Cause Of Deep Venous Thrombosis Research Articles

Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study

BackgroundPulmonary embolism (PE) and deep venous thrombosis (DVT) are the two most important manifestations of venous thromboembolism (VTE). DVT remains a significant condition since associated morbidity is significant and has elevated healthcare-related costs.MethodsA retrospective cohort study was conducted among DVT patients admitted to Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul’s Hospital Millennium Medical College on follow-up from July 1, 2017, to July 01, 2020. Data on sociodemographic characteristics, types of DVT, laboratory findings, medications, risk factors of DVT, complications and outcomes of DVT were collected. The data were analyzed using SPSS version 25. Multivariate logistic regression analysis was conducted to determine predictors of DVT recurrence and major bleeding. A P value < 0.05 was considered to identify significant predictors.ResultsThe mean age of the participants was 45.2 years, with SD of 15.36. The major causes of DVT included immobilization (29.9%), previous surgery (27.5%) and cancer (21.1%). The DVT recurrence rate was 22.5%. Nine (2.2%) of the participants died, and 19.9% developed complications. Bilateral DVT (Adjusted odds ratio (AOR) = 2.8, 95% Confidence interval (CI) = 1.14, 6.66), obesity (AOR = 3.3, 95% CI = 1.15, 9.59), hypertension (AOR = 6.5, 95% CI = 2.90, 14.70) and retroviral infection (AOR = 6.3, 95% CI = 2.34, 16.94) were predictors of recurrent DVT. Nineteen (4.7%) patients had major bleeding, and patients with bilateral DVT, active cancer and terminal age had an increased risk of major bleeding.ConclusionsThe overall DVT recurrence rate was alarmingly high and further complicated by PE, post thrombotic syndrome and chronic vein insufficiency, resulting in a 2.2% death rate. Major bleeding after DVT and PE remained high. Close monitoring should be performed for patients with advanced age, active cancer, bilateral DVT, retroviral infection, obesity and hypertension to prevent the recurrence of DVT and major bleeding.

Venous anomalies: an underrecognized but important cause of venous thromboembolism

AbstractAnatomical variants, such as May-Thurner syndrome (MTS) and inferior vena cava (IVC) variants, are underrecognized causes of deep venous thrombosis (DVT), despite affecting management. We aimed to identify the proportion of anatomical variants in proximal lower limb DVT. A retrospective cohort study was performed with cases of acute proximal DVT from 2014 to 2021 identified from ICD-10 codes. We identified 4731 DVTs and included 1268 proximal DVTs. Thirty-six (2.84%) had an anatomical variant (25 MTS and 11 IVC variants), with a rate of 14.39% in females <50 years old. Compared with nonvariant DVTs, they were more likely to be unprovoked (81% vs 23%), younger (median age, 37 vs 63 years), female (67% vs 37%), and have postthrombotic syndrome (22% vs 9%). Variants frequently received thrombolysis (58% vs 1%) or angioplasty (47% vs 0%) and indefinite anticoagulation (83% vs 40%). Further investigation for variants should be considered for high-risk patients, as variants affect management.

Conservative treatment vs thrombus removal for Iliofemoral vein thrombosis in patients with congenital abnormalities of the inferior vena cava: a case report and systematic review of the literature

