Calf Deep Venous Thrombosis Research Articles

Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair.

The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. Level Ⅲ.

Age-adjusted D-dimer, clinical pre-test probability-adjusted D-dimer, and whole leg ultrasound in ruling out suspected proximal and calf deep venous thrombosis.

D-dimer (DD) and ultrasonography (US) are part of the diagnostic workup for lower-extremity deep vein thrombosis (DVT). Recent studies have shown that adjusting DD level cut-offs by age or clinical pre-test probability (PTP) decreases the use of US. We compared diagnostic accuracy of PTP-adjusted DD and age-adjusted DD in 3883 patients (F: 61.1%; age: 65.3 ± 16.8 y) referred to our unit for clinically suspected DVT. All patients underwent clinical evaluation, DD, and US. Proximal DVT was detected in 477 (12.4%) patients, and distal DVT was isolated in 342 (8.9%) patients. In the remaining 3064 patients there were 23 venous thromboembolic events (0.75%, 95% CI: 0.50-1.12) during the 3-month follow-up. The specificities of DD, age-adjusted DD, and PTP-adjusted DD in patients without high PTP levels were 47% (95% CI: 45-49), 61% (95% CI: 59-62), and 67% (95% CI: 65-68), respectively. The negative predictive value (NPV) was 96% (95% CI: 95-97) for all diagnostic strategies. When only proximal DVTs were considered, the NPV increased to 99% (95% CI: 98-99). US was avoided in 37% (95% CI: 36-38) of patients with a fixed cut-off DD, 48% (95% CI: 47-50) with age-adjusted DD, and 52% (95% CI: 51-54) with PTP-adjusted DD. The failure rate for all DVTs of DD, age-adjusted DD, and PTP-adjusted DD was 2.0% (95% CI: 1.6-2.5), 2.7% (95% CI: 2.2-3.2), and 2.5% (95% CI: 2.1-3.0), respectively. Compared with the standard DD cut-off, both age-adjusted and PTP-adjusted DD reduced the proportion of patients who required US at the cost of a small increase in failure rate.

The First Reported Case of Pulmonary Embolism and Deep Vein Thrombosis Associated with Intraductal Papillary Mucinous Neoplasm: A Case Report

Background: Reported cases of Intraductal papillary mucinous neoplasm (IPMN) are becoming more and more frequent. The risk of hypercoagulability associated with IPMN is not clearly established in the literature as it was only reported in four cases. Therefore, we present a unique case of a patient with IPMN who subsequently developed acute pulmonary embolism (PE) and deep venous thrombosis (DVT). Case presentation: A 70-year-old healthy female patient complained of palpitation, chest pain, and dyspnea at rest. She had normal vital signs and findings on physical examination. Laboratory tests showed an increase in the D-Dimer level of 3,730 ng/mL fibrinogen equivalent unit (FEU). Bilateral DVT ultrasound (DVT-US) of the lower extremities was positive for acute calf DVT in the right lower extremity involving the soleal vein. CT-PE chest with IV contrast was remarkable for segmental and subsegmental pulmonary arteries thrombosis. She was started on a heparin drip and then transitioned to rivaroxaban for the treatment of PE and DVT. She was discharged in stable condition with outpatient follow-up. Conclusion: IPMN of the pancreas is an exocrine pancreatic neoplasm often detected on Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). It is usually non-malignant but was found to be more prone to progress into cancer in contrast to the other types of pancreatic cysts. An increased risk of hypercoagulability with pre-malignant pancreatic lesions such as IPMN has not yet been well established. As far as we know, this case report is the first article presenting IPMN associated with both acute DVT and PE in a relatively healthy individual with no prior risk factor for hypercoagulability. Although there is scattered evidence suggesting an increased risk of thromboembolic events with IPMN, this unique case of DVT and PE associated with IPMN highlights the importance of close monitoring of these patients, especially those who have risk factors for thrombosis.

Characteristics and Treatment Strategy of Isolated Calf Deep Venous Thrombosis after Fractures: A Review of Recent Literature.

