Limb Deep Vein Thrombosis Research Articles

Assessment of Lower Limb Deep Vein Thrombosis: Characterization and Associated Risk Factors Using Triplex Doppler Imaging.

Deep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism. The study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors. This is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value <0.05 was considered a significant statistic. Among the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518-15.513), surgery (OR = 2.66, 95% CI = 0.411-17.281), trauma (OR = 2.30, 95% CI = 0.452-11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335-6.969). Acute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.

The effect of low molecular weight heparin combined with air pressure in the prevention of lower extremity venous thrombosis after cesarean section: A single-center retrospective study.

In this study, we investigated the effect of low-molecular-weight heparin combined with pneumatic pressure in preventing lower extremity deep vein thrombosis after cesarean section, as well as on the visual analog scale (VAS) score. 120 women who underwent cesarean sections at full term in our hospital from January 2019 to January 2022 were included and divided into a control group (55 cases) and an observation group (65 cases) based on the different treatment methods: the control group was treated with low-molecular-weight heparin and the observation group was treated with pneumatic compression therapy based on the control group. The 2 groups were analyzed for thrombosis, clinical efficacy of the treatment methods, and VAS scores. The incidence of deep vein thrombosis in the observation group were significantly lower than in the control group (4.62% vs 21.82%, P < .05). There were no statistically significant differences in activated partial thromboplastin time, prothrombin time, and thrombin time between the 2 groups (P > .05) before treatment; however, after treatment, activated partial thromboplastin time, prothrombin time, and thrombin time in the observation group were significantly higher than those in the control group (P < .05). The clinical efficacy was significantly higher in the observation group compared with the control group (95.38% vs 78.18%, respectively). The VAS scores in the observation group were significantly lower than those in the control group (P < .05). Hence, low-molecular-weight heparin combined with pneumatic pressure therapy significantly reduces the incidence of lower limb deep vein thrombosis after cesarean section. It also improves the coagulation index and reduces post-operative pain. Therefore, it should be considered for use in clinical practice.

Combination of Ultrasound and Molecular Markers in Evaluating Isolated Distal Deep Vein Thrombosis in Lower Limbs: A Prospective Cohort Study.

To evaluate the risk factors of isolated distal deep vein thrombosis (IDDVT) in the lower limbs by using a combination of Doppler ultrasound and thrombus molecular markers. A prospective cohort study was used. We selected 145 patients with deep vein thrombosis of the lower limbs. They were divided into the IDDVT group and the non-IDDVT group. We compared the differences in Doppler ultrasound and biochemical indexes between the two groups. The independent influencing factors of IDDVT were analyzed using logistic regression, and we plotted the receiver operating characteristic (ROC) curve. We compared 47 IDDVT cases diagnosed by DSA with 47 non-IDDVT cases selected at random. The diameter of the common femoral vein (CFV) of the affected side, deep femoral vein, and the great saphenous vein, thickness of subcutaneous tissue, and serum D-dimer (D-D) and thrombin-antithrombin III complexes (TAT) were significantly higher in the IDDVT group than the non-IDDVT group (P < .05). Logistic regression analysis showed that CFV diameter, subcutaneous tissue thickening, D-D, and TAT were all independent risk factors for IDDVT (P < .05). The combined predictor had higher predictive sensitivity, specificity, and Youden's index (93.6, 87.2, and 0.808, respectively) than using thrombus molecular markers alone or Doppler ultrasound alone. D-D and TAT, the thrombosis molecular markers, CFV diameter, and thickening of subcutaneous tissue, as well as the Doppler ultrasound, all have their own independent effects on IDDVT. When Thrombosis molecular markers and Doppler ultrasound are used in combination, they can predict which patients are at high risk of IDDVT and help doctors in making clinical decisions pertaining to prevention and treatment.

Determination of the Relative Frequency of Lower limb Deep Vein Thrombosis Risk Factors in Patients Referred to Teaching Hospitals of Yasuj, Iran, 2013 to 2014

Determination of the Relative Frequency of Lower limb Deep Vein Thrombosis Risk Factors in Patients Referred to Teaching Hospitals of Yasuj, Iran, 2013 to 2014

A female with left lower limb deep vein thrombosis

A female with left lower limb deep vein thrombosis

Iron Deficiency Anemia as a Potential Risk Factor for Unprovoked DVT in Young Patients: A Case Series.

Deep vein thrombosis (DVT) is a serious and potentially life-threatening condition due to the occurrence of pulmonary embolism (PEs) in the acute phase. DVT can be provoked or unprovoked. Provoked DVT can be associated with transient or persistent causes. Iron deficiency anemia (IDA) with reactive thrombocytosis can act as a prothrombotic condition. We present two case reports of lower limb DVT which was associated with moderate anemia. Association between IDA and thrombosis has been reviewed.