Congenital abnormalities of the Inferior Vena Cava (IVC) should be suspected in cases of Deep Venous Thrombosis (DVT), especially in young patients, with no other risk factors and apparent causes. Currently, there is no guidance regarding the management of such patients. We report a case of Iliofemoral vein thrombosis in a young patient with congenital absence of the IVC that was successfully treated with catheter-directed thrombolysis (CDT) and perform a systematic review of the literature to identify evidence about the epidemiology, clinical presentation, management, and prognosis of this rare cause of DVT. A total of 42 studies reporting on 56 cases were included in the review. The mean age of the patients at the presentation of their first DVT episode is 23.6years, 83.9% of patients were males, conservative management with anticoagulation was used in 68% of the reported cases, and thrombolysis was used in 32% of the cases. Only 10.7% of patients presented with PE potentially justified by the abnormal anatomy of the deep veins which makes the propagation of thrombi into the pulmonary arteries less possible. Comparing the long-term outcomes of the two treatment groups; 42.3% of the patients treated conservatively vs 15.4% of the patients treated with thrombolysis developed chronic symptoms (residual heaviness, pain, swelling, and cramping). 11.5% of patients who received conservative treatment developed post-thrombotic syndrome. None of the patients treated with thrombolysis developed post-thrombotic syndrome. There were no procedure-related complications and thrombolysis was well tolerated by the entirety of the thrombolysis treatment group. Recurrence of DVT occurred in 13% of the patients treated conservatively and in 7.7% of patients treated with thrombolysis. Thrombus removal by means of thrombolysis is the recommended treatment and can offer excellent short and long-term results. Anticoagulation with NOACs may be prescribed for life to prevent recurrence or for at least 6months and then reconsidered following further evaluation of patients' bleeding risk. It may be of value to organise an international registry for such patients. Guidelines issued by the relevant scientific societies will then be able to make a clear recommendation about the management of such patients.

Left lower limb deep venous thrombosis, May-Thurner syndrome and endovascular management.

Objectives:To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention in these patients.Methods:A record-based descriptive study was carried out in Radiology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia, including patients who underwent lower limb duplex ultrasounds between January 2015-2021. Patients with bilateral DVTs, known pelvic masses, and pelvic surgeries were excluded. All patients positive for DVTs were identified and further imaging was reviewed. Left common iliac vein compression of 50% or more on computed tomography (CT) was considered positive for MTS. Endovascular interventions (venoplasty alone or with stenting) were evaluated and success recorded by observing patency of vein on follow-up imaging or improvement of symptoms on follow-up visits.Results:Of 182 patients with left lower limb duplex studies, 51 patients were positive for DVTs. A total of 37 patients had CTs and 21 patients had MTS (17 females, 3 males). A total of 15 patients underwent endovascular interventions, 2 patients had venoplasties alone (one successful) and 13 patients had venoplasties with stenting (10 successful).Conclusion:Patients with MTS as cause of DVT may benefit from early endovascular intervention.

Pengaruh Range Of Motion (ROM) Angkle Terhadap Resiko Deep Vein Thrombosis (DVT) Pada Pasien Diabetes Mellitus Dengan Luka Ulkus: Literature Review

Background: Diabetes Mellitus (DM) is the most chronic disease throughout the world which is a chronic metabolic disease due to pancreas that cannot produce enough insulin and the body cannot use effective insulin, as evidenced by the number of diabetes mellitus prevalence that can continue at any time increased. Diabetes mellitus is a metabolic disease which is very high risk of death. Patients with diabetes mellitus participate with thrombosis in blood vessels, one of which is diabetic foot ulcer. Thrombosis in patients with diabetic foot ulcers will increase thrombosis in the lower limbs that are part of venous thromboembolism, or Deep Vein Thrombosis (DVT). One effort to repair the wound can be done with practice. Exercise is one of the first management strategies proposed for new patients diagnosed with diabetes, because along with diet and policy modifications, exercise and exercise are important components of all diabetes intervention programs, which by doing exercises can help very much.Research Objectives: This literature review discusses the causes of deep venous thrombosis (DVT), causes of ulcer wounds and looks for the influence of the Angkle range of motion (ROM) on the risk of Deep Vein Thromosis (DVT) in patients with diabetes mellitus with ulcer wounds.Method: The literature database search method was conducted at Google Scholar and Pubmed. The literature used is literature that meets the inclusion criteria and published the last five years, is approved then selected and reviewed.Results: Final results There are 4 literatures that can be reviewed. Based on the literature conclusions, it can be found several exercises in patients with diabetes mellitus so as to increase diabetes, and can reduce the need for Deep Vein Thromosis (DVT). To find out the risk of Deep Vein thrombosis (DVT) can be determined by the D-Dimer test. If the D-Dimer test shows positive results, then the patient must use DVT