Isolated calf deep venous thrombosis (ICDVT) includes thrombosis located at the far end of the popliteal vein, such as the anterior tibial vein, posterior tibial vein, fibular vein, and intramuscular vein of the soleus and gastrocnemius. This type of thrombosis has the highest incidence, accounting for approximately half of all deep vein thrombosis (DVT) cases; however, there is no consistent recommendation for ICDVT treatment across countries, and there is also no optimal management strategy. In recent years, increasing evidence has shown that ICDVT can develop into proximal DVT, even causing pulmonary embolism (PE). Therefore, some experts suggest anticoagulant therapy for this type of DVT, while others hold an opposing attitude. Therefore, the treatment strategy for this type of DVT has become a hot and difficult research topic. The purpose of this review is to summarize the characteristics of ICDVT and the effects of different treatment strategies by analyzing recent and important classical works in the literature in an attempt to provide recommendations for the treatment of this most common type of DVT in orthopaedic clinics.

Incidence and risk factors of preoperative isolated calf deep venous thrombosis following hip fractures.

There is still a lack of data on isolated calf deep vein thrombosis (ICDVT) following hip fractures surgery. The study aimed to determine the incidence of preoperative ICDVT and the associated risk factors in patients with hip fractures requiring surgery.The 289 patients who required hip surgery were included, duplex ultrasonography was routinely used to make a definite diagnosis of preoperative ICDVT located in unilateral or bilateral calf. Data on demographics and laboratory-associated blood biomarkers results were included. Univariate analyses were used to analyse the data of demographics, comorbidities, personal history operation related indexes and laboratory biomarkers, then the multivariate logistic regression analysis was employed to identify the independent risk factors associated with ICDVT.Sixty-eight (23.5%) patients were diagnosed with preoperative ICDVTs. The univariate analyses showed significant differences regarding ICDVT were age, current smoking, alcohol consumption, time from injury to operation, albumin, white blood cells, lymphocyte, red blood cells, hemoglobin, hematocrit, and activated partial thromboplastin time level among the 44 factors. The multivariable model confirmed 3 risk factors were significantly independent in association with preoperative ICDVTs, including current smoking, time delay from injury to operation and activated partial thromboplastin time ( < 28seconds).The incidence of preoperative ICDVT in hip fracture was 23.5%, and patients with associated risk factors are prone to form ICDVTs, identification of these factors may help to reduce the incidence of ICDVT with hip fractures by taking early prevention measures.

Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics

BackgroundIt remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT.Materials and methodsIn this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients’ electronic charts.ResultsDVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT.ConclusionsIsolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.

Noncompressible Filling Defects: Propagation in Isolated Calf Vein Thrombus in the Critical Care Population

The natural history of isolated calf deep venous thrombosis (CDVT) or noncompressible filling defects is controversial. We aimed to characterize our patient population by differentiating those who had just an isolated, asymptomatic deep venous thrombosis (DVT) limited to the calf from those with a symptomatic CDVT. The presence of edema or pain in the calf and findings of thrombus formation within the soleal, gastrocnemius, posterior tibial, or anterior tibial veins describe symptomatic CDVT. Our objective was to study the incidence, evolution, and clinical consequence of asymptomatic CDVT within the critical care population. A retrospective analysis incorporating venous duplex ultrasound scans of neurocritical care patients was performed during a 32-month period from January 2016 to September 2018. Based on a risk assessment profile score >5, a venous duplex ultrasound scan was obtained 3 days after the patient’s admission and weekly thereafter until discharge. Demographics including age, sex, comorbidities, anticoagulation status, principal admission problem, and in-hospital mortality were noted. Symptomatic patients with a diagnosis of a DVT were excluded. The development of a proximal DVT or pulmonary embolus vs resolution of the thrombus during the study period was also recorded. Approximately 5375 lower extremity venous studies were performed. CDVT was identified in 121 (2%) asymptomatic patients. The main admitting diagnosis was traumatic brain injury. The majority (83 patients) underwent follow-up scans consistent with recommendations. During the 32-month period, approximately 50% of them (42/83) had no changes, whereas 36% of patients (30/83) had a complete resolution of the calf vein thrombus. Approximately 13% (11/83) progressed while remaining asymptomatic. Of those 11 patients, 3 patients subsequently developed symptomatic above-knee DVT (3/83 [3.6%]). No pulmonary embolism was recorded. There was no recorded in-hospital mortality. CDVT was identified in only a small percentage of our high-risk patient population who remain without symptoms. Moreover, the rate of progression from asymptomatic CDVT to symptomatic above-knee DVT was only 3.6%. Asymptomatic CDVTs rarely lead to significant clinical consequences and did not correlate with hospital mortality. We recommend against repeated DVT scans after diagnosis of asymptomatic CDVT, more appropriately termed noncompressible venous filling defects, solely based on protocols and without symptoms.

