Deep Thrombosis Research Articles

Thrombotic Complications of Varicose Veins

Some recent publications have emphasized the risk (up to 25%) of deep venous thrombosis (DVT) coexisting with a clinical evidence of superficial venous thrombosis (SVT). However, most papers on this topic are old and do not consider the use of the duplex scanning. To determine what the spontaneous risk is of venous thrombosis and emboli in varicose patients, in the superficial veins, and in the deep veins; what the risk is of extension or coexistence between superficial and deep thrombosis; and whether the treatments of varicose disease are responsible for thrombosis? Review of the literature. The frequency of venous thrombosis appears to be increased in patients with varicose disease. In all cases of clinical SVT a duplex scan examination of both deep and superficial veins is necessary in order to provide a complete diagnosis. The treatment of SVTs depends on the situation and the size of the thrombi. In case of associated DVT, the most important treatment is of the DVT. The interest of heparin or low molecular weight heparin (therapeutic doses) is proved for patients with coexisting DVT, and thought so for ascending SVT. Interest and doses have not been stated in other cases. SVT must be considered as a risk factor of DVT and treated from this point of view. Biological analysis and a complete check-up are mandatory in cases of varicose thrombosis in young patients and in cases of recurrence.

The syndrome of the "coup de fouet". Is it always a benign disease?

The "coup de fouet" syndrome is an uncommon condition characterized by a spontaneous intramuscular venous hemorrhage of the calf, sometimes accompanied by a deep thrombosis of the leg. The purpose of this work is to verify the real incidence of the thrombotic complications, making use of the most recent noninvasive diagnostic instruments, such as the duplex scanner and color Doppler. From January 1992 to December 1993, we examined 24 subjects (average age, 38.5 years) suffering from the so-called "coup de fouet" syndrome, which had appeared during physical activity: walking (nine cases), running (six cases), and sudden changes of position (nine cases). In all cases we performed a clinical and instrumental examination (analogical and tensive arterial and venous Doppler, arterial and venous duplex scanner, and color Doppler). Clinically we found, in 17 subjects, a hematoma in the posterior calf with increased thickness and, in 10 cases, with spontaneous sharp pain. In the other seven cases we found a modest hematoma without subjective or other objective symptoms. The arterial Doppler and scanner findings were normal. In the first group of 17 cases, the average clinostatic Doppler venous pressure, measured using a method developed by us and already described, was 32 +/- 4 mm Hg (normal value, 15 +/- 7 mm Hg); in the other seven cases the value was 19 +/- 4 mm Hg. The duplex scanner and color Doppler examination confirmed in all subjects the presence of an intrafascial hematoma in the gemellar zone; in 10 cases (41.7%), with more painful symptomatology, in a zone contiguous to the hemorrhage, we found a gemellar (six cases) or popliteal (four cases) phlebothrombosis. Lastly, we must point out that the syndrome is not always benign and that, therefore, a correct and more vigilant diagnostic and therapeutic approach is necessary.

Long-term results of unsuccessful thrombolysis and secondary thrombectomy of deep leg-pelvic vein thromboses: a critical analysis

According to the literature, fibrinolytic therapy of acute thrombosis of the pelvic and deep lower leg fails in about 15%. As the primary patency rate correlates with the long term results, we intended to investigate whether the failures of 15% might be improved by a secondary thrombectomy. 87% of 31 thromboses treated by secondary thrombectomy were investigated by clinical, morphological and functional examinations. The data show that in case of the intervention taking place within 8 days (total age of the thrombus including the period of lysis treatment) the results were excellent, within 8-14 days they were still good. Patients below the age of 30 years benefited most by the therapy. However, the postulated "airtight effect" could not be demonstrated. Early diagnosis is of paramount importance. The period of lysis treatment should be limited and in case of failure a secondary thrombectomy should be offered to the patient.

Pourquoi et comment explorer les thromboses veineuses profondes?

A retrospective investigation was carried out in 69 patients with etiologically unclear acute deep vein thrombosis. A causal disease could be detected in 20 % of all patients. These findings indicate that all patients with deep veinous thrombosis should have an appropriate workup, particularly with regard to the risk of haemostasis abnormalities or occult malignant diseases.

Suction Lipoplasty

Suction lipoplasty comprising 3511 procedures in 2009 patients was followed up prospectively for 6 to 12 months over a 5-year period. Eighty-eight percent of the procedures led to patient satisfaction and 3.4 percent led to dissatisfaction. Males were more dissatisfied than females. No mortality, deep thrombosis, pulmonary embolism, hypotension, or respiratory distress (fat emboli syndrome) was registered. Excessive bleeding and complications from anesthesia were the most common general complications. No hematoma, skin slough, or damage to adjacent organs occurred. Hypertrophic scarring and skin problems caused by external factors were the most common local complications. Only one clinical bacterial infection occurred. Three hundred and seventy-nine undesired results were registered by the 6-month follow-up, and 213 revisions because of asymmetry, underresection, or skin problems were performed. A total of 121 procedures unexpectedly required secondary suction, skin excision, or fat grafting. Forty-five sequelae were not corrected by revisions. Medial thigh, buttock, ankle, and facial suction emerged as the most difficult locations with regard to the results and complication rate. The age group 20 to 49 years emerged as the least troublesome.

