Complication Of Deep Venous Thrombosis Research Articles

Plasma Homocysteine and Vascular Disease

Vascular disease is the leading cause of death and disability in the Western World: atherosclerosis is responsible for the majority of deaths in virtually all westernized societies; pulmonary embolism, a complication of deep venous thrombosis, is the leading cause of morbidity and mortality, resulting in approximately 50,000 deaths per year in the United States; approximately 1.5 million acute myocardial infarcts occur each year, each infarction bearing a 30% mortality rate; and strokes represent the third leading cause of death in developed countries (1). While the adverse effects of hypertension, hypercholesterolemia, diabetes, and smoking on the vascular system have received widespread publicity, another important risk factor for vascular disease--less well-known outside the medical community but recently gaining increasing attention in the literature is an elevated plasma level of the amino acid homocysteine. Bolstered by findings of an association between hyperhomocysteinemia and a variety of vascular disorders, theories implicating homocysteine in the pathogenesis of these disorders have inspired researchers to explore novel approaches in the prevention and treatment of vascular disease. With the biochemistry of homocysteine metabolism already well understood, vitamin supplementation has emerged as a promising strategy for reduction of plasma homocysteine levels, with consequent arrest or reversal of the postulated pathogenic mechanisms involved in homocysteine-associated disorders of the vasculature, and, thus, potential prevention and treatment of vascular disease in hyperhomocysteinemic patients.

Correlation between Deep Venous Thrombosis and Inflammation in Patients after Implantation of Permanent Pacemaker

The correlation between postoperative deep venous thrombosis (DVT) and inflammation in patients with permanent cardiac pacemaker implantation was analyzed. A total of 130 cases undergoing permanent pacemaker implantation in the 305 Hospital of Chinese PLA and Fuwai Hospital from May 2014 to February 2017 were selected. Of the 130 cases, 60 patients complicated with DVT were selected as the observation group, and the remaining 70 cases without complications of DVT were selected as the control group. The relationship and influence of various factors were explored. The number of patients smoking and the number of subjects with DVT history in the observation group were higher than those in the control group. In the observation group, plasminogen activator inhibitor (PAI)-1: Ag, PAI-1: Ac, thrombin-activated fibrinolysis inhibitor (TAFI): Ag, and TAFI: Ac levels were higher than those in control group (P<0.05). The levels of inflammatory factors of the peripheral blood of the observation group were significantly higher than those of the control group (P<0.05). In the correlation analysis of serum inflammatory factors and coagulation factors, CRP, IL-6, IL-10 were positively correlated with PAI-1: Ag level. Age, BMI, smoking history, number of implanted electrodes, DVT history, duration of immobilization and inflammatory factor levels had independent predictive value on postoperative complicated DVT. The serum inflammatory factors are closely associated with postoperative DVT in patients implanted with permanent cardiac pacemaker, and the serum inflammatory factors are a good reference for the evaluation of DVT.

AKT question relating to complications of deep venous thrombosis

AKT question relating to complications of deep venous thrombosis

AKT answer relating to complications of deep venous thrombosis

AKT answer relating to complications of deep venous thrombosis

PULMONARY EMBOLISM WITH THROMBUS IN TRANSIT ACROSS A PATENT FORAMEN OVALE

Thromboembolism-in-transit is a rare complication of deep venous thrombosis (DVT) in patients with a patent foramen ovale (PFO). A healthy 51-year-old male presented with shortness of breath. He was diagnosed with a pulmonary artery saddle embolus and extensive lower extremity DVT. Bedside

How to manage venous thromboembolism risk in hospitalized medical patients

BACKGROUND: Deep venous thrombosis causes morbidity and mortality for hospitalized patients. There are several risk factors for developing deep venous thrombosis including trauma, immobilization, and surgery. Complications of deep venous thrombosis result from the delay in diagnosis and treatment, so prophylaxis is the perfect option to avoid these serious complications, especially for those at risk. AIM: The aim of this is to investigate the impact of DVT protocol on thromboprophylaxis in minimizing the disease burden of under-recognized and preventable pathology. MATERIALS AND METHODS: This is a retrospective descriptive study which used DVT protocol through the Knowledge Translation Committee (KTC). RESULTS: Suboptimal prophylaxis decreased from 47% in 2011 to 6% in 2017, whereas appropriate prophylaxis increased among patients from 45% in 2011 to 89% in 2017. CONCLUSION: There was an increase in offering DVT prophylaxis for hospitalized medical patients as a result of the implementation of DVT protocol through KTC.