Developing Deep Venous Thrombosis while on Rivaroxaban: A Review of Rivaroxaban

Rivaroxaban is a Direct Oral Anticoagulant (DOAC), which has six licensed indications, including the use for prevention of stroke and systemic embolism with non-valvular Atrial Fibrillation (AF) and the treatment of Venous Thromboembolism (VTE). The pharmacokinetics and the pharmacogenetics of rivaroxaban are reviewed by the author because of a previously reported case of a 43-year-old Caucasian female, who was diagnosed with popliteal and calf Deep Venous Thrombosis (DVT) while on anticoagulation treatment in the form of rivaroxaban 20 mg PO daily. This treatment was started because of a previously verified bilateral Pulmonary Embolism (PE) 5 months earlier. Rivaroxaban is more frequently used in clinical practice, and many physicians are aware that rivaroxaban requires adaptation mainly on the patient's renal function. However, there is still a need to increase awareness of rivaroxaban's interactions with drugs that share its pathways when the hepatic CYP450 and/or P-gp/BCRP are involved. These pathways are utilized by several medications, which are used in cardiovascular and neurological diseases, and the treatment of infections. These interactions can result in under or overexposure to rivaroxaban, which both effects can be detrimental. The author makes several cautious suggestions to decrease the incidence of under/overexposure of rivaroxaban. Physicians, including primary care physicians, could receive a clinical course focusing on DOACs for anticoagulation treatment or direct clinical training within a short-term Anticoagulation Team (ACT) stewardship program concerning adequate prescriptions of rivaroxaban/DOAC as well as their interactions. Also, patients who are elderly and/or with polypharmacy while taking rivaroxaban require more frequent controls. Furthermore, research exploring the effects of ABCG1, ABCG2, CYP3A4, CYP3A5, and Drug-Drug Interactions (DDI), is warranted. Finally, there is a need to identify a validated method for measuring rivaroxaban in primary care.

COT-20 PERIOPERATIVE STATUS OF SERUM D-DIMER LEVEL AND VENOUS THROMBOSIS IN PATIENTS WITH MALIGNANT BRAIN TUMOR

BACKGROUNDSThe patients with malignant brain tumors frequently show the hypercoagulability state and a decrease in fibrinolysis ability with an elevation in D-dimer. This is partially due to tumor-related hemiparesis or surgical stress including long-term bed-ridden positioning during and after operation,which could lead to development and extension of deep venous thrombosis (DVT) in lower extremities and eventually fatal pulmonary embolism.METHODSWe retrospectively examined the pre- and postoperative serum D-dimer levels and DVT state in 75 consecutive patients with malignant brain tumors (i.e. glioma,malignant lymphoma; mean age 64 yo,28 females) operated at our hospital from January 2015 to April 2017. Serial D-dimer levels were measured with the latex agglutination method (Roche) at 2 days before and right after operation,postoperative day (POD) 1,3,and 7. Lower limb venous ultrasound (LVUS) or contrast CT was performed if preoperative D-dimer was 0.5μg/ml or higher.RESULTSAverage BMI was 21.3,nine patients with diabetes mellitus,10 had recurrent diseases after chemotherapy,and 10 presented paresis in the lower extremities preoperatively while two developed transient paresis postoperatively. While two patients had prior DVT history,central and calf DVTs were identified preoperatively in one and 12 (15%) patients,respectively. Among four patients with re-elevation of D-dimer after POD 7,infection (2 patients),new DVT (2),and hemorrhagic events (gastrointestinal 2,including 1 death; epistaxis 2) developed,where a cut-off value D-dimer > 1.69 yielded sensitivity 100% and specificity 80%. Intraoperative intermittent calf compression prevented perioperative pulmonary embolism in those with calf DVT.CONCLUSIONSAppropriate perioperative DVT managements could prevent development of pulmonary embolisms in all patients with”high-risk” malignant brain tumors. Not only D-dimer > 1.5,but age of 80 or older,high preoperative D-dimer levels with calf DVT and taking DOAC may be risk factors for postoperative venous thromboembolism.

