tends to extend up the leg, giving off emboli intermittently as it goes. The severity of embolism was almost as great in silent as in symptomatic embolism and in popliteal phlebitis as in iliac phlebitis in this series. Seventy-five per cent of the emboli were silent. Treatment with heparin was the mainstay of therapy. Dose-related results showed that 20,000 U of heparin per day provided 89 per cent protection against further embolization. Thrombectomy in iliofemoral phlebitis was found to be effective when the clot was not adherent to the vein wall. Ligation of the superficial femoral vein was utilized to prevent late emboli and late development of a valveless recanalized vessel. No postoperative emboli occurred.

Femoral neuropathy and anticoagulants.

Case 1. N. H., a 51-year-old man entered the hospital with pain in the left lower quadrant of the abdomen, left groin and thigh. He had been hospitalized 3 weeks earlier for phlebitis and was receiving 15 mg. of sodium warfarin daily at discharge. Severe bilateral talipes equinovarus had been present since birth and had never been corrected. Prothrombin time on the day before admission was 43.7 minutes (control time 11.7 minutes). Abdominal tenderness in the left lower quadrant, a questionable mass and pain on extension of the hip were present on physical examination. Diverticulitis or pelvic thrombophlebitis were among the initial diagnostic considerations. The dose of sodium warfarin was reduced because of prolonged prothrombin time. Initial hemoglobin and white blood cell count were 12.2 Gm./100 ml. and 4,490. Subsequently the hemoglobin fell to 5.7 Gm./100 ml. and the mass in the left lower quadrant became obvious. The patient developed a left quadriceps femoris weakness, an absent knee jerk and hypesthesia over the distribution of the femoral nerve. There were eccymotic areas at the sites of the injections over the arms and buttocks. Barium enema x-ray showed small intestinal loops pushed to the right with a similar but lesser displacement of the recto-sigmoidal portion of the colon. Sodium warfarin was discontinued and vitamin K and a total of six units of blood were given. With splinting and physical therapy, there was partial recovery of motor and sensory function at the time of discharge one month after admission. At the end of additional 4 months, recovery was complete and the patient was able to return to work. Case 2. B. S., a 53-year-old woman with bilateral varicose veins was admitted with acute phlebitis in the right leg. She had

Origin and evolution of radioactive pulmonary emboli in man.

THE DELINEATION of the distribution of pulmonary blood flow by the technic of lung scintiscanning with radioiodinated macroaggregated albumin (131I-MAA) involves the deliberate but clinically safe blockade of pulmonary capillaries by labeled microemboli. Such emboli quickly undergo fragmentation and degradation so that they are retained in the lungs for no more than several hours (1). In 2 patients injected with 131I-MAA preliminary to lung scanning, technical difficulties were encountered in administering the material, and the labeled aggregates were incorporated inadvertently into blood clots which caused larger and delayed embolization to the lungs. Serial lung scanning in these patients gave us the unique opportunity to study the clinical behavior of three types of radioactive pulmonary emboli: (a) 131I-MAA of usual particle size; (b) 131I-MAA incorporated into fresh blood clot from a syringe; and (c) 131I-MAA incorporated in an organizing clot from a vein in the forearm. Grossly abnormal lung scans persisted from one to six weeks. In one case, a partially organized radioactive embolus was recovered at autopsy with the aid of a detector and a dissecting microscope. Case I: Sudden severe dyspnea and diaphoresis developed in a 24-year-old quadriplegic male on his seventy-seventh day in the hospital. Fixed splitting of the pulmonary second sound was noted, with a shift in electrical axis of the electrocardiogram to +120°. There was bilateral ankle edema, but no physical evidence of acute phlebitis. Anticoagulant therapy was administered. The serum lactic dehydrogenase rose from 350 units on the first day to a high of 510 units five days later (normal, <300 units). The chest roentgenogram was normal. The findings on lung scintiscanning with a 3-inch commercial scanner were interpreted as consistent with the diagnosis of pulmonary embolus (Fig. 1). All lung scans were performed with 300 microcuries of 131I-MAA injected into an antecubital vein with the patient in the supine position. A repeat lung scan was attempted on the one hundred and twenty-seventh hospital day (fifty days later). Difficulty was encountered during the injection of the 131I-MAA. A small quantity of blood was withdrawn into the syringe to verify that the needle was within the vessel. The subsequent injection was stopped because a hematoma developed at the injection site. Two to three minutes later a second venipuncture was performed, and the contents of the syringe were administered. Scintiphotos were obtained with an 11-inch “Anger” scintillation camera. These scintiphotos were interpreted as revealing focal radioactive pulmonary emboli (Fig. 2). Survey of the patient's upper extremity disclosed that some of the 131I-MAA had remained at the injection site.