Femoral Vein Thrombosis Research Articles

CT evaluation of Crohn's disease: effect on patient management.

CT scans from 80 consecutive patients with clinically symptomatic Crohn's disease were reviewed retrospectively to determine the effect of CT diagnosis on patient management. The initial clinical impression and any subsequent change in patient management because of the CT findings were noted. In 22 (28%) of the 80 patients, significant previously unsuspected findings led to a change in medical or surgical management. These included 12 patients with fistulae, four with abscess, two with avascular necrosis of the femoral head, two with sacral osteomyelitis, and single cases of pelvic inflammatory disease and femoral vein thrombosis.

Atrial pacing for conversion of atrial flutter

Fifty-seven episodes of atrial flutter in 46 consecutive medically treated patients (aged 60 ± 17 years) were treated by rapid atrial pacing. Thirty-three patients (72%) had structural heart disease. Most pacing trials were conducted in patients receiving digoxin (88%) and antiarrhythmic drugs (77%). In 51 of 57 trials (89%), patients were successfully converted to normal sinus rhythm. Multivariate analysis revealed that patients who had congestive heart failure and who were older were more likely to be refractory to pacing. Left atrial size did not influence outcome. Confirmation of local atrial capture with a bipolar atrial electrogram and use of multiple atrial pacing sites enhanced the success rate. Eight patients (17%) demonstrated sinus node suppression after atrial pacing; sinus node disease was previously unsuspected in 4 of these patients. These bradyarrhythmias were easily managed because a pacing catheter was already in place. The only significant complication was femoral vein thrombosis in 1 patient. It is concluded that atrial pacing is an effective, safe and convenient method for the elective conversion of atrial flutter in the general population of medically treated patients. This technique is an attractive alternative to transthoracic cardioversion, and may be preferable in many patients.

The Main Components of the Fibrinolytic System: Biochemical and Physiological Properties

Physiological fibrinolysis appears to be regulated by specific molecular interactions between (tissue-type) plasminogen activator and fibrin, between plasminogen and fibrin, and between plasmin and α2-antiplasmin. Regulation occurs at two levels: localised plasminogen activation at the fibrin surface and sequestration of the formed plasmin from circulating α2-antiplasmin. Fibrinolysis thus appears to be a surface-mediated phenomenon which is triggered by fibrin. A purified tissue-type plasminogen activator, isolated from the culture fluid of human melanoma cells, was found to be indistinguishable from the activator isolated from human uterus and immunologically related to the activator in blood. Kinetic analysis showed that theactivation of plasminogen by this plasminogen activator followed Michaelis-Menten kinetics, with KM = 65 µM in the absence of fibrin and KM = 0·15 µM in the presence of fibrin. These findings are fully consistent with the interpretation that activation of plasminogen in blood (concentration 1–2 µM) occurs efficiently in the presence of fibrin. The thrombolytic properties of purified melanoma activator were studied in rabbits with a pulmonary embolus, in dogs with femoral vein thrombosis, in rabbits with jugular vein thrombosis and in dogs with experimental myocardial infarction. The melanoma plasminogen activator was found to have a much higher specific thrombolytic activity than urokinase. Furthermore, the melanoma plasminogen activator, unlike urokinase, caused thrombolysis without significant systemic plasminogen activation, α2-antiplasmin consumption, or fibrinogen breakdown. Preliminary experiments in two patients with venous thrombosis have confirmed the specific thrombolytic action of tissue-type plasminogen activator in man. The gene of human tissue-type plasminogen activator has recently been cloned and expressed. A translation product of the cloned gene was found to have very similar thrombolytic properties to those of the natural activator.

イヌ大たい静脈血せんモデルにおける組織性プラスミノーゲンアクチベーターの効果

Tissue plasminogen activator (TPA) was purified either as a single chain or as a two chain form from the culture medium of a human melanoma cell line. The thrombolytic activity of TPA was investigated in beagle dogs with an experimental femoral vein thrombosis and compared with urokinase. The 125I-fibrinogen labeled thrombus was formed in the femoral vein, and the thrombolytic agents were infused over a 4 hour period. The degree of thrombolysis was measured as the difference between the injected and recovered 125I. In six control animals with a saline infusion, the degree of thrombolysis was 16.3±3.8 percent (mean±S. E. M.), in 5 dogs receiving 100, 000IU urokinase, 17.4±3.7 percent and in 4 dogs with 1, 000, 000IU urokinase, 40.6±4.8 percent. Infusion of 100, 000IU single chain TPA in 5 dogs resulted in 33.5±7.8 percent lysis and of 100, 000IU two chain TPA in 5 dogs in 60.1±10.8 percent. Infusion of 300, 000IU one chain TPA yielded 57.5 percecent lysis and of the same amount of two chain TPA 72.9 percent. Significant activation of plasminogen, consumption of α2-antiplasmin and fibrinogen breakdown was only observed in the animals receiving the high dosis of urokinase but not in the saline, TPA or the low dose urokinase groups. It is thus concluded that in this thrombosis model, human TPA has a higher specific thrombolytic effect than urokinase, without systemic fibrinolytic activation and fibrinogen breakdown.

Effect of urokinase on fibrinolysis and fibrinogenolysis.

The thrombolytic (fibrinolytic) effect of the urinary plasminogen activator, urokinase (UK), was compared with its fibrinogenolytic effect, using an artificial circulating system, and in in vivo pulmonary embolus and femoral vein thrombosis models. The thrombus lysing efficiency (fibrinolysis/fibrinogenolysis) was, in all cases, below 1.00, indicating that fibrinogenolysis is a primary function of UK while fibrinolysis is a secondary one.