VC 2. Early Identification of Patients With Iliofemoral Deep Venous Thrombosis Using Plasma D-Dimer Concentration

Venous thromboembolism represents one of the most common diseases and is a significant source of morbidity and mortality. Effective management requires early detection and treatment. Venous ultrasound is the most widely used imaging study for the diagnosis of deep venous thrombosis (DVT). Evidence-based practice suggests that specific management depends on the anatomic location of the thrombus. For this reason, early identification of anatomic location of the thrombus (iliofemoral [IF], femoropopliteal [FP], or calf) can expedite appropriate investigation and treatment. The aim of this study was to investigate a possibility to identify the anatomic location of DVT using existing risk stratification instruments. This was a nested matched case-control study using the Jobst Vascular Institute cohort of patients who presented to the emergency department with suspected DVT. From 1443 patients who had a complete risk assessment (D-dimer and Wells score) and duplex ultrasound within 24 hours from presentation, a total of 221 (15.3%) were diagnosed with acute DVT. These patients (study group) were frequency matched by age and sex with patients who had no DVT in a 1:2 ratio (control group, n = 1103). IF DVT was found in 75 (34%) patients, FP DVT in 92 (42%), and calf DVT in 54 (24%) patients. D-dimer level in the IF DVT group was 4132 ± 4129 ng/mL compared with 1748 ± 1706 ng/mL in the FP DVT group (P < .0001), 1012 ± 793 ng/mL in the calf DVT group (P < .00001), and 445 ± 343 ng/mL in the control group (P < .000001). Receiver operating characteristic curves showed high diagnostic value of D-dimer to identify IF DVT patients (area = 0.83) with the best cut point value of 700 ng/mL. Multivariate analysis showed that patients with D-dimer level exceeding 700 ng/mL are 22 times more likely to have IF DVT than any other level of DVT or having no DVT (odds ratio, 22.5; 95% confidence interval, 11.2-45.1). These findings suggest that D-dimer level of 700 ng/mL or higher is seven times more likely to be associated with IF DVT. Hence, urgent imaging studies in these patients may result in more timely management decisions, including early initiation of catheter-directed thrombolysis.

Incidence of Lower Limb Deep Venous Thrombosis and Coagulation Status in Severe Patients after Thoracic Surgery

背景与目的分析胸外科术后重症患者住重症加强护理病房（intensive care unit, ICU）期间的下肢深静脉血栓（deep venous thrombosis, DVT）发生率与凝血指标。方法回顾性分析2016年7月-2018年6月接受物理预防血栓的胸外科术后重症患者，将床旁下肢静脉超声、血常规、凝血四项、血栓弹力图等结果完善的病例纳入研究，对发生血栓人群的一般信息、病种、手术方式、凝血指标等进行分析。结果共纳入患者50例，年龄22岁-80岁，男34例，女16例。共有11例患者出现小腿深静脉血栓（22.0%），男性发生术后血栓的比例为29.4%（10/34），女性为6.3%（1/16）。恶性肿瘤的DVT发生率为23.5%（8/34），非恶性肿瘤的发生率为18.6%（3/16）。比较发生血栓和未发生血栓组的血小板计数、凝血四项、血栓弹力图等，除活化部分凝血活酶时间血栓组较无血栓组显著延长外，余无统计学差异。结论即便在充分物理预防的基础上，胸科术后重症患者下肢深静脉血栓仍为高发，且男性、恶性肿瘤患者多见；术后超声筛查有助于早期发现DVT。

Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference.

Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians' confidence.

Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis.

There are currently no established guidelines for appropriate antithrombotic prophylaxis following periacetabular osteotomy (PAO) or derotational femoral osteotomy (DFO). The purpose of this study was to determine the incidence of clinical deep venous thrombosis (DVT) following PAO and/or DFO wherein a portable, mechanical device and low-dose aspirin were used postoperatively for DVT prophylaxis. Patients who had undergone staged hip arthroscopy and primary PAO and/or DFO were prospectively reviewed. Following PAO/DFO, patients were prophylactically treated for thromboembolic disease with a portable, mechanical compression device for 3 weeks and low-dose aspirin for 4 weeks. Patients were followed in clinic until 24 months postoperatively. During the study period, 145 hips (124 patients) underwent surgery (PAO: 109, DFO: 24, PAO + DFO: 12). Overall, the incidence of clinically apparent DVT was 0% in the study cohort. Average estimated blood loss during surgery was 601 mL and five cases required blood transfusions of 1 or 2 units. Ten patients were seen in the emergency room 10–20 days after surgery presenting with calf tenderness and DVT was ruled out in all cases with ultrasound. There were no postoperative bleeding or wound complications. A portable, mechanical compression device and low-dose aspirin effectively lessens the risk of DVT following staged hip arthroscopy and PAO/DFO without an increased risk of bleeding complications.

Diverse management of isolated calf deep venous thrombosis in a university hospital.

The management of patients with isolated deep venous thrombosis (DVT) is controversial, leading to overtreatment and undertreatment with several complications and increased cost. The aim of this study was to describe the management of isolated calf DVT (ICDVT) in a university hospital. Data on patients with acute DVT in our hospital are prospectively entered in a database through our venous thromboembolism team. All patients had an objective diagnosis with duplex ultrasound (DU) in our accredited vascular laboratory. A retrospective analysis was performed on patients with ICDVT from July 2015 to June 2016. Patients with proximal DVT were excluded. The management of the patients was assessed for use of different types of anticoagulation, use of sequential compression devices, serial follow-up with ultrasound, or any combination. Patients' demographic information, risk factors, calf DVT anatomic location, DVT extension into calf deep veins, DVT propagation to proximal deep veins, and pulmonary embolism were collected as well. There were 159 patients diagnosed with ICDVT in 1year, of whom 52% were female with a mean age of 59years. Nearly half of the patients were smokers (48%), 62% had limited or no mobility, 36% had surgery within the past 30days, and 23% were considered readmissions. Anticoagulation was given to 121 patients who received seven different types of treatment varying from prophylactic dosing to thrombin inhibitors. In the rest of the 38 patients, 28 had a contraindication to anticoagulation and two had an inferior vena cava filter placed. Eighty-six patients had one DU follow-up study, 39 patients had two follow-up studies, and 21 had three follow-up studies. In the 86 patients with one DU study, seven propagated within the calf (8.1%) and two to the proximal veins (2.3%). Two patients developed nonfatal pulmonary embolism (1.2%). Sequential compression devices were applied in 75 patients despite that the majority were receiving anticoagulation and having serial DU examinations. Significant variation in the management of ICDVT was found on the basis of the physician's preference. The type of treatment overall did not follow a plan based on the patient's risk. Such an approach may increase the cost in the management of these patients without ensuring benefit.