Efficacy of venous recanalization by non-invasive pulsed ultrasonic cavitation therapy on swine model of acute deep venous thrombosis with 14 days of follow-up

Post thrombotic syndrome is a frequent complication of deep venous thrombosis, associated with high morbidity. Treatments currently available are invasive. Pulsed cavitational ultrasound therapy (PCUT) is a new technique to destroy remotely soft tissue. We demonstrated that PCUT was able to recanalize non-invasively in in-vitro model of human blood clot. We aim to test the safety and efficacy of venous recanalization by non-invasive PCUT in vivo swine model of acute venous thrombosis. All the experiments were performed on White large X Landrace swine. We induced an acute femoral deep venous thrombosis by using endovascular approach combined with local injection of thrombin. A 3 cm length occlusive thrombosis was obtained after 2 hours. Swine were divided in three groups: one with PCUT without follow-up ( n = 11), one with PCUT and follow-up at 14 days ( n = 8), and a control group also followed for 14 days ( n = 5). Acutely and during follow up all swine received curative anticoagulation. To achieve PCUT, a 2.25 MHz transducer (Imasonic©) centered by a linear probe was used and cavitation was obtained in the centre of the vein. Effectiveness of recanalization was evaluated by echo-Doppler and phlebography. Safety was assessed by Doppler ultrasound and by histological analysis of vein, artery and lungs. Among the 24 swine, we obtained 22 occlusive venous thromboses and 2 partials. The median length of the thrombus was 26 ± 4.4 mm. Acutely, thrombosis recanalization was obtained among the 19 swine with PCUT with median treatment duration of 33 min. After a 14-day follow-up, 75% of recanalisation remains permeable vs. 0% of vein permeable in the no therapy group ( P = 0.008). Residual diameter was 2.6 ± 1.2 mm, 50% of the venous diameter. No embolism or pulmonary infarction was observed in all pigs ( Fig. 1 ). We have demonstrated in vivo the safety and the efficacy of PCUT for non-invasive venous recanalization, persistent after 2 weeks.

Risk and protective factors for post-thrombotic syndrome after deep venous thrombosis

ObjectiveThe most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by atorvastatin and rosuvastatin. The aim of this study was to test the influence of lipid-lowering therapy with statins on PTS development. MethodsAll patients between January 2002 and June 2018 with diagnosed DVT were enrolled in this study and analyzed retrospectively. Documentation was performed using the standardized system M1 (CompuGroup Medical, Koblenz, Germany) throughout the observation period. Patients received therapeutic anticoagulation and compression stockings. In case of recurrent DVT, patients received lifelong therapeutic anticoagulation. All patients received clinical examination and duplex ultrasound evaluation 3 to 6 months after primary diagnosis and annually thereafter. ResultsA total of 579 patients with DVT were enrolled in this study. Of these patients, 414 (71%) developed PTS (337/414 [81%] presented with the mild version; mean Villalta score, 5.79). Risk factors for PTS development were recurrent DVT (P = .001) and malignant disease (P = .001). Protective factors were therapy with platelet aggregation inhibitors (P = .049) and lipid-lowering therapy with statins (P = .001). After multivariable analysis, the only risk factor was recurrent DVT (P = .001), and the only protective factor was lipid-lowering therapy (P = .001). ConclusionsPost-thrombotic changes might be reduced by lipid-lowering therapy.