Intermittent Calf Compression: A Randomized Trial In Elective Hip Replacement

We have evaluated venous thrombosis prevention with intermittent calf compression in 78 patients aged over 50 years having elective hip replacement. 38 patients were randomly allotted to intermittent calf compression with a “BOC-Roberts Venous Flow Stimulator”, begun at the start of surgery and continued for 7 days, while 40 patients had no prophylaxis. Age, weight, length of surgery, and other risk factors were similar in the two groups. All patients had ascending venography of the operated leg on the seventh day, or bilateral venography if routine 125I fibrinogen legscanning and impedance plethysmography suggested thrombosis on the unoperated side.Venography showed thrombosis in 12/38 patients treated with intermittent calf compression (32%) and 21/40 untreated patients (53%). The difference is not statistically significant, but further analysis showed some interesting treatment effects: (a) calf vein thrombosis was found in 13% of treated and 35% of untreated patients (p <0.05), (b) femoral or popliteal vein thrombosis developed in 24% of treated and 38% of untreated patients, while isolated femoral vein thrombosis (without calf vein thrombosis) developed in 18% of treated and untreated patients, but (c) the femoral vein thrombi were smaller in treated patients - 8% of treated and 30% of untreated patients had femoral vein thrombi with an estimated length above 5 cm (p <0.05).This suggests that intermittent calf compression prevents calf vein thrombosis and prevents extension of femoral vein thrombi after elective hip replacement, although it cannot prevent the initiation of femoral vein thrombi which is presumably due largely to local vein trauma. This limited effect may be clinically valuable, allowing delay in starting anticoagulant prophylaxis until this is safe.

Temporary transvenous pacing and femoral vein thrombosis.

The true incidence of thrombosis and pulmonary embolism in patients requiring temporary transvenous pacing via the femoral vein in unknown. Twenty-nine patients, mean age 66.2 years (range 38-79 years) who required temporary pacing were studied by bilateral contrast venography and perfusion lung scanning after removal of the pacing catheter. The patients were subdivided into two subgroups based on hemodynamic status. There was no statistical difference between the two groups with respect to mean age or the time the pacer catheter was in place and all patients were placed on low-dose heparin therapy. Ten patients (34%) had venographic evidence of thrombosis; six of them (60%) showed lung scan evidence of pulmonary emboli. The hemodynamically compromised group consisted of seven patients, six (85%) of whom had thrombosis; three of these six (50%) had pulmonary emboli. Of the 22 patients in the hemodynamically stable group, four (18%) had thrombosis and two of these (50%) had pulmonary emboli. Venous thrombosis, with subsequent pulmonary emboli, is a serious complication of temporary transvenous pacing using the femoral approach, despite the use of prophylactic low-dose heparin.

Temporary transveous pacing and femoral vein thrombosis

Temporary transveous pacing and femoral vein thrombosis

Blood Clotting and Cholesterol Crystal Embolization

<h3>To the Editor.—</h3> In a recent article (241:807, 1979), Kempczinski described lower extremity arterial emboli from ulcerating atherosclerotic plaques. Neither heparin nor warfarin had been effective in preventing recurrent embolization.^1-3 We observed a 65-year-old man in whom, two days after initiation of treatment of bilateral femoral vein thrombosis with streptokinase, livedo reticularis of the lower part of the body developed; a few days later, necrosis of skin and toes and acute renal failure developed. The renal failure was treated conservatively; for several reasons, hemodialysis was not performed. At autopsy, severe ulcerative atheromatosis of the aorta with cholesterol crystal embolization (CCE) in both kidneys was found (Figure), as well as in the liver, spleen, prostate, and medium-sized and small femoral arteries. The time course and the finding of CCE in only the lower part of the body may suggest a lysis of the protecting thrombi from the aortic atheromas by

Biphasic venous emptying from the calves in venous-occlusion plethysmography.

The pathophysiological significance of the biphasic venous emptying curves from the lower limbs in venous occlusion plethysmography was examined in three patients peroperatively by clamping the iliac veins in different locations. The clinical significance of biphasic curves was analysed in fifty-four patients, thirty-one of whom were pregnant and twenty-three had a suspected deep vein thrombosis. It was found that the primary venous emptying time (PVET) was helfpul in locating the obstruction. Patients with femoral and pelvic vein thrombosis had shorter PVET than patients with pregnancy or other pelvic vein obstructions. With PVET of 0.5 sec, or shorter, thrombosis should be strongly suspected. The ratio between the slow and fast emptying phases was useless in localization of the intrapelvic process.

The effect of O-(beta-hydroxyethyl)-rutoside (HR) on macromolecular leakage, thrombosis and haemostasis in experimental animals.

O-(beta-hydroxyethyl)-rutoside (HR) (Venoruton, Zyma AS, Nyon, Switzerland) has been investigated experimentally to evaluate the effect on microvascular permeability and thromboembolism. Permeability to macromolecules is diminished in a hamster cheek-pouch model. Haemostatic plug formation is impaired whereas laser-induced intravascular platelet aggregation is uninfluenced. There is a small but insignificant protection against sodium morrhuate (Eli Lilly and Co., Indianapolis, Indiana) induced femoral vein thrombosis.

Femoral vein thrombosis and total hip replacