Deep Vein Thrombus Research Articles

Endovenous laser procedure in a clinic room: feasibility and side effects study of 1700 cases

To assess the feasibility of saphenous veins ablation by laser in a clinic room. To study immediate and short term (1 to 6 months) complications and to pinpoint those that could be directly linked to this environment. Efficacy of the technique should also be documented. Retrospective study (22 centres) carried out in France and Switzerland. Patients with insufficiency of great saphenous vein (GSV) or small saphenous vein (SSV). Clinical stages of clinical, [corrected] aetiological, anatomical and pathophysiological classification (CEAP) C2 to C6. Endovenous laser procedures were performed outside an operating theatre, under local anaesthesia and without high ligation. Efficacy criteria: occlusion of the vein and disappearance of the pathological reflux (duplex scan assessment). The side effects and complications were studied. A total of 1703 procedures (1422 patients) were performed; 74% of the patients were women. [corrected] The mean age of the patients was 57. A total of 1394 GSV and 309 SSV were treated (mean diameters 7.2 mm and 6.4 mm, respectively). Overall success level was 97% and mean length of veins treated was 40 cm for GSV and 21 cm for SSV. Energy applied in joules per centimeter was homogenous (mean and median 64 for GSV and 65 for SSV). Complications were rare and 'simple' apart from one pulmonary embolism which occurred 10 days after a GSV procedure, although no deep vein thrombus was found. A total of two infections were observed: one was an infection localized at the site of access and the other was erysipelas. [corrected] Except 2 limited infections (0.1%), this large retrospective study of laser procedures performed outside the operating theatre did not reveal any significant specific complications as regards the environment required. The efficacy results were equivalent to those found in the literature. Regarding cost and constraints induced by operating theatre environment, the clinic room should be able to offer an easier and economic alternative option for saphenous veins ablation with laser [corrected]

P-220 Can Laboratory Data and Cardiac Echocardiographic Findings Predict Deep Vein Thrombus in Congestive Heart Failure Patients?

P-220 Can Laboratory Data and Cardiac Echocardiographic Findings Predict Deep Vein Thrombus in Congestive Heart Failure Patients?

Observation in application of artery hemostatic instrument in hemostasis by compression of puncture site after coronary arteriography

Objective To observe effect of artery hemostatic instrument in hemestasis by compression of puncture site after coronary arteriography. Methods 92 patients who were to undergo coronary arteriog-raphy were divided randomly into the experimental group(47 cases)and the control group(45 cases). Artery hemostatic imstruments were used in the experimental group, the control group used routine compression method for hemostasis. Subcutaneous hemorrhage, subcutaneous hematoma, hematocyanosis, vesicle, uroschesis, deep vein thrombus, false aneurysm, backache, extremity numbness, anxiety and sleep disorder were compared in the two groups. Results Incidence of hematocyanosis, vesicle, uroschesis, backache, ex-tremity numbness, anxiety and sleep disorder in the control group was lower than that in the experimental group. No significant difference was seen in hemorrhage and hematoma in the two groups. There was no deep vein thrombus in the two groups. There was one case of false aneurysm in the experimental group, but no false aneurysm happened in the control group, but there was no statistical significance. Conclusions there was reduced incidence of hematocyanosis, vesicle, uroschesis, backache, extremity numbness, anxiety and sleep disorder in hemostasis by compression with artery hemostatic instrument after coronary arteriography. This can improve patients' comfort and achieve effective hemostasis. Key words: Artery hemostatic instrument; Coronary arteriography; Hemostasis by compression

Effects of primary deep venous valvular incompetence of lower limb in deep vein thrombus after total knee replacement

To evaluate the effects of primary deep venous valvular incompetence of lower limb (PDVI) to the occurrence of deep vein thrombosis (DVT) after human total knee replacement (TKR). One hundred and twenty-six patients who planed to receive TKR were examined by color doppler flow imaging (CDFI). The patients were divided into 2 groups depending on whether they were found backstreaming in femoral vein or not. When the refluxing time > 1 s, the patients were included in PDVI group; When the refluxing time < or = 1 s, the patients were included in without PDVI group. In 7 d after operation all the patients were re-examined by CDFI to find if there was DVT. The results were tested by chi2 statistical analysis. Among the 126 patients, 54 had PDVI, and 72 without PDVI. Fifty patients had DVT, total incidence rate 39.7% (50/126). In PDVI group 33 patients had DVT (61.1%, 33/54); In without PDVI group 17 patients had DVT (23.6%, 17/72), which was lower than PDVI group (chi2 = 21.227, P < 0.05). PDVI may be a risk for occurrence of DVT after TKR.