Risk Factors of Severe Post-Thrombotic Syndrome in Young Patients from the North-West of Russia

Introduction - Sever post-thrombotic syndrome (PTS) (CEAP4-6) is a complication of deep venous thrombosis leading to decreased quality of life. Вut what kind of predictors associated with the development of severe PTS is not fully identified. Methods - We retrospectively studied 120 young patients after acute DVT up to 45 years old (men − 57, women − 63, middle age − 37.4). For grading PTS, we used the clinical scale of chronic venous insufficiency (CEAP0-6). Sixty seven (55.8%) patients were genotyped for nine polymorphisms: factor I (FI) –455 G/A, FI Thr312Ala, FII 20210 G/A, FV 1691 G/A, FXII 46 C/T, FXIII Val34Leu, PAI-1 –675 4G/5G, TPA 311 bp I/D, EPCR Ser219Gly, that were discriminated by PCR-RFLP method. All results were analyzed with the SPSS software version 17.0 (SPSS Inc, Chicago, IL, USA). The differences in genotype distributions were estimated by Fisher’s exact test with calculating odds ratios (OR), their 95% confidence intervals (CI) and p-value. The discriminant analysis was used to define the predictors of severe PTS. Results - Severe PTS (CEAP4-6) was registered in 15 out of 67 genotyped patients (22.4%). The risk of severe PTS was increased dramatically in patients with established genetic risk factors, in particular, G20210A mutation (OR=4.3; 95%СI: 1.3-14.1; p=0.01), FV Leiden variant (OR=2.6; 95%СI: 0.9-7.1; p=0.05) and the homozygous FXIII 34Leu/Leu genotype (OR=6.9; 95%СI: 0.7-67.5; p=0.057). However, the discriminant analysis with inclusion of additional criteria (clinical and acquired) had shown that ipsilateral recurrence of DVT (p=0.05), obesity (p=0.002), varicose veins (p=0.07) and short courses of anticoagulant therapy (less than 3 months) (p=0.030) were associated with the risk of the sever PTS. None of studied DNA variations played a significant role in the outcome of DVT: FV 1691GA (p=0.160), FII 20210GA (p=0.501), FXIII 34Leu/Leu (p=0.141). Conclusion - Short courses of anticoagulant therapy is one of the most important risk factors of severe PTS in young patients.

P2765Efficacy of venous recanalization by noninvasive pulsed cavitational ultrasound therapy on swine model of acute deep venous thrombosis

Abstract Background Post thrombotic syndrome is a frequent complication of deep venous thrombosis and is associated with high morbidity and hospitalization. Treatments currently available are invasive, involve use of endovenous procedures with stents and balloons, and frequently require general anesthesia. Pulsed cavitational ultrasound therapy (PCUT) emerged recently as a new technique to destroy remotely soft tissue. We recently demonstrated that PCUT was able to recanalize non-invasively in in vitro model of acute venous thrombosis (human blood clot). Purpose We aim to test the safety and efficacy of venous recanalization by noninvasive PCUT in vivo swine model of acute venous thrombosis. Methods All the experiments were performed on White large X Landrace swine. We induced an acute femoral deep venous thrombosis by using occlusive balloons introduced from jugular and popliteal vein combined with local injection of 50 IU of human thrombin. A 3 cm length occlusive thrombosis was obtained after 2 hours. Swines were divided in three groups: one with PCUT without follow-up (n=11), one with PCUT and follow-up at 14 days (n=8), and a control group also followed for 14 days (n=5). Acutely and during the follow up all swines received curative anticoagulation. To achieve PCUT, a 2.25 MHz transducer centered by a linear probe was used and cavitation was obtained in the center of the vein (Figure). After manual determination of thrombus location, a robotic arm was used to automatically move the transducer along the thrombus. Effectiveness of recanalization was evaluated by echo-Doppler and phlebography. Safety was assessed by Doppler ultrasound of the insonified area (artery, veins and surrounding tissue) and by histological analysis (local femoral vein and artery and lungs for pulmonary embolism). Results Among the 24 swines, we obtained 22 occlusive venous thromboses and 2 partial. The median length of the thrombus was 26±4.4 mm with vein diameter of 8.5±1.6 mm. Acutely, thrombosis recanalization was systematically obtained among the 19 swine with PCUT with median treatment duration of 33 minutes with residual diameter of 2.9±0.9 mm. No extravasation of contrast material or hematoma was observed after the therapy. After a 14-day follow-up, 75% of recanalisation remain permeable vs. 0% of vein permeable in the no therapy group (p=0.008). Residual diameter was 2.6±1.2 mm, which correspond to 50% of the venous diameter. No vein or artery damage and no embolism or pulmonary infarction was observed in all pigs. Figure 1 Conclusion We have demonstrated in vivo the safety and the efficacy of PCUT for non-invasive venous recanalization, persistent after 2 weeks. Acknowledgement/Funding French society of cardiology