Prevalence, risk, and outcomes of venous thromboembolic events in kidney transplant recipients: a nested case-control study

Introduction Thromboembolism is more common in kidney transplant recipients (KTRs) than in the general population. Studies evaluating arterial and venous thromboembolism (VTE) in KTRs are scarce and the magnitude and risk factors are mostly undefined. Methods A nested control study was conducted from January 1, 2007, to December 31, 2019. Adult KTRs who were detected to have VTE events during this period were included. The primary outcome was to assess the prevalence of VTE in this population. Secondary outcomes were the assessment of the time to occurrence of the thromboembolic events after transplantation and assessing the risk factors and patient survival. For each subject studied, 4 controls were matched from the data set. Results Amongst 2158 patients, 97 (4.5%) were found to have VTE. The median follow-up time was 3.9 years (6–156 months). A total of 101 VTE events were recorded. The most common site of VTE was the lower limb deep vein thrombosis in 79 patients (0.03%)). In multivariate Cox regression analysis, serum creatinine of more than 3 mg/dl [HR 1.30, 95% CI (1.03–1.38)] was independently associated with increased VTE risk. Patients who developed a VTE had higher mortality as compared to patients who did not develop VTE. No increased risk of graft failure was found in VTE patients. Conclusion This study suggests that kidney transplantation surgery is a moderate risk factor for VTE, and VTE is associated with higher morbidity and mortality. However, prospective studies are needed to establish a definite role of VTE in outcomes in KTRs.

A rare case of KILT syndrome in Ireland: A case report

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is associated with significant morbidity and mortality. Congenital absence of the inferior vena cava (IVC) is reported in current literature as a rare risk factor for DVT. The presence of kidney and IVC abnormalities on computed tomography together with lower limb thrombosis is collectively referred to as KILT syndrome (Kidney and IVC Abnormalities with Leg Thrombosis), an extremely rare cause of extensive bilateral lower limb DVT.We present a case of KILT syndrome, diagnosed for the first time after the age of 60 years and the first case reported in the Irish population. The patient presented to the emergency department with unilateral limb pain with a prior history of provoked DVT. Clinical gestalt, a high Wells Score, and raised D-Dimer strongly supported a diagnosis of DVT. Lower limb duplex ultrasound confirmed bilateral external iliac and femoral vein thrombus, with computed tomography venography revealing an absent infrarenal IVC and atrophy of the left kidney. The medical team subsequently admitted the patient for therapeutic anticoagulation and investigation. After review by haematology, the patient was discharged on an indefinite duration of anticoagulation with follow-up with our coagulation services. In any patient with bilateral lower limb DVT, comprehensive assessment and investigation, with particular emphasis on imaging, is imperative to exclude rare associated conditions.

Functional impact of pediatric postthrombotic syndrome

BackgroundPostthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children. ObjectivesWe aimed to assess the impact of pediatric PTS on functioning as assessed by movement ability, mobility, functional disability, and physical activity levels in children after diagnosis of limb DVT. MethodsPatients aged 8-21 years in follow-up care after objectively documented limb DVT were prospectively recruited in this cross-sectional study. Measures of functioning (outcomes) included self-reported questionnaires that assessed: 1) movement ability, measured with the Movement Ability Measure-Computer Adaptive Test version; 2) mobility, evaluated with the Computer Adaptive Test version of the Patient-Reported Outcomes Measurement Information System Pediatric Physical Functioning, Mobility domain; 3) functional disability, evaluated with the Functional Disability Inventory; and 4) physical activity levels, evaluated with the Godin Leisure-Time Exercise Questionnaire. The main predictor was PTS severity, which was assessed using the index for the Clinical Assessment of PTS in children. The association between PTS and outcomes was analyzed using linear models. ResultsEighty-seven patients (median age, 16 years; 25th-75th percentile, 15-18 years; 56% boys) were enrolled. Adjusted for age, sex, and underlying condition, increasing PTS severity was associated with lower current movement ability, a wider gap between current vs preferred movement ability, lower mobility, and slightly higher functional disability scores. There was a nonsignificant effect of PTS severity on moderate-strenuous physical activity. ConclusionIn children, increased PTS severity is associated with lower movement ability and impaired mobility. Reducing the gap between the patients’ current vs preferred movement ability is a relevant aspect of PTS management in children.

Predictive Value for Increased Red Blood Cell Distribution Width in Unprovoked Acute Venous Thromboembolism at the Emergency Department.

Acute venous thromboembolism (VTE) is a common worldwide disease admitted to emergency departments (ED), usually presenting as pulmonary embolism or lower limb deep vein thrombosis (DVT). Due to the lack of typical clinical and biomarker diagnostic features of unprovoked VTE, early identification is challenging and has direct consequences on correct treatment delay. Longitudinal, prospective, observational study. Patients admitted to ED with a suspicion of unprovoked acute VTE between October 2020 and January 2021 were included. Clinical and laboratorial variables were compared between VTE positive and negative diagnoses. Red cell distribution width (RDW) cut point was determinate through a receiver operating characteristic analysis. RDW accuracy, sensitivity, and specificity were calculated. Fifty-eight patients were analyzed. And 82.8% of suspected patients with VTE were diagnosed with an acute thrombotic event confirmed by imaging examination. In patients with VTE, RDW at admission in ED was higher than with other diagnosis, respectively, 14.3% (13.2-15.1) and 13.5% (13.0-13.8). Platelet count was the only additional characteristic that revealed difference between the 2 groups (264×109/L for VTE and 209×109/L for non-VTE). Logistic regression models showed good discriminatory values for RDW≥14%, with an area under the curve (AUC) = 0.685 (95% confidence interval, 0.535-0.834). These findings were more pronounced in isolated DVT, with a sensitivity of 76.9%, specificity 100%, and accuracy 85.7%. Our study demonstrated a significant association between an early high RDW and the diagnosis of acute unprovoked DVT. RDW ≥ 14% has an independent predictor of unprovoked VTE in adult patients.

Retracted: Effects of CDT on Hemodynamics and Quality of Life in a Subgroup of Patients with Lower Limb Deep Vein Thrombosis Carel: A Case‐Control Study

Retracted: Effects of CDT on Hemodynamics and Quality of Life in a Subgroup of Patients with Lower Limb Deep Vein Thrombosis Carel: A Case‐Control Study

Research progress of D-dimer in the diagnosis of perioperative lower limb deep vein thrombosis in fracture

Deep vein thrombosis is a disorder of venous return caused by abnormal intravascular coagulation, which has a high perioperative incidence in orthopedic patients and can develop into venous thrombosis syndrome and even fatal pulmonary embolism in severe cases. As a specific marker of thrombosis, D-dimer is widely used in diagnosing perioperative deep vein thrombosis in fractures, but its specificity in clinical diagnosis is low. It is often necessary to combine dynamic monitoring, ultrasound, Wells score, fibrinogen, and homocysteine to improve the accuracy of diagnosis. The authors have searched the literature and compiled a review of the latest research on D-dimer in diagnosing and managing deep vein thrombosis for clinical reference.

May-Thurner Syndrome: a case of unilateral left lower limb deep vein thrombosis

The May–Thurner Syndrome (MTS) is a rare anatomical condition in which the compression of the left common iliac vein by the right common iliac artery causes an outflow obstruction, presenting frequently as chronic venous insufficiency or deep venous thrombosis (DVT). This variant is rarely considered when investigating DVT, especially in patients with other risk factors. MTS requires careful workup and management to avoid complications such as chronic venous insufficiency, post-thrombotic syndrome, and primary lymphedema. The authors present a 63-year-old woman admitted to the emergency department with a 24-hour history of left lower limb pain and edema. Initial assessment, with computed tomography of the lower left limb and pelvis, showed compression of the left common iliac vein with an extensive thrombus of the left common iliac and external iliac veins, as well as femoral and popliteal left veins, consistent with MTS. Therapeutic enoxaparin initially implemented, was then switched to oral anticoagulation. At 6 months reevaluation, venous duplex ultrasound showed only partial recanalization of the femoral vein. Investigation for May-Thurner Syndrome in patients with left lower limb venous thrombotic events, regardless of risk factors, should always be present since the establishment of an effective therapeutic plan and eventually, endovascular treatment can minimize the long-term sequelae of deep vein thrombosis.

Upper Limb Deep-Vein Thrombosis Following Vaccination with Janssen Vaccine

Deep-vein thrombosis (DVT) is a vascular condition that commonly presents in the lower limb(s). Although reported, its occurrence in the upper limbs is rare. Furthermore, problems with the risk of serious adverse effects in response to vaccination against COVID-19 are relatively rare, despite the unprecedented speed of vaccine production using advanced modern technology. Although infrequent, administration of certain mRNA-based and certain viral vector vaccines have been associated with vaccine-induced thrombotic thrombocytopenia cases in an otherwise healthy patient: most commonly in the central venous sinus or abdominal splanchnic veins or lower limb. Here, we present an unusual case of post Janssen vaccination upper limb DVT, with an average platelet count.