Reduction of venous thrombosis complicating phlebography.

Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reduction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.

VENOUS THROMBOSIS AFTER FRACTURES OF THE UPPER END OF THE FEMUR

1. One hundred patients with fractures of the upper end of the femur were investigated clinically and radiographically to ascertain the incidence and site of deep venous thrombosis during convalescence. 2. The technique of phlebography used has its own inherent dangers, but we believe that familiarity with the technique reduces the risk of complications. 3. The investigation revealed thrombi that were clinically unsuspected and indicates a need for further investigation of factors such as manipulation and retraction that may promote deep thrombosis. 4. The study has provided a control series for an investigation of the effect of prophylactic anticoagulants upon the incidence of deep venous thrombosis and pulmonary embolism after fractures about the hip.

Oestrogens and puerperal thrombosis.

71 cases of puerperal thrombosis from 1954-1964 in University College Hospital London were compared with unmatched controls (the next delivery) and matched controls (next delivery of same age) with respect to time and use of estrogen to suppress lactation. Superficial thrombosis usually occurred in the first week (39) rather than the second (9). Deep thrombosis was found rarely in the first week (5) compared with the second (16). No effect of estrogens on the occurrence of thrombosis was demonstrable since 7 patients had received estrogens by the day of onset of thrombosis and 6 matched controls had estrogens by the corresponding day. This comparison was difficult to complete because records were sparse for controls after they left hospital.

The practical uses of venography.

1. The clinical problem of varicose veins and so-called varicose ulcers is discussed. 2. The relationship of many of these ulcers to previous deep thrombosis is stressed and the evolution of the post-thrombotic leg from the acute stage to the chronic stage with central recanalised vein is illustrated. 3. The help given by the Valsalva technique in differentiating these cases with large, patent, valveless femoral veins, from those with normal valves is shown. This problem has been one of the main stumbling blocks in selecting patients for deep vein ligation. 4. The part played by the perforating veins in the lower third of the leg in the genesis of ulcers is mentioned. A venographic technique for showing these veins is given, and illustrative radiographs are shown.

Deep thrombophlebitis and pulmonary embolism in thromboangiitis obliterans

Deep thrombophlebitis and pulmonary embolism in thromboangiitis obliterans

Sequelae of deep thrombosis in the lower limbs; follow-up study of patients initially treated by conservative measures.

Sequelae of deep thrombosis in the lower limbs; follow-up study of patients initially treated by conservative measures.

The surgical treatment of mitral stenosis. Valvuloplasty: Harken, D. E., Ellis, L. B., Ware, P. F., and Norman, L. R.: New England J. Med. 239:801 (Nov. 25), 1948

The surgical treatment of mitral stenosis. Valvuloplasty: Harken, D. E., Ellis, L. B., Ware, P. F., and Norman, L. R.: New England J. Med. 239:801 (Nov. 25), 1948

New test in diagnosis and surgical treatment of varicose veins: Two hundred vein ligations evaluated

1. 1. A new diagnostic test, called the multiple tourniquet test is presented to locate accurately incompetent perforator veins in the thigh and leg in Trendelenburg double positive cases. 2. 2. With this test both the regular Trendelenburg determination and the location of “blowouts” are simultaneously accomplished. Because the test is simple and quickly performed it lends itself to clinic use. 3. 3. Two hundred consecutive ligations on 140 patients were analysed to demonstrate the value of this test. It is a significant fact that 57.5 per cent of all operations were combined high and low or high and lesser saphenous vein ligations as compared with only 21 per cent of multiple ligations in a previous series where this test was not used. 4. 4. The recurrence rate of 3.4 per cent for multiple ligations was contrasted with a national average of from 10 to 25 per cent. 5. 5. The importance of the lesser saphenous vein as a factor of venous stasis was emphasized and an incidence of 9 per cent reported. 6. 6. Reasons why the author abandoned retrograde injection were discussed and the danger of deep thrombosis and embolism stressed. 7. 7. The author's technic for low ligations was described. 8. 8. The importance of an adequate follow-up of all treated patients was emphasized. 9. 9. Reasons why the author considers vein stripping operations unnecessary when incompetent perforators are encountered were presented.

HEPARIN THERAPY IN ACUTE DEEP VENOUS THROMBOSIS

In the summer of 1940 at the Mariestad Hospital a method was introduced for treating thrombosis of the deep veins of the leg, the main principles of which were (1) early diagnosis, (2) intensive heparin treatment and (3) early mobilization. This procedure has now been in routine use without an alteration for more than five years. The combination of measures characterizing this method was the result of studies on thrombosis and embolism which have been in progress at Mariestad since 1938. In the course of these investigations phlebograms were made on nearly 600 patients, all relevant clinical data being at the same time noted and compared with the roentgenologic findings. The conditions in acute deep thrombosis of the leg were studied in 246 cases. In another group, nearly as large, an examination was made of what might be called the chronic stage of the disease, i.e. the fate of thrombosis