Total hip arthroplasty in treating elderly femoral neck fracture with hemiplegia

Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty (THA) in treating elderly femoral neck fracture patients with hemiplegia. Methods From June 2015 to January 2017, Forty-three elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system. There were 15 males and 28 females with an average age of 71.5±5.6 years (60-84 years). The left side was involved in 20 cases, while the right side in 23 cases. There were 15 cases with Garden III type and 28 cases with type IV. Lower limb muscle strength grade were 20 cases in grade 3, 19 cases in grade 4, and 5 cases in grade 5. Sixteen cases walked independently before injury, while 27 of them walked with the aid of crutches. The duration between injuries to operation ranged from 2 days to 5 days. The size of the prosthesis and off-set distance were recorded by template technique pre-operation. The appropriate type of prosthesis was selected to restore the offset and to reconstruct the abductor muscle arm, according to the actual measurement in the operation and the preoperative plan. Based on the bone mineral density and medullary cavity morphology, biological or cemented femoral stem prosthesis was selected. The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation. The patients were followed-up at 2 weeks, 1 months, 2 months, 3 months, 6 months, 1 and 2 years. Functional exercise guidance and complications were recorded at the follow-up duration. At the last follow-up, the hip function and limb function were evaluated according to the Harris score and Fugl-Meyer motor function assessment respectively. Results Based on pelvic X-ray evaluation after operation, all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm (average 2.2±0.8 mm). The follow-up duration ranged from 6 to 24 months with an average of 11.2±3.5 months. There was no complication such as prosthesis dislocation and infection. Deep venous thrombosis in calf occurred in 3 patients at 2 days after operation, who underwent recanalization after thrombolysis. At the last follow-up, the average score of Harris hip function and Fugl-Meyer were 90.2±3.8 (77 to 96) and 97.1±2.5 (83 to 100), respectively. No dislocation, infection, loosening, subsidence and osteolysis phenomenon was found during the follow-up. Conclusion The elderly patients with Garden type III or IV femoral neck fractures accompanied with hemiplegia can be treated with anti-dislocation prosthesis THA. It does have the advantages of low dislocation rate and improved hemiplegic limb function. Key words: Femoral neck fractures; Hemiplegia; Aged; Arthroplasty, replacement, hip

Pattern Analysis of Lower Extremity Venous Thrombosis: Implications for Point of Care Ultrasound (POCUS) Protocols

Introduction Emergency department point-of-care ultrasound (POCUS) can identify lower extremity venous thrombosis (LEVT) with a published accuracy is 85–90%. The aim of this study was to compare the patterns of LEVT with protocol results and determine the clinical impact of the study results. Methods Patterns of superficial venous thrombosis(SVT) and deep venous thrombosis (DVT) were collated from positive venous duplex ultrasound (VDU) studies. Each pattern was mapped to the potential findings by the described POCUS protocols. Analysis of the literature was used to identify the potential clinical impact of the findings and the functional efficacy of each strategy and a numerical result was developed. Results One hundred six studies were positive for DVT (42), SVT (44), or both (20) on VDU. Patterns for DVT (single or multiple levels and unilateral or bilateral) and SVT (great saphenous vein above and/or below knee or small saphenous vein in single, multiple or bilateral and juxta-junctional) were noted. The patterns covered by the “two-area” protocol showed DVT = 80% and SVT = 38%, and by “three-point compression” DVT = 74% and SVT = 0%. Particular areas not covered included proximal disease (iliac and vena cava) and calf DVT and SVT in all areas except juxta-junctional. The potential impact for DVT is high, whereas for SVT it is moderate to low. The functional efficacy of the “two-area” protocol (5.9) exceeds the “three-point compression” strategy (3.7) but falls short of the “gold standard” VDU (10). Conclusion Pattern analysis of venous thrombosis identifies weakness in POCUS strategies; the clinical implications allow for an assignment of the functional efficacy of each study. Knowledge of these findings should inform emergency room POCUS strategies.

Venous Recanalization, Reflux, and Obstruction After Calf Deep Venous Thrombosis

Venous Recanalization, Reflux, and Obstruction After Calf Deep Venous Thrombosis

Diverse Management of Isolated Calf Deep Venous Thrombosis in a University Hospital

Diverse Management of Isolated Calf Deep Venous Thrombosis in a University Hospital

Should We Treat Patients with Isolated Calf Deep Venous Thrombosis

For isolated deep venous thrombosis (DVT) of the calf, American College of Chest Physicians guidelines suggest (1) anticoagulation in patients with

Should Patients with Isolated DVT of the Calf Be Anticoagulated

Approaches to managing acute isolated calf deep venous thrombosis (DVT) range widely and include no treatment, repeat imaging, and therapeutic