INFERIOR VENA CAVA AGENESIS: ANATOMICAL VARIANT AS CAUSE OF RECURRENT DVT

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Abnormalities of the inferior vena cava (IVC) are rare causes of deep venous thrombosis (DVT). The clinical presentation is often similar to that of an inherited hypercoagulabe condition. CASE PRESENTATION: A 27-year-old man with a past medical history of premature birth presented to the emergency department (ED) with left lower extremity (LLE) tightness and pain for one day. He had no history of recent travel and family history was negative for clotting disorders. Ultrasound (US) of the left leg showed an occlusive thrombus from the left common femoral to the left popliteal vein. The patient was discharged from the ED on rivaroxaban. Two weeks later, he presented to the ED again with progressive LLE swelling despite medication compliance. Physical exam was negative for testicular masses. Interventional Radiology (IR) performed a LLE venogram, which showed thrombus extention to the common iliac vein. US-assisted catheter thrombolysis (EKOS) was initiated. Heparin infusion was started and the patient was transferred to the intensive care unit. Repeat visualization the following day revealed improved clot in the left femoral and external iliac veins and a chronically thrombosed left common iliac vein. LLE pain and swelling improved and EKOS was discontinued twenty-four hours later. Hypercoagulability work-up was negative except for lupus anti-coagulant, the significance of which was difficult to determine, given prior anticoagulant exposure. On discharge, the patient was transitioned back to rivaroxaban. Five days later, the patient presented to the ED again with worsening LLE pain and swelling after initial improvement. Repeat venous US showed occlusive thrombus throughout much of the left femoral vein with only some flow at the distal aspect. An inferior vena cavogram revealed agenesis of the IVC with azygous continuation. CT angiogram of the abdomen and pelvis confirmed an occluded infra-renal IVC secondary to atresia. Patient was discharged on indefinite rivaroxaban therapy. DISCUSSION: This patient presented with an unprovoked DVT involving the common iliac vein that extended despite appropriate anticoagulation. Eventually, a venogram revealed agenesis of the IVC as the predisposing risk factor. In this condition, venous stasis presumably leads to increased risk of clotting. While bilateral DVTs are rare in the general population (approximately 10% of cases), they have been described in up to three quarters of patients with IVC abnormalities. This patient however, had extensive unilateral clot burden, usually seen in more distal anatomical abnormalities, such as May-Thurner syndrome. His premature birth likely predisposed him for an anatomical malformation. CONCLUSIONS: Unprovoked DVT in a young patient, recurrent DVTs despite medication compliance, and occlusion of the iliac veins, should raise suspicion for anatomical abnormalities, such as IVC atresia. Reference #1: 1. Chee YL, Culligan DJ, Watson HG. Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young. Br J Haematol. 2001;114(4):878. Reference #2: 2. Ruggeri M, Tosetto A, Castaman G, Rodeghiero F. Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep-vein thrombosis. Lancet. 2001;357(9254):441. Reference #3: 3. Hamoud S, Nitecky S, Engel A, Goldsher D, Hayek T. Hypoplasia of the inferior vena cava with azygous continuation presenting as recurrent leg deep vein thrombosis. Am J Med Sci. 2000;319(6):414. DISCLOSURES: No relevant relationships by Amy Cohen, source=Web Response No relevant relationships by David Cohen, source=Web Response No relevant relationships by Aaron Dickinson, source=Web Response No relevant relationships by Mouhanned Eliliwi, source=Web Response No relevant relationships by Jennifer Meyfeldt, source=Web Response

Deep Venous Thrombosis With Symptomatic Bilateral Pulmonary Embolism After Using an Infrapatellar Strap for Patellofemoral Pain in an Athletic Cardiothoracic Surgeon.

Knee braces and patellar straps are frequently prescribed devices for treatment of patellofemoral pain syndrome. In this report, we describe the occurrence of localized deep venous thrombosis (DVT) after use of an infrapatellar strap. Until now, external mechanical compression has not been recognized as a cause of DVT. In young and athletic patients presenting with DVT, after exclusion of the most prominent risk factors, untraditional causes should be considered to mistakenly label a DVT as unprovoked.

Association between factor V Leiden mutation and recurrent pregnancy loss in the middle east countries: a Newcastle-Ottawa meta-analysis.

