Deep Veins Of Lower Limbs Research Articles

The anticoagulant treatment dilemma in pulmonary embolism associated to cancer

Abstract Pulmonary embolism (PE) is defined by the obstruction of pulmonary arteries by thrombi or emboli (malignant, grease, air). Most frequently, thrombi arise from deep veins of lower limbs. Pulmonary embolism is a medical emergency with a high death risk. Early mortality is high, sudden death occurs in about a quarter of the patients. On long term, it can lead to post-embolic pulmonary hypertension and recurrent pulmonary embolia. The high risk of death in acute phase and on long-term depends on the severity of the acute phase, on the recurrence, and on the co-morbidities. PE can be the first manifestation of on occult malignancy, or it may complicate an already diagnosed cancer. We present a retrospective analysis on PE associated to malignancy, on 106 patients, with classic anticoagulant treatment (low weight molecule heparin and/or antivitamin K agents) or novel oral anticoagulants (NOAC) and compare the early and late mortality associated to PE and anticoagulant treatment. Our observations note a higher percentage of recurrences but significantly lower mortality in patients treated with NOAC as compared to classic treatments.

Abstract 12959: Clonal Hematopoiesis of Indeterminate Potential Predicts Incident Venous Thromboembolism in the UK Biobank Cohort

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) refers to the formation of genetically distinct subpopulations of blood cells due to somatic mutations. CHIP is associated with a variety of adverse outcomes, including hematological cancers, cardiovascular disease, and death. We sought to investigate the association of CHIP with incident venous thromboembolism (VTE). Methods: We analyzed exome sequence data from 200,628 individuals in the UK Biobank cohort using Mutect2 to identify a prespecified list of somatic mutations in DNMT3A, TET2, and ASXL1, which are known genetic drivers of CHIP. CHIP was defined as harboring a somatic mutation at a variant allele fraction (VAF) ≥10% and individuals with VAF <2% were deemed as non-carriers. VTE was ascertained using verbal interview data and diagnostic/procedural codes and defined as a composite of the following: thrombophlebitis of deep veins of lower limbs, embolism/thrombosis of vena cava, pulmonary embolism, venous thrombectomy of lower limb veins or IVC filter insertion. We implemented a nested case-control design with incidence density sampling to identify incident cases and controls matched (1:8 ratio) for sex, smoking status, and history of malignancy at baseline. Conditional logistic regression analysis adjusted for age, BMI, and genetic ancestry was performed to assess the association between CHIP and incident VTE. Results: Among 200,628 individuals, we identified 3,885 individuals with CHIP at baseline and 748 incident VTE events during a median follow-up of 9.2 years. In 748 incident cases and 5984 matched controls, CHIP was associated with increased risk of incident VTE independent of conventional risk factors for VTE, namely, age, sex, BMI, smoking, and history of malignancy (incidence rate ratio [95% confidence interval]; 1.60 [1.04-2.46], p=0.032). When we restricted the cases to individuals with incident pulmonary embolism (n=441), we observed a stronger association with CHIP (1.80 [1.08-3.05], p=0.025). Conclusions: CHIP is associated with increased risk of VTE independent of history of malignancy and other conventional risk factors. The pathophysiological basis for this association needs further investigation.

Efficacy of apixaban in prevention of haemorrhagic complications in treatment of deep vein thromboses with endovascular techniques

This study was undertaken to investigate efficacy of apixaban in prevention of haemorrhagic complications during treatment of proximal thromboses of deep veins of the lower extremities using endovascular techniques. We retrospectively studied the results of treating a total of 50 patients presenting with deep vein thromboses at late stages of the pathological process. The patients were subdivided into 2 statistically homogeneous groups. Group One was composed of 30 patients undergoing treatment consisting in a combination of catheter-guided thrombolysis with urokinase and percutaneous mechanical thrombectomy, with rivaroxaban used for prolonged anticoagulation therapy. Group Two comprised 20 patients subjected to similar endovascular treatment with additional venous stenting. Prolonged 6-month anticoagulation therapy was carried out with apixaban. The results of treatment were assessed after 12 months by means of control ultrasonographic and clinical examination in order to determine the degree of restoration of the lumen of deep veins and severity of venous outflow impairments. After 1 year, in Group One patients there was no evidence of impaired venous outflow in 40% of patients, with a mild degree revealed in 40%, moderate degree in 13.3%, and severe degree in 6.7% of patients. In Group Two patients, there were no symptoms of venous insufficiency in 83.4%, with a mild degree revealed in 16.6%. Neither moderate nor severe impairments of venous outflow were observed. In Group One, manifestations of haemorrhagic syndrome on the background of taking rivaroxaban were noted to occur in 10% of patients and in Group Two on the background of taking apixaban also in 10% of patients. The use of apixaban in patients with proximal thromboses of deep veins of lower limbs on the background of treatment by endovascular techniques proved effective and safe.

Endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound

Objective: To evaluate the clinical efficacy of endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound. Methods: The clinical data of 40 patients with non-thrombotic right iliac vein compression syndromereceiving intravascular ultrasound-assisted balloon dilatation combined with stent implantation from January 2012 to December 2018 were retrospectively analyzed. There were 32 males and 8 females, the average age of whom was 63 (46-81) years old. The patients were classified according to the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) classification: 7 cases as C3, 18 as C4, 10 as C5 and 5 as C6. All patients underwent percutaneous right femoral vein puncture, intravascular ultrasound, and balloon dilatation combined with stentimplantation in the right iliac vein lesion location. Results: The success rate of clinical operations was 100%. There were no serious complications during the perioperative period. All patients were followed up for 4-58 months. During the follow-up period, the relief rate of limb edema was 88.6% (31/35), the pain relief rate was 86.7%(13/15), and the healing rate of ulcers was 100% (6/6). After the stent implantation, the endovascular area of the compression site was significantly enlarged (34.5mm(2)± 11.1mm(2)vs129.8 mm(2)±17.2 mm(2), P<0.001). The follow-up of color Doppler and/or anterograde angiography for deep veins of lower limb with digital subtraction angiography showed that the blood flow in the stentsweres mooth in all patients. Three cases were observed that the intimal hyperplasia led to mild in-stent restenosis, no obvious in stent restenosis (>50%). The abdominal X-ray plain film showed no obvious displacement and fracture of the stents. The venous clinical severity score (VCSS) was statistically significant (13.0±2.4 vs 6.2±2.0, P<0.001). The statistical results of short-form health surver SF-36 showed that the scores of life quality in all dimensions of the affected limb were significantly improved after operation (P=0.000). Conclusion: Intravascular ultrasound-assisted balloon dilatation combined with stent implantation is not only a safe and effective treatment for non-thrombotic right iliac vein compression syndrome, but also has a good mid-term patency rate.

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review.

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

Free floating thrombus in right heart associated with pulmonary embolism: The effect of streptokinase

Floating right heart thrombus in -transit originate from the deep veins of lower limbs, travel to the pulmonary arteries and is uncommon in patients with pulmonary embolism. This condition is a medical emergency due to the high risk of mortality. However, the most appropriate treatment is yet to be determined and there is no clear consensus in the literature on therapeutic management. We have described two cases of deep vein thrombosis complicated with pulmonary embolism and right heart thrombus, which were treated with streptokinase and had diverse outcomes.

Effect of intermittent pneumatic compression on coagulation function and deep venous hemodynamics of lower limbs after rectal cancer resection

To investigate the effects of intermittent pneumatic compression (IPC) on coagulation function, deep venous hemodynamics and prevention of deep venous thrombosis (DVT) of lower limbs in patients after rectal cancer resection. A total of 120 patients undergoing rectal cancer resection were randomly divided into non-IPC group (control group, n=60) and IPC group (n=60). The control group received routine treatment after resection and the IPC group received IPC based on the routine treatments. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and volume of D-dimer (D-D) were detected before operation and 1-, 3-, 5- and 7-day after operation. Meanwhile, blood flow velocity and caliber of external iliac vein, femoral vein and popliteal vein were examined by color Doppler ultrasound, then the average blood flow velocity and blood flow volume were calculated. Incidence of lower limb DVT was 13.3% (8/60) and 1.7% (1/60) in control group and IPC group respectively with significant difference (P<0.05). The differences in PT, APTT and INR were not significant (P>0.05) at 1-day after operation as compared to the preoperative level, while FIB and D-D both increased (P<0.05), all presented no significant difference among the two groups (P>0.05). PT shortened gradually (P<0.05), APTT and INR did not change significantly (P>0.05), FIB and D-D increased gradually (P<0.05), and no significant differences were found between the two groups at the same time point (all P>0.05). All the above parameters in the control group were significantly lower than those in IPC group (all P<0.05). IPC can improve hemodynamics indexes of deep veins of lower limb in patients after rectal cancer operation, and prevent the lower limb DVT. IPC is a safe, simple and convenient physical therapy.

Unusual communication of profunda femoris vein with the popliteal vein in the middle of the popliteal fossa

Profunda femoris vein (PFV) rarely forms a direct communication with the lower end of the femoral vein (FV) or popliteal vein (PV). During regular dissections for medical undergraduates, we came across a rare anatomical variation of PFV in the right lower limb of an 80-year-old female cadaver. PFV commenced from the PV just above its formation by the union of anterior and posterior tibial veins. It traversed the popliteal fossa on the lateral side of the popliteal artery and entered into the adductor canal after piercing the adductor magnus muscle. Finally, it emptied into the FV in the lower part of the femoral triangle. Furthermore, the PV had a small caliber than that of PFV. Deep veins of leg are the common site for formation of thrombosis. In terms of diagnosis and operative procedures, the location of thrombosis in the deep veins of lower limb is clinically of great importance. Thus detailed knowledge of the anatomical variation reported here is useful during diagnosis and treatment of deep vein thrombosis.