Comparison of mortality and complications between bilateral simultaneous and staged total hip arthroplasty: A systematic review and meta-analysis.

Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.

MON-197 Peri-operative Outcomes of Vaginoplasty Using an Individualized Approach to Hormone Management in Transgender Women

For transgender and gender diverse individuals, gender identity is not congruent with the sex assigned at birth. Cross sex hormone therapy (HT) and gender affirming surgery can relieve significant dysphoria associated with gender incongruence and improve health outcomes. With changes in private insurance, state and federal regulations to cover gender-affirming treatments and procedures, there has been an increasing need and demand for trained providers and centers to provide gender-affirming health care. However, there is little data to guide management of peri-operative HT with regards to limiting risks. Most surgeons follow a protocol to stop feminizing HT 2 weeks before vaginoplasty with little data that this is effective and necessary or whether this might provoke significant dysphoria peri-operatively. We sought to determine if an age-specific and route-specific peri-operative protocol for feminizing HT was associated with increased risk for complications, changes in hormone concentrations or cardiometabolic profile. At our tertiary care academic center, transgender women over the age of 50 discontinued oral estradiol 6 weeks prior to surgery to allow enough time for clotting factors to normalize but could choose to switch to transdermal estradiol until 2 weeks prior to surgery. Younger women continued estradiol until surgery. All women restarted estradiol upon discharge from the hospital. We performed a retrospective review of pre and postoperative body mass index (BMI), blood pressure (BP), estradiol (E2) and total testosterone (TT) concentrations, fasting glucose and lipids 6 months before and after vaginoplasty. Results: A total of 59 transgender women underwent vaginoplasty over 20 months. Ten women age ≥ 50 (O) had a median age of 58 [Interquartile range (IQR) 56-62]. 49 women < age 50 (Y) had a median age of 31 [IQR 27-37]. O had significantly higher BMI than Y [29.7(IQR 28.3-34.2) vs 24.6 (21.6-28.4), p<0.01 and significantly higher BP, triglycerides, and LDL. More Y women were taking oral estradiol (53% vs 20%). There was no difference in baseline or post-surgical E2 or TT concentrations or fasting glucose. There were no complications of deep venous thrombosis, cardiovascular events or significant changes in BMI, BP, fasting glucose or lipids. In both age groups, only about half were able to decrease their estrogen dose post operatively (Y 57% vs O 44%, p=0.5). Conclusions: Continuing feminizing hormone therapy before vaginoplasty is not associated with an increased risk for complications in women under the age of 50. An individualized approach could be considered to limit the risk of worsening dysphoria post-operatively while avoiding increased risks in older women. Why estrogen doses could not be reduced more frequently after orchiectomy requires further investigation.