Heritable thrombophilia is a category of genetic disorders of the coagulation cascade with the increasing risk of thrombus formation and recurrent pregnancy loss (RPL). Factor V Leiden (FVL) (R506Q) mutation is the most common genetic cause of deep venous thrombosis, but its association with RPL has been inconsistent in studies arising from non-Western countries. The present metanalysis was aimed to determine whether an association exists between FVL and RPL in the Middle East. We searched PubMed, MEDLINE Web of Science, Scopus, and Embase, evaluating the association between the FVL and RPL. The Middle East countries (Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, The State of Palestine, Syria, Turkey, TheUnited Arab Emirates, and Yemen) were evaluated in succession. Raw data were extracted, and 19 case-control studies were included in our final analysis. Overall, 2513 cases and 1836 controls in the Middle East showed a prevalence of FVL mutation as 12.6% and 4.9% in patients and controls, respectively. To evaluate the relationship between FVL mutation and RPL, we used Forest plot (random effect model) with the overall random OR of 2.37 (CI 95%: 1.50-3.75). FVL mutation was associated with a higher risk of RPL. In Iran, the OR was 1.90 (95% CI 1.04-3.45), and in Turkey, the OR was 3.01 (95% CI 1.10-8.23). The results of our study support an association between FVL mutation status and RPL in women of the Middle East countries. It is recommended that specific policies include comprehensive testing for FVL mutation as a standard of care in women of the Middle East region with unexplained RPL.

Study of deep venous thrombosis in lower extremities after femoral neck fracture

Objective To explore the causes of deep venous thrombosis of the lower extremities after femoral neck fracture. Methods To retrospectively analyze the clinical data of 483 cases of femoral neck fractures treated from September 2014 to December 2017 from Department of Traumatic Orthopedics, Xi′an Jiaotong University School of Medicine Affiliated Honghui Hospital. Please record the patient′s complications, blood transfusion volume, reduction method, internal fixation, operative time, intraoperative blood loss, and postoperative thrombosis. Count data were expressed as percentage(%) and analyzed by χ2 test between the two groups; measurement data were expressed as (±s), and two independent samples was used by t test. To calculate the incidence of postoperative deep venous thrombosis in patients with femoral neck fractures and to investigate the causes of deep vein thrombosis of the lower extremities after femoral neck fractures. Results Of the 483 patients, 149 cases of deep vein thrombosis of the lower extremities occurred after surgery, with an incidence of 30.8%. The reduction method, internal fixation, and intraoperative blood loss all affected the occurrence of deep venous thrombosis after femoral neck fracture (P<0.05). Among the reset methods, 367 cases were open and closed, 33.2% (122/367) had deep venous thrombosis, closed reduction was 116 cases, and 23.3%(27/116) had deep venous thrombosis. The incidence of open reduction deep venous thrombosiswas higher than closed reduction; among the internal fixation methods, fixation, the incidence of deep venous thrombosis after total hip arthroplasty and intramedullary nailing was the highest, which was 52.8% and 50.0%, respectively. The hemorrhage volume in the thrombosis group (246.9±178.1) ml was higher than that in the non-thrombosis group(206.3±126.7) ml. Conclusions The incidence of deep venous thrombosis after femoral neck fractures is high, and the way of reduction, internal fixation, bedtime before operation, and blood loss during operation can affect the occurrence of deep venous thrombosis after femoral neck fracture. There are many factors affecting deep venous thrombosis after femoral neck fracture. It is necessary to fully evaluate the risk of deep venous thrombosis after operation. Key words: Femoral neck; Fractures, bone; Lower extremity; Venous thrombosis

Thrombose veineuse profonde du membre supérieur chez une violoniste : « le syndrome de l’archet »

Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging. A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode. The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined. Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations.