The clinical application of damage control orthopaedics strategy in treatment of multiple traumas combing with bone injuries.

Objective To evaluate the feasibility and safety of the damage control orthopedics (DCO) strategy in the treatment of multiple traumas combine with bone injuries. Methods Forty-seven se-vere multiple injuries patients were treated by DCO strategy in our center. There were 35 males, 12 females, with a mean age of 32.8 years (17-55 years). There were 28 for open fractures, and 19 for close fractures. Other system injuries mainly include: brain injury 15 cases, breast injury 20 cases, abdominal injury 17 cases. Mean injury severity score was 33.4, mean glasgow coma score was 11.4, mean systemic inflammatory response syndrome score was 2.9. After the early resuscitation and one-stage of damage control surgery, all patients were send to ICU for a profound resuscitation. Two -stage definitive osteosynthesis were executed when the patients were stabilization. The data of time spend, blood loss, and complications of operations were recorded to evaluation. Results In the one-stage procedure, the mean time spend on bone injury for each patients was 65 min, blood loss during the operation was 185 ml. The two-stage definitive osteosynthesis were performed average 7 days after the one-stage procedure, and the time spend and blood loss during the oper-ation were (142±29) min and (420±70) ml, respectively. Three patients died from the deteriorate after one-stage procedure. Six cases development complications after the operation. Fat embolism, deep vein thrombus and others deteriorate associate with the one-stage procedure were not found. Four patients were all obtained neurologic improvement who has spinal fractures combined with spinal cord injuries. 39 cases were followed up for a mean time of 9 months (range, 3-14 months). No long-term complications were found, and the frac-tures got a satisfactory healing. Conclusion DCO appears to reduce the extent of second-hit, control the in-crease of systematic inflammatory response, deduce the risk of the operation for those severe multiple trauma patients, and have a satisfactory clinical outcome, is a safe, effective, feasible treatment strategy. Key words: Multiple trauma; Fractures; Surgical procedures, operative

Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme

Gliadel (BCNU) wafer and concomitant temozolomide (TMZ) therapy, when used individually as adjuvant therapies, extend survival from that achieved by resection and radiation therapy (XRT) for glioblastoma multiforme (GBM). It remains unstudied whether combining Gliadel and TMZ therapy is safe or further improves survival in patients with newly diagnosed GBM. The authors reviewed their initial experience utilizing combined Gliadel, TMZ, and radiation therapy for the treatment of GBM. All cases involving patients undergoing primary resection of GBM with or without Gliadel wafer (3.85% BCNU) implantation and adjuvant XRT over a 10-year period (1997-2006) were retrospectively reviewed. Beginning in 2004, concomitant TMZ became the standard of care at the authors' institution and all patients with Gliadel implantation also received concomitant TMZ (Stupp protocol). Overall survival and treatment-related morbidity were assessed for all patients treated with Gliadel plus concomitant TMZ (XRT + Gliadel + TMZ). Age-matched (<or= 70 years) comparison of survival and morbidity was performed between the XRT + Gliadel + TMZ (post-2003) and XRT + Gliadel (pre-2004) cohorts. Thirty-three patients were treated with XRT + Gliadel + TMZ. The median survival in this group was 20.7 months, with a 2-year survival rate of 36%. Six-month morbidity included surgical site infection in 1 case (3%), perioperative seizures in 2 cases (6%), deep-vein thrombus in 1 (3%), pulmonary embolism in 3 (9%), and cerebral edema requiring admission for intravenous dexamethasone in 1 case (3%). Myelosuppression required premature termination of TMZ in 7 patients (21%) (thrombocytopenia in 5, neutropenia in 2 cases). In patients <or= 70 years of age, XRT + Gliadel + TMZ (30 patients, post-2003) was independently associated with improved median survival (21.3 vs 12.4 months, p = 0.005) versus XRT + Gliadel (78 patients, pre-2004), with 2-year survival of 39 versus 18%, respectively. In these patients, XRT + Gliadel + TMZ was not associated with an increase in perioperative morbidity in comparison with XRT + Gliadel. In this experience, concomitant TMZ therapy in addition to Gliadel wafer implantation was associated with a median survival of nearly 21 months without increased perioperative morbidity. Temozolomide can be safely administered to patients receiving Gliadel wafers after resection of GBM.

Paradoxical Embolism to the Central Nervous System After Sexual Intercourse in a Young Woman with a Complex Atrial Septal Abnormality

Ischemic stroke during sexual intercourse is an unusual occurrence. We report the evaluation and treatment of a young woman on oral contraceptives, with a complex atrial septal abnormality and right lower extremity deep vein thrombus, who had an ischemic stroke during sexual intercourse. Successful treatment was accomplished with administration of intra-arterial tissue plasminogen activator and subsequent transvascular occlusion of the atrial septal abnormality.

Informatics: The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves?

Citation: Thede, L., (Aug 18, 2008) Electronic Health Record: Will Nursing Be on Board When the Ship Leaves? OJIN: The Online Journal of Issues in Nursing Vol. 13 No. 3. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Informatics/ElectronicHealthRecord.aspx You and your care team in the emergency room have just received an unconscious, air-flighted, car-accident victim. Yet even before she arrived, you had learned, in addition to the information about her new injuries provided by the paramedics and nurse aboard the helicopter, the name of her primary physician, the source of her insurance, that she was from a town 1,500 miles away, that her blood type was A positive, and that she was on an anticoagulant and had had a hip replacement six months ago after which she developed a deep vein thrombus. Sound far fetched? The technology to make this happen is with us today, and in some countries it is already a reality. The technology used in communicating the information in the scenario above included a healthcare smartcard and an electronic health record (See Table). Electronic health records are designed to provide nationwide access to designated information compiled from data found in medical records created by various providers regardless of whether providers are in the same healthcare system, or as in the case of the accident victim described above, in a different system far from the patient's home. You are probably already familiar with at least some components that will be included in an electronic health record. Your agency may already be using computerized provider order entry (CPOE), or have implemented other computerized systems, such as a medication administration system. These components are all building blocks for a complete agency record that is labeled the electronic medical record (EMR) (See Table) (National Alliance for Health Information Technology, 2008) that is owned by the provider that has created it. In contrast, an electronic health record (EHR) (See Table) is created when information from records created by a variety of agencies that are under different ownership is made available to other healthcare providers within a network. The EHR allows those healthcare providers designated by the patient to obtain healthcare information related to past episodes of healthcare. It is hoped that such a record will eventually be a birth-to-death electronic healthcare record. Sharing healthcare information between unrelated providers will probably start with the creation of a Regional Health Information Organization (RHIO) in which providers in the same area share information. This step involves the electronic exchange of health-related information between organizations in the same geographical area using agreed-upon standards, protocols, and other criteria (National Alliance for Health Information Technology, 2008). Eventually, the RHIOs will be combined into larger entities until all the healthcare providers are connected in a National Health Information Network (NHIN) throughout the United States. This network will provide access to patient-designated healthcare information for clinical decision making nationwide (United States Department of Health and Human Services, n.d.). As you can imagine, there are many technical issues involved in creating the NHIN, including data security, data access, patient identification, and the ability for all systems to communicate with one another. Information technology specialists are currently addressing these issues. Additional issues that will affect nursing even more directly are the types of nursing data that will be included in electronic health records, and the terminologies used to convey this data. In the past, and currently, nursing notes, unless used institutionally in infection control reports, quality improvement projects, or for legal issues, are filed upon patient discharge in medical records departments and then are generally ignored. …

Intravenous lobular capillary hemangioma originating in the iliac veins: A case report