Tratamiento de Flegmasía Cerúlea Dolens con Trombólisis; Reporte de Caso

La Flegmasía Cerúlea Dolens es una complicación rara y severa de la trombosis venosa profunda, que se manifiesta clínicamente con edema profuso, dolor y cianosis del miembro inferior afectado. La obstrucción masiva del sistema venoso determina un aumento de la presión de los compartimentos de la extremidad, que finalmente compromete la circulación arterial. Su tratamiento debe ser agresivo para evitar la gangrena y/o la muerte. Presentamos el caso de una paciente atendida en la Clínica La Sagrada Familia, Armenia – Colombia, quien consultó por cuadro clínico de edema progresivo en miembro inferior izquierdo, encontrando cambios isquémicos en falanges distales y edema grado III en miembro inferior izquierdo, con reporte de dúplex venoso con trombosis venosa profunda iliofemoral extensa izquierda y dúplex arterial con reducción de los flujos arteriales secundario a edema severo de tejidos blandos, se indica flebografía con trombólisis venosa por catéter regional en miembro inferior izquierdo con infusión continua de trombolítico. Con respectivos controles angiográficos a las 24 y 48 horas con recanalización del 80% de las venas iliaca, femoral y poplítea, se suspendió infusión y se retiró catéter, continuó anticoagulación con heparina no fraccionada hasta lograr paso a anticoagulación oral con posterior egreso hospitalario dado su evolución satisfactoria.

Rutosides for treatment of post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the treatment of PTS. This is the second update of the review first published in 2013. To determine the effectiveness (improvement or deterioration in symptoms) and safety of rutosides for treatment of post-thrombotic syndrome (PTS) in patients with DVT compared to placebo, no intervention, elastic compression stockings (ECS) or any other treatment. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 21 August 2018. Two review authors independently assessed studies for inclusion. Studies were included to allow the comparison of rutosides versus placebo or no treatment, rutosides versus ECS, and rutosides versus any other treatment. Two review authors extracted information from the trials. Disagreements were resolved by discussion. Data were extracted using designated data extraction forms. The Cochrane 'Risk of bias' tool was used for all included studies to assist in the assessment of quality. Primary outcome measures were the occurrence of leg ulceration over time (yes or no) and any improvement or deterioration of post-thrombotic syndrome (yes or no). Secondary outcomes included reduction of oedema, pain, recurrence of DVT or pulmonary embolism, compliance with therapy, and adverse effects. All of the outcome measures were analysed using Mantel-Haenzel fixed-effect model odds ratios. The unit of analysis was the number of patients. We used GRADE to assess the quality of the evidence for each outcome. Ten reports of nine studies were identified following searching and three studies with a total of 233 participants met the inclusion criteria. Overall quality of evidence using the GRADE approach was low, predominantly due to the lack of both participant and researcher blinding in the included studies. The quality of the evidence was further limited as only three small studies contributed to the review findings. A subjective scoring system was used to obtain the symptoms of PTS so it was important that the assessors were blinded to the intervention. One study compared rutosides with placebo, one study compared rutosides with ECS and rutosides plus ECS versus ECS alone, and one study compared rutosides with an alternative venoactive remedy. Occurrence of leg ulceration was not reported in any of the included studies. There was no clear evidence to support a difference in PTS improvement between the rutosides or placebo/no treatment groups (OR 1.29, 95% CI 0.69 to 2.41; 164 participants; 2 studies; low-quality evidence); or between the rutosides and ECS groups (OR 0.80, 95% CI 0.31 to 2.03; 80 participants; 1 study ; low-quality evidence). Results from one small study reported less PTS improvement in the rutosides group compared to an alternative venoactive remedy (OR 0.18, 95% CI 0.04 to 0.94; 29 participants; 1 study; low-quality evidence). There was no clear evidence to support a difference in PTS deterioration when comparing rutosides with placebo/no treatment (OR 0.61, 95% CI 0.19 to 1.90; 80 participants; 1 study); with ECS (OR 0.61, 95% CI 0.19 to 1.90; 80 participants; 1 study); or an alternative venoactive remedy (OR 0.19, 95% CI 0.01 to 4.24; 29 participants; 1 study). No clear evidence of a difference in adverse effects between the rutosides and placebo/no treatment groups was seen ('mild side effects' reported in 7/41 and 5/42 respectively). In the study comparing rutosides with ECS, 2/80 could not tolerate ECS and 6/80 stopped medication due to side effects. The study comparing rutosides with an alternative venoactive remedy did not comment on side effects AUTHORS' CONCLUSIONS: There was no evidence that rutosides were superior to the use of placebo or ECS. Overall, there is currently limited low-quality evidence that 'venoactive' or 'phlebotonic' remedies such as rutosides reduce symptoms of PTS. Mild side effects were noted in one study. The three studies included in this review provide no evidence to support the use of rutosides in the treatment of PTS.