Priapism and pyrexia of unknown origin presenting as a relapse of multiple myeloma

Pyrexia of unknown origin (PUO) is defined as a body temperature &gt;38.3°C on several occasions for &gt;3 weeks with failure of diagnosis despite one week of inpatient investigations or three outpatient visits. Aetiology for PUO may be infective, inflammatory, autoimmune, malignant, miscellaneous or remains undiagnosed. We describe a patient diagnosed with multiple myeloma (ISS-stage II) who completed induction chemotherapy and presented with PUO and extensive thrombosis as a complication of relapsed myeloma (very rare; 0.2% in myeloma). A 62-year-old man, with diagnosed multiple myeloma, achieved a very good partial remission after 6 cycles of bortezomib-thalidomide-dexamethasone regimen, presented with PUO and right lower limb deep vein thrombosis. His thrombosis was managed successfully with anticoagulation. While on therapeutic anticoagulation with warfarin and being investigated extensively for PUO without a focus, he developed priapism due to bilateral internal pudendal vein thrombosis. His anticoagulation was intensified to a target INR of 2.5-3.5. He recovered without residual damage. Despite broad spectrum antimicrobial agents, trial of antimalarial and anti-tuberculosis treatment, he remained pyrexial with rising inflammatory markers (ESR, CRP). Relapsed multiple myeloma was confirmed with 30% bone marrow plasma cells and raised serum monoclonal para-protein levels of 23.78g/L. He was restarted on chemotherapy with bortezomib-lenalidomide-dexamethasone. His PUO of two months subsided with one week of chemotherapy.&#x0D; This case illustrates an atypical presentation of relapsed myeloma and highlights the importance of achieving early diagnosis with a systematic approach and making optimum treatment choice after careful evaluation of previous treatment, drug toxicities, patient’s condition and available treatment options.

Long-term effectiveness of different patellar treatments in primary total knee arthroplasty

To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA). A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination. All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups ( P>0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups. There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.

454P To study the prevalence of lower limb deep vein thrombosis in patients who present with stage III/IV solid tissue malignancies in Indian patients

Deep Vein Thrombosis and Pulmonary Embolism have been associated with significant morbidity and mortality worldwide. The risk of developing lower limb Deep Vein Thrombosis may be associated with cancer-related, patient, and treatment-related risk factors. Although the association between cancer and venous thromboembolism is well known, there is a paucity of information in Asian patients with respect to cancer-associated thrombosis.

ROLE OF COLOUR DOPPLER STUDY FOR EVALUATION OF LOWER LIMB DEEP VEIN THROMBOSIS

Introduction- Deep vein thrombosis is a common clinical problem. It can endanger life of a person by producing pulmonary embolism and may cause venous hypertension. and chronic venous insufciency. Evaluation of patients wi Aim- th suspected deep vein thrombosis by using color Doppler ultrasonography. After obtaining clearance from Institute's ethical commit Method- tee, all the patients fullling the inclusion criteria were selected and written consent is obtained. They will be investigated with color Doppler using GE logic P9 and P5 ultrasound machine's high frequency linear transducer. The protocol begins with the patient in supine position from upper thigh till foot with longitudinal and transverse scanning to examine the veins from the common iliac veins down to calf veins. Results- In our study 50 patients with clinically suspicion of lower limb deep vein thrombosis were subjected for Doppler examination. Out of all the patients the maximum incidences of deep vein thrombosis were noted in the age group of 31-50 yrs. i.e. 48%, and minimum incidence in the age group of 11-30 yrs. i.e. 14%. The age group of 51-70 yrs. had 22% of patients and that of 71-90 yrs. of age group had 16% of patients out of total patients in the study. Out of all the patients it was found that majority of the patients were male 78% while incidence in female patients is 22%. Out of 50 suspected patients of deep vein thrombosis 60% of them were found to be positive or presence of deep vein thrombosis and 40% of them had negative or absence of deep vein thrombosis.Deep vein thrombosis was more common in right extremity i.e. 50% then left extremity i.e. 46%. Only 4% of patients had bilateral involvement. Deep vein Conclusionthrombosis of lower limbs can be detected reliably, non-invasively and rapidly by the use of colour doppler ultrasonography. Gray scale ndings together with colour doppler helps in qualitative evaluation of the venous system of lower limbs and early detection of deep vein thrombosis in clinically suspected Thus it can be concluded that keeping in mind the limitations. and the advantages offered by the colour doppler ultrasonography, it is a good, reliable, inexpensive and rapid method of investigation for deep vein thrombosis of lower limbs.

Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy

BackgroundPerforming percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred.Case presentationWe are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect.ConclusionOur experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.

Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial

Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.