Intravenous lobular capillary hemangioma is a rare benign lesion that can mimic other intravascular lesions encountered by vascular surgeons, such as angiosarcoma, papillary endothelial hyperplasia, and deep vein thrombus. These lesions have been described originating in the veins of the head, neck, and upper extremities. To our knowledge, there are no reported cases of intravenous capillary hemangioma arising from within a pelvic vein. We report a case of an elderly woman found to have an extensive intravenous lobular capillary hemangioma originating in the internal iliac vein. She was successfully treated with resection, including the tumor and normal iliac vein. Diagnosis of these lesions can be difficult. We describe the utility of duplex ultrasound and magnetic resonance venography in aiding preoperative diagnosis and surgical planning. The diagnosis is ultimately confirmed with histology that demonstrates multiple capillaries lined with flattened endothelial cells grouped in a lobular fashion admixed with fibromyxoid stroma containing collagenous fibers, spindle cells, and mitotic figures. Preoperative work-up should include a duplex ultrasound and magnetic resonance venogram. Treatment should be with resection and specimen processing to rule-out malignant vascular tumors.

Pulmonary embolism in a patient with multiple myeloma receiving thalidomide–dexamethasone therapy

Massive pulmonary embolism is an uncommon complication of multiple myeloma treated with thalidomide-dexamethasone regimen. In 2006, multiple myeloma was diagnosed in a 72-year-old man, who received thalidomide-dexamethasone therapy. In January 2007, echocardiography and computerized tomography identified massive pulmonary embolism in the pulmonary arteries and a deep vein thrombus of the right leg. The patient also had an elevated concentration of B-type natriuretic peptide. After heparinization and warfarin therapy, the patient's condition improved. This is the first report of a patient with a rare complication of pulmonary embolism from thalidomide-treated multiple myeloma.

Low Platelet Counts in Cancer Patients: Should Heparin for Venous Thromboembolism Prophylaxis Be Instituted?

and platelet levels of 18,000/mm 3 who developed an acute upper extremity deep vein thrombus. Although in her case, it was clearly related to a peripherally inserted central catheter in the affected limb, we wonder if it demonstrates her being at a considerably high risk for spontaneous thromboembolic events. The treating team could not gather sufficient evidence to institute prophylactic dosage of heparin in view of her high presumed risk of bleeding. Two out of the three majorrandomized,double-blind,placebo-controlledtrialsonthromboembolism prophylaxis in hospitalized patients (the Prophylaxis in Medical Patients with Enoxaparin trial and the Prevention of Recurrent Venous Thromboembolism study), have specifically excluded patients with platelet counts less than 100,000/mm 3 . 2,3 As such, evidence for thromboembolism prophylaxis in patients with platelet count less than 100,000/mm 3 is probably not clear.

Venous thromboembolism: a need for more public awareness and research into mechanisms.

Articles in this Series: Heit J. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28:370-372. Moll S. A clinical perspective of venous thromboemobolism. Arterioscler Thromb Vasc Biol. 2008;28:373-379. Gross P and Weitz J. New anticoagulants for treatment of venous thromboemobolism. Arterioscler Thromb Vasc Biol. 2008;28:380-386. Wakefield TW, Myers DD, Henke PK. Mechanisms of venous thrombosis and resolution. Arterioscler Thromb Vasc Biol. 2008;28:387-391. Link RP. National heart, lung, and blood institute programs for deep vein thrombosis. Arterioscler Thromb Vasc Biol. 2008;28:392-393. Beckman MG, Critchley SE, Hooper WC, Grant AM, Kulkarni R. CDC division of blood disorders: public health research activities in venous thromboembolism. Arterioscler Thromb Vasc Biol. 2008;28:394-395. Fenninger R. Patient advocacy to promote public awareness about thrombosis and thrombophilia. Arterioscler Thromb Vasc Biol. 2008;28:396-397. Hunt BJ. The awareness and politics of venous thromboembolism in the United Kingdom. Arterioscler Thromb Vasc Biol. 2008;28:398-399. In 2005, the US Senate declared March as deep vein thrombosis (DVT) awareness month in the United States to increase the American public’s understanding of deep vein thrombosis.1 This was triggered by the death of 39-yr-old David Bloom, a National Broadcasting Company (NBC) reporter who died on April 6, 2003 from a massive pulmonary embolism (PE), and the activities of his widow, Melanie Bloom.2 Two days before his death David Bloom had developed cramping leg pain that was not recognized as a DVT2—leg DVT was only found postmortem. He had several risk factors for DVT and PE (collectively called venous thromboembolism [VTE)]): (1) prolonged immobility (working and sleeping in a cramped position in a tank in the war in Iraq); (2) long distance flights between the US and Kuwait, (3) dehydration, and (4) postmortem the discovery that he was heterozygous for the prothrombotic variant of factor V called factor V …

The Effect of a Temporary Inferior Vena Cava Filter in the Treatment of Deep Vein Thrombosis in Critically-Ill Patients

We studied the clinical courses of patients with deep vein thrombus (DVT) who underwent insertion of temporary inferior vena cava filters (tIVCF) and evaluated the effectiveness of the tIVCF. From January 2003 to March 2008, tIVCF were placed in 12 patients with a diagnosis of DVT in the Intensive Care Unit (ICU) of Gunma University Hospital. The mean age of the patients was 52 +/- 16 years (range, 18-82). Eight were medical patients who had not undergone any prior surgery, and 4 were postoperative patients, including 3 with a malignancy. The diagnosis of DVT was made using enhanced computed tomography. The Toray Neuhaus Protect catheter (6Fr, Toray Medical, Tokyo) was used as a tIVCF in all 12 patients. We evaluated the clinical course of the patients before and after placement of a tIVCF and studied their prognosis. DVT occurred on 15 +/- 9 days after surgery or admission to hospital. Pulmonary thromboembolism (PTE) was detected in 7 patients prior to the placement of a tIVCF, 3 of whom required cardiopulmonary resuscitation. The mean duration of tIVCF placement was 18 +/- 9 days; no episodes of PTE occurred after tIVCF placement. DVT completely or almost completely disappeared during the period of tIVCF placement; subsequently, tIVCFs were successfully removed in 10 patients (83%). A permanent IVCF was placed in only 1 patient, and the tIVCF was removed in the remaining patient because of suspected catheter infection. There were 2 complications related to tIVCF placement: infection at the insertion site and suspected catheter infection. tIVCF placement could prevent the occurrence of PTE without provoking life-threatening complications. The results suggest that tIVCF is useful in the prevention of PTE in patients with DVT.

Simultaneous but, Different Two Cardiac Masses

Case A 76-year-old male was referred for cardiac masses on chest CT which was performed to evaluate adenocarcinoma of lung. He was already found metastasis to adrenal gland. He underwent a transthoracic echocardiogram, which revealed two cardiac masses. One was located in interventricular septum of base level, and the other was oscillating in right atrium (Fig. 1 and 2). It seemed that they contacted with each other via tricuspid annulus. No vascular flow at inside of mass was found. Transthoracic echocardiography showed neither valvular dysfunction or left ventricular systolic dysfunction. Low extremity doppler ultrasound showed no evidence of deep vein thrombus. Though electrocardigram (ECG) shows T wave inversion in inferior leads, ECG monitoring during admission (14 days) revealed no specific arrhythmia like ventricular tachycardia. In pulmonary artery CT angiogram showed no evidence of pulmonary embolism. Mass at interventricular

Custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved

The therapeutic results of managing proximal tibial osteosarcoma have been dramatically improved because of the recent advancements in imaging, chemotherapy, and surgical techniques. Further, the prognosis of patients with proximal tibial osteosarcoma is improved and the chance of survival with limb salvage surgery is increased. Among the limb salvage procedures, endoprosthetic reconstruction is now preferred to other methods such as allograft, composite allograft prosthesis, or arthrodesis. However, the treatment for proximal tibial osteosarcoma with proximal tibiofibular joint involved has not been reported. The report of the preliminary results of custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved following the primary tumor resection. The oncological results, functional outcomes, and complications were assessed in this present study. Eleven patients with osteosarcoma of the proximal tibia and proximal tibiofibular joint were studied in 1995-2005, at Qilu Hospital of the Shandong University. Seven cases were males and four cases were females, with a mean age of 17 years (range 14-23). The surgical stage of all of the patients was Stage IIB, according to the Enneking Surgical Staging System. After neo-adjuvant chemotherapy, all of the patients underwent en bloc resection. This procedure included the proximal tibiofibular joint and the upper end of the fibula, followed by custom prosthetic replacement. The extensor mechanism was repaired by reattachment of the patellar tendon to the slot in the tibial component, with reinforcement by autologous bone-graft and suturing of the patellar tendon to a medial gastrocnemius rotation flap. The medial gastrocnemius rotation flap was then used to cover the implants. During the mean follow-up time of 47 months (range 12-96), six patients lived free of the disease, and five patients experienced various complications. One patient was still alive yet affected by the disease; one patient had an amputation due to local recurrence; and three died of pulmonary metastases. Several early complications had occurred amongst those five patients: one developed skin necrosis; two experienced transient palsy of the common peroneal nerve; and two developed deep vein thrombus of the lower limb. The mean Musculoskeletal Tumor Society score was 70% (range 55-86%), the mean postoperative range of motion was 85 degrees (range 0-120 degrees ), and the mean extension lag was 11 degrees (range 0-20 degrees ). Custom prosthetic reconstruction could yield as much satisfactory results as neoadjuvant chemotherapy and limb salvage surgery, for patients with osteosarcoma in proximal tibia and proximal tibiofibular joint. During the present study, most patients had good or excellent motor functioning with few incidences of complications. However, more attention should have been given to both the quality of function and long-term survival of patients.