Rutosides for prevention of post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. The current standard care for the prevention of PTS following DVT is elastic compression stockings. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the prevention of PTS. This is the second update of the review first published in 2013. To determine the effectiveness and safety of rutosides for prevention of post-thrombotic syndrome (PTS) in patients with deep vein thrombosis (DVT), compared to placebo, no intervention, or reference medication. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 21 August 2018. We planned to include trials of rutosides versus any alternative (placebo, no intervention, or reference medication) in the prevention of PTS in patients with DVT. Two review authors independently assessed studies for inclusion and intended to extract information from the trials. No studies were identified comparing rutosides versus any alternative in the prevention of PTS. As there were no studies identified in this review there is currently insufficient evidence to determine the effectiveness and safety of rutosides for prevention of PTS in patients with DVT. Some studies suggest that rutosides may provide short-term relief of PTS symptoms. However, there is nothing published on their use as a preventative therapy for PTS. High quality randomised controlled trials of rutoside versus any alternative are required to build the evidence base in this area.

Prevalence and Characteristic Features of Deep Venous Thrombosis in Patients with Severe Motor and Intellectual Disabilities.

Sudden death associated with patients with severe motor and intellectual disabilities (SMID) have been thought to be caused in part by venous thromboembolism (VTE), but actual situation of VTE in SMID is not clear. We examined the prevalence and location of deep venous thrombosis (DVT), and the relation of the development of crural veins in 16 patients with SMID, using ultrasonography. The maximum diameter of soleal vein was 1.6±0.5 mm. In most cases, DVT was found in the femoral veins. We could not detect thrombus in the soleal veins. In the present study, the detection ratio of DVT was high in patients with SMID who had restricted mobility capability and were bedridden, and we found the veins centrally from popliteal veins in DVT in SMID, not soleal veins, as the initial sites of the DVT. In the literature, the mean diameter of soleal veins, in healthy adults is 6.7±1.8 mm, that in contrast in SMID being smaller. Underdevelopment of intramuscular veins is possibly related to the mechanism of DVT in SMID. In the current guidelines for the management of VTE, there is limited in scope of ambulatory adults and no application cases who exhibit to SMID restricted mobility of the lower extremities and are bedridden associated with cerebral palsy and developmental motor disabilities, and such patients have associated high risk of the complications of DVT. According to our present study, it is necessary to provide appropriate guidelines for DVT in SMID considering characteristic features. (This is a translation of Jpn J Phlebol 2017; 28: 29–34.)

Beneficial Effect of Endovascular Treatment on Villalta Score in Japanese Patients With Chronic Iliofemoral Venous Thrombosis and Post-Thrombotic Syndrome.

Post-thrombotic syndrome (PTS), the most common complication of deep venous thrombosis (DVT), develops in ≥50% of patients with iliofemoral DVT. However, the benefit of endovascular treatment in Japanese patients with chronic DVT and PTS remains unclear. Methods and Results: Between June 2014 and May 2016, endovascular treatment was performed in 11 consecutive Japanese patients with chronic iliofemoral DVT and PTS refractory to anticoagulant therapy and elastic compression stockings. We evaluated the technical success rate, complications, patency, Villalta score, calf circumference, and popliteal vein reflux in both the acute stage (the day following endovascular treatment) and chronic stage (after 6 months). Imaging follow-up included venous duplex scanning and/or magnetic resonance venography. The technical success rate was 81.8%, without complications. In patients with successful intervention, the Villalta score improved significantly, from 9.0±3.7 preoperatively to 3.6±2.5 in the acute phase (P<0.01) and 2.9±2.1 in the chronic phase (P<0.001). The bilateral difference in lower thigh circumference also improved significantly, from 2.6±1.0 cm preoperatively to 1.4±1.0 cm in the chronic phase (P<0.001). However, popliteal vein reflux did not improve. In patients with successful intervention, venous patency rate was 100% at 6 months post-intervention. Endovascular treatment is safe and effective in Japanese patients with chronic iliofemoral DVT and PTS.

Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis.

Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS. This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS. This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol. The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79-2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03-1.75). The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.

Circulating immune complexome analysis identified anti-tubulin-α-1c as an inflammation associated autoantibody with promising diagnostic value for Behcet's Disease.

BackgroundBehcet’s disease (BD) is a chronic, multisystem-involved vasculitis and its pathogenesis remains elusive. No specific serological markers for BD diagnosis have been established. Identification of novel diagnostic biomarkers will be helpful in timely diagnostic and treatment for Behcet’s disease.ObjectiveTo screen novel autoantigens or autoantibodies with potential diagnostic value in circulating immune complexes (CICs) from BD patients.MethodsA proteomic strategy for immune complexome analysis was developed, in which CICs were separated from serum sample of 10 BD patients and 10 healthy controls and then subjected to Orbitrap mass spectrometry for autoantigen profiling. Anti-tubulin-α-1c antibody levels were further determined by enzyme-linked immunosorbent assay (ELISA) in sera of patients with BD, systemic lupus erythematosus (SLE), recurrent aphthous ulcers (RAU), ANCA associated systemic vasculitis (AASV), Takayasu's arteritis (TA) and 59 healthy controls.ResultA total of 17 potential antigens were identified in CICs from BD patients, but not in HC. The autoantibody to one of the identified antigens, tubulin-α-1c, was significantly increased in BD patients compared with that in healthy and disease controls. The sensitivity and specificity of tubulin-α-1c antibody in the diagnosis of BD in this study were 61.36% and 88.4%, respectively. Further analysis demonstrated that anti-tubulin-α-1c was associated with complications of deep venous thrombosis and erythema nodosum in BD. The levels of anti-tubulin-α-1c were also significantly correlated with the BD inflammation and disease activity markers ESR, CRP and BVAS.ConclusionAnti-tubulin-α-1c antibody is a promising biomarker in diagnosis and severity evaluation of BD and in indicating the risk of deep venous thrombosis and erythema nodosum. The immune complexome analysis by proteomic CIC autoantigen screening is a feasible way of identifying novel biomarkers in BD.

Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery.

Surgery for adult spinal deformity (ASD) can significantly improve quality of life but is associated with significant risk of morbidity. Among the most devastating potential complications after these operations is death. The current study aims to report the incidence, preoperative factors, and postoperative complications associated with all-cause mortality within 1 year following ASD surgery. Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. The primary outcome was death within 1 year of ASD surgery. Propensity score matching was used to control for confounding factors, followed by univariate/multivariable logistic regression to predict the odds of death within 1 year of ASD surgery. A total of 6,158 patients underwent ASD surgery and 61 (0.99%) died within one year of surgery. Preoperative factors: controlling for age, gender, American Society of Anesthesiologists (ASA) score and postoperative complications, four independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: increased age (OR =1.03; 95% CI, 1.01-1.06; P=0.012), ASA score (OR =4.32; 95% CI, 2.68-6.94; P<0.001), cancer history (OR =7.91; 95% CI, 4.23-14.78; P<0.001) and unintentional weight loss (OR =4.65; 95% CI, 1.68-12.89; P=0.003). Postoperative complications: using propensity score matching and multivariable logistic regression, three independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: pneumonia (OR =4.00; 95% CI, 1.68-9.53), deep venous thrombosis (DVT) (OR =3.12; 95% CI, 1.20-8.10) and unplanned intubation (OR =3.13; 95% CI, 1.15-8.50). Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.