A Rare Complication of Artificial Urinary Sphincter: Deep Venous Thrombosis Due to Compression of Femoral Vein by Pressure Regulating Balloon

The placement of artificial urinary sphincters (AUSs) is a common procedure for stress incontinence following treatment for prostate cancer. Complications are relatively rare, and the most common reasons for device removal and revision are cuff erosion, infection, and mechanical failure. We present a case of a 66-year-old male with a history of radiation therapy for prostate cancer that developed a deep venous thrombosis (DVT) and pulmonary embolism (PE) following his second AUS due to compression by a pressure regulating balloon (PRB). Compression of the femoral vein was not originally diagnosed as the cause for DVT on initial hospitalization, and there was an additional hospitalization due to worsening symptoms prior to identification of PRB compression. This is the first published case of migrating PRB causing femoral DVT and PE following the placement of a second AUS in an irradiated tissue field, and one of two published cases of DVT due to PRB compression.

Primary study on deep venous thrombosis in children after neurosurgery

Objective To study the incidence and related causes of deep venous thrombosis of lower extremities in children after neurosurgery. Methods The children with or without deep venous thrombosis of lower extremities after neurosurgery in our hospital from January 2007 to December 2011 were selected.The clinical data including primary diseases and operation time were collected to be compared to find the related causes of deep vein thrombosis.Results There were 18 children with postoperative deep venous thrombosis.All of them had deep venouscatheter invasive operation.The major primary disease was craniopharyngioma.They all had longer operation time compared with those without thrombosis.Conclusions The causes of deep venous thrombosis in neurosurgical children involve not only deep venous catheter -related but also neurological primary disease and operation time. Key words: Neurosurgery ; Children; Deep venous thrombosis; Craniopharyngioma

Chronic Iliac Vein Occlusion and Painful Nonhealing Ulcer Induced by High Venous Pressures from an Arteriovenous Malformation

Chronic femoral vein compression (May-Thurner Syndrome) is a known rare cause of deep venous thrombosis. Subsequent angiogenesis and the development of arteriovenous malformation (AVM) in the setting of chronic venous thrombosis is by itself a rare and poorly understood phenomenon. We report a case in which elevated venous pressures resulting from such compression appear to have resulted in the development of a pelvic arteriovenous malformation, which was further complicated by chronic, nonhealing painful lower extremity ulcers, and the development of extensive subcutaneous venous collaterals. Following successful embolization of the pelvic AVM and ablation of veins under the ulcers with laser and sclerotherapy, the patient's ulcers healed and she became pain-free.

Iliac vein compression syndrome: An underdiagnosed cause of lower extremity deep venous thrombosis

Iliac vein compression syndrome (CS) is a rare cause of deep venous thrombosis. It is caused by an anatomic anomaly in which the right common iliac artery overlies the left common iliac vein causing mechanical compression. Subsequent endothelial changes within the vessels have the potential to spur thrombus formation. Aggressive diagnostic and therapeutic interventions must be implemented upon suspicion to avoid long-term complications. We report on a 19 year old male who presented with ICS. We discuss the clinical presentation, diagnosis, and current treatment options.

The Pathophysiology of Venous Thromboembolism: Implications With Compression Garments

The highest risk of venous thromboembolism lies with abdominoplasty and liposuction and deaths increase when combined with other procedures. The objective of this study was to evaluate physiologic changes in the deep venous system with compression-garments and asses whether there is a correlation between these procedures, rectus plication, and garments. Part 1 of this article is a retrospective review of all office surgical incidents that resulted in an abdominoplasty and/or liposuction death in the state of Florida over the past 8 years. Part 2 is a clinical study, evaluating the effect compression garments have on the pathophysiology of venous thromboembolism. Duplex ultrasounds were performed with and without garments to evaluate venous changes. Literature was reviewed related to intraabdominal pressure and high-tension abdominal closures and surgeons were polled about their use of rectus plication and garments/binders. In 8 years, 13 patients died related to abdominoplasty, liposuction, or the combination of the 2. In 100% of subjects, ultrasounds showed a decrease in venous flow, proximal vessel dilation, and loss of normal biphasic flow within the popliteal vein. Multiple publications have reported an increased morbidity and mortality related to liposuction and abdominoplasty procedures. The most frequent cause of death with these types of procedures was thromboembolism, and we discuss possible reasons for this increased rate. The exact cause of deep venous thrombosis in these procedures remains unknown, but postoperative garments may affect the physiology of venous flow, and may be involved in the formation of deep venous thrombosis and should be considered along with other patient safety procedures.

Haplotypes of IL1B , IL1RN , IL1R1 , and IL1R2 and the Risk of Venous Thrombosis

It has been suggested that the overall effect of the major proinflammatory cytokine interleukin-1 (IL-1) on coagulation and fibrinolysis is prothrombotic. The aim of this study was to investigate whether common variations in IL1B, IL1RN, IL1R1, and IL1R2 influence the risk of venous thrombosis. In a case-control study on the causes of deep venous thrombosis, the Leiden Thrombophilia Study (LETS), we genotyped 18 single nucleotide polymorphisms (SNPs) in IL1B, IL1RN, IL1R1, and IL1R2, enabling us to tag a total of 25 haplotype groups. Overall testing of the haplotype frequency distribution in patients and controls indicated that a recessive effect was present in IL1RN (P=0.031). Subsequently the risk of venous thrombosis was calculated for each haplotype of IL1RN. Increased thrombotic risk was found for homozygous carriers of haplotype 5 (H5, tagged by SNP 13888T/G, rs2232354) of IL1RN (Odds ratio=3.9; 95% confidence interval: 1.6 to 9.7; P=0.002). No risk was associated with haplotype 3 of IL1RN, which contains the frequently examined allele 2 variant of the intron 2 VNTR. We found that IL1RN-H5H5 carriership increases the risk of venous thrombosis.

Congenital Hypoplasia of the Inferior Vena Cava: An Underappreciated Cause of Deep Venous Thromboses among Young Adults

This report illustrates how newer imaging techniques are identifying vasculopathies as risk factors for deep venous thrombosis (DVT). In this case, a healthy young man presented with a straightforward DVT but without traditional risk factors. Doppler ultrasonography confirmed a proximal clot, and contrast-enhanced computed tomography identified a hypoplastic inferior vena cava (IVC). DVTs cause considerable morbidity and death each year, including approximately 200,000 fatal pulmonary embolisms. Specific treatment of DVTs and long-term management and prevention strategies are contingent on the etiology, which can be determined in approximately 85% of cases. A hypoplastic IVC was discovered during efforts to find the cause of thrombosis, and a Medline search suggests that this anomaly should be considered for young persons with DVTs. DVTs are common and their underlying etiology should be identified to help guide long-term management. Evidence is emerging that an anomalous IVC should be ruled out as a cause of DVT among young patients.

Five-year outcome study of deep vein thrombosis in the lower limbs

Venous disease was evaluated in relation to post-thrombotic syndrome 5 years after deep venous thrombosis (DVT) in patients treated with a regimen of low-molecular-weight heparin (LMWH) and warfarin in a Hospital-in-the-Home program. The presence of flow, reflux and compressibility in 51 patients (102 limbs, 54 with DVT and 48 without DVT) was assessed by duplex ultrasound scanning. Blood tests were carried out for prothrombotic screening. Venous disease was related to pathologic severity of post-thrombotic syndrome, characterized by the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification on a scale of 0 to 6. In the 102 limbs studied, 30 patients (59%) had an underlying thrombophilic disorder. The most common cause of DVT was postoperation and prolonged immobilization not related to postoperation. The most common thrombophilic abnormalities were anticardiolipin antibody and a deficiency of protein C or S, or both. Twenty-six limbs (48%) had proximal involvement (proximal and proximal plus distal DVT); resolution (recanalization or normal vein) in these limbs was seen in 85% at 6 months and 96% at 5 years. After 5 years, 25 of these proximal DVT limbs (96%) developed reflux and there were 4 limbs in CEAP class 0, 8 in classes 1 to 3, and 14 in classes 4 to 6. All of the 28 limbs (52%) with distal DVT showed DVT resolution by 6 months. After 5 years, 10 limbs (36%) developed reflux, and 13 limbs were in class 0, 12 in classes 1 to 3, and 3 limbs in classes 4 to 6. No DVT was detected in the 48 contralateral limbs, but reflux was detected in 25 limbs (52%), predominately in the superficial veins (16 limbs, 64%). The resolution of thrombus was more rapid and complete in patients with distal DVT than in those with proximal DVT. Patients with proximal DVT developed a more severe form of post-thrombotic syndrome that was likely related to the development of deep venous reflux. An important finding of this study was an unexpectedly high incidence of venous reflux in the apparently unaffected limb. Although these non-DVT limbs were not investigated at presentation, our data is consistent with the hypothesis that DVT may result in a more systemic disorder of venous function.