Review of Acute Pulmonary Embolism in a General Hospital

Acute pulmonary embolism (APE) is a serious cardiovascular disease associated with high mortality rates. We analyzed the clinical characteristics, treatment, and outcome of patients with APE in a general hospital in Japan. The subjects were 14 patients with APE: 6 with out-of-hospital onset and 8 with in-hospital onset. The incidence of APE in hospitalized patients was 0.03% (95% confidence interval, 0.01%-0.05%). Eight patients suffered shock and three patients suffered cardiac arrest. Advanced age, deep vein thrombus (DVT), cancer, fracture, obesity, and surgery were common risk factors. In the hospitalized patients, surgery was a major risk factor: APE developed perioperatively in five (63%) of eight patients. Nine patients were treated with heparin alone, three were treated with thrombolysis, and two underwent surgical embolectomy for right heart thrombi. Three of the patients who suffered shock died during hospitalization and another died of recurrence 2 months after the first episode. Overall in-hospital and 3-month mortality rates were 21% and 29%, respectively, and the in-hospital mortality rate of the patients with shock was 38%. Acute pulmonary embolism was associated with high mortality rates and surgery was the most common risk factor predisposing to APE in hospitalized patients. Thus, standardized prophylaxis against DVT is essential for patients undergoing surgery.

Treatment of Deep Vein Thrombosis With Enoxaparin in Pediatric Cancer Patients Receiving Chemotherapy

There are few data regarding the use of enoxaparin in children undergoing myelosuppressive therapy for malignancies even though thrombosis is a known risk in pediatric patients with malignancies. Low-molecular-weight heparin such as enoxaparin has become widely used in adult patients with thrombosis. The purpose of this study was to review the utilization of low-molecular-weight heparin, enoxaparin (Lovenox), in children with cancer at our institution who had thrombosis while undergoing myelosuppressive chemotherapy. In particular we were interested in the efficacy of enoxaparin in these patients, and in whether these children were able to continue their chemotherapy without adjustment or interruption secondary to bleeding complications. We conducted a retrospective review from 1999 through April 1, 2004. Seven patients (4-17 years of age) were identified. Diagnosis included B-precursor acute lymphoblastic leukemia (ALL) (n=three), T-ALL, Hodgkin's disease, anaplastic large cell lymphoma, and rhabdomyosarcoma (n=one each). Six patients had a deep vein thrombus (DVT) or clot of the vena cava. One of these six patients also had a pulmonary embolus. One patient presented with manifestations of a unilateral cerebral vascular accident without evidence of DVT. Most patients were screened for known hypercoaguable abnormalities. Treatment was enoxaparin, 1-1.5 mg/kg/dose twice daily to maintain a heparin anti-Xa level of 0.5-1.5 IU/mL till clot resolution. The dose was then decreased to daily for a total of 3-6 months of therapy. All patients had resolution of their thrombosis within 1-2 months of initiation of enoxaparin, and none required delays or dose reduction of their chemotherapy regimens while on anticoagulation, though some were supported by blood and platelet transfusions. Enoxaparin was safely administered to this series of seven patients for thrombotic complications in children undergoing cancer chemotherapy.

Safety, feasibility, and outcome of retrievable vena cava filters in high-risk surgical patients

Retrievable vena cava filters (rVCFs) are being used frequently in the perioperative setting for preventing pulmonary embolism. The indications and safety profile for placement of preoperative retrievable vena cava filters (rVCFs) remains undefined, however. This study sought to determine the safety, feasibility, and outcome of rVCFs in bariatric surgery patients, who are known as a high-risk population for periprocedural deep vein thrombus (DVT) or pulmonary embolus, or both. Between June 1, 2004, and October 1, 2005, protocols were developed and implemented at a tertiary referral hospital for placement of rVCFs in 59 consecutive high-risk patients undergoing laparoscopic gastric bypass or duodenal switch if they met any of the following criteria: body mass index >55 kg/m(2), hypercoagulable state, severe immobility, venous stasis, or previous history of DVT or pulmonary embolus. Using both Site-Rite (Bard Access Systems, Salt Lake City, Utah) ultrasound and fluoroscopy, Günther Tulip (Cook, Inc., Bloomington, Ind) rVCFs were placed immediately after general anesthesia, just preceding the bariatric procedure. The internal jugular vein was the preferred approach, followed by the femoral vein. Retrieval was performed after the fourth postoperative week. During a 16-month period, 60 rVCFs were placed in 61 attempts, 57 through the internal jugular vein and three through the femoral vein. Six patients refused the retrieval attempt. Of the remaining 54 rVCFs, the primary retrieval success was 90% (49/54), with all failures due to severe filter tilt. The secondary retrieval success was 100% (3/3). The two remaining patients refused secondary retrieval attempt. The mean +/- standard deviation dwell time of the rVCFs was 63 +/- 30 days. No procedure complications occurred in placement or retrieval. One patient developed a clinical pulmonary embolism with the filter in place while not receiving postoperative anticoagulation. No patients died. The mean body mass index of the patients was 61 +/- 10 kg/m(2). Placement and retrieval of retrievable vena cava filters in high-risk bariatric surgery patients is safe, feasible, and offers potential clinical benefit to patients requiring short-term protection from pulmonary embolism.

Adjunctive Proximal Vein Ligation with Endovenous Obliteration of Great Saphenous Vein Reflux: Does It Have Clinical Value?

The risk of clot extension to the deep venous system or pulmonary embolism following endovenous great saphenous vein (GSV) obliteration is possibly related to the size of the proximal GSV. Some practitioners therefore exclude endovenous GSV obliteration for veins greater than an arbitrary size, starting as little as 15 mm. Others provide adjunctive proximal GSV ligation either routinely, or in selected patients with large veins. The clinical value of adjunctive proximal GSV ligation is unknown. A survey of either the American Venous Forum or the American College of Phlebology, selected for their pedagogic or long-time experience with endovenous GSV obliteration. Respondent characteristics included obliteration technique (laser, radiofrequency [RF], or foam sclerotherapy), academic status, surgical training, indication for and frequency of adjunctive proximal GSV ligation, and society membership. The incidence of pulmonary embolus (PE) and deep vein thrombus (DVT) was also tallied. Twenty-one thousand nine hundred sixty-five endovenous GSV obliteration cases were reported, 10,290 with a laser (46.8%), 6,275 (28.6%) with RF, and 5,400 (24.6%) with foam. Only two PEs were reported. Of the 34 patients with DVT, at least 11 had only asymptomatic ultrasound evidence of thrombus extension into the femoral vein, and at least five had only calf vein thrombosis. Comparing ligators (7) with non-ligators (15), the only characteristic significantly correlating with adjunctive proximal GSV ligation was whether the respondent had complete general or vascular surgical training; non-surgeons never ligated the saphenous vein (p < .001). There was no difference between outcomes of ligators and non-ligators. Endovenous obliteration of the GSV poses little risk of PE or DVT, no matter what size the proximal GSV. Although these adverse events may be reduced with adjunctive proximal GSV ligation, the results of this study suggest that adjunctive proximal GSV ligation is superfluous in most patients.

Pulmonary embolism developed on the first postoperative day of total knee arthroplasty due to deep vein thrombus formed intraoperatively: A case report

Pulmonary embolism developed on the first postoperative day of total knee arthroplasty due to deep vein thrombus formed intraoperatively: A case report