Mutación del factor V de Leiden como causa de trombosis venosa

Venous thrombosis is infrequent in paediatrics. A lot of prothrombotic risk factors have been described. Disturbances of coagulation are present in more than half of children with stroke. Leiden V factor mutation is emphasized as one of the most common genetic cause of deep venous thrombosis in Caucasian children and adults, which represents 20-25%, depending on series. Two years-old girl with hypoxic-ischemic disease and West syndrome, which presents a deep venous thrombosis in both legs. This evolved to gangrene, requiring surgical exceresis of scar and amputation of 2nd, 3rd and 4th fingers of left foot. She also presented a right frontoparietal intraparenchima haemorrhagic stroke with tetraventricular bleeding and hydrocephalus. It required an external ventricular derivation and later a Ventricular-peritoneal valve. The coagulation study confirmed the Leiden V factor mutation in our patient. Later studies showed the same mutation in the father. The risk of recurrence and the severity of venous thrombosis indicate life antiaggregant treatment, currently maintained with aspirin.

Iliac artery aneurysm presenting with lower extremity deep vein thrombosis

A 63-year-old man presented to the Emergency Department with the complaints of pain and swelling of the right lower extremity. The history included intermittent pain and swelling of the right leg for about 1 year that had become prominent and intractable in the last day. At the time of admission the patient was conscious and cooperative. The vital signs were normal. Physical examination revealed diffuse edema of the entire right leg with a positive Homan’s sign. Peripheral arterial pulses of the right leg distal to the popliteal artery were faint on palpation. Respiratory system examination was unremarkable. The abdomen was not tender, bowel sounds were normal, guarding or rebound was not present. Abdominal palpation was suspicious for a pelvic mass. The patient was evaluated by color Doppler sonography examination that revealed thrombosis of the deep veins of the right lower extremity and also in the right common and external iliac veins. A mass 10 cm in diameter was noted in the pelvic cavity adjacent to the right common iliac vein. Color encoding demonstrated that the right common iliac artery was displaced anteriorly and the mass was contiguous to the artery. The mass was presumed to be a thrombosed iliac artery aneurysm. On computed tomography (CT) scan, the arteries were shown to have a tortuous course with thrombosis of the veins from the right iliac to the femoral vein (Figure 1). The mass that was detected by color Doppler sonography was shown to be an aneurysm of the right common iliac artery, originating from the portion just distal to the iliac artery bifurcation (Figures 1,2). The aneurysm developed from the posterior aspect of the common iliac artery, fusiformly grew distally with its partially thrombosed lumen, and became a huge space-occupying mass in the pelvic cavity (Figure 2A). The right iliac vein was laterally displaced by the aneurysm and the distal venous system was thrombosed by its mass effect (Figure 2B). The patient underwent an operation in which the aneurysm was extirpated, an ilio-femoral bypass graft was implanted, and femoral vein thrombectomy was performed. Deep venous thrombosis (DVT) results mainly from three factors: the slowing down or obstruction of the blood stream secondary to an injury to the veins, or due to the hypercoagulability states. External compression is one of the major causes of DVT, however, isolated iliac artery aneurysm is an uncommon mass that may cause lower extremity DVT. Apart from the compressive effect in the pelvic cavity, iliac artery aneurysms also have some important potential risks. The rupture of the aneurysm and development of an arteriovenous fistula are the major possible complications that are catastrophic clinical events (1,2). Inappropriate treatment of patients with venous obstruction from unrecognized arterial aneurysms has been reported to be associated with great mortality and morbidity (1). The elimination of hazardous risks may be provided by accurate diagnosis and timely aneurysm repair, as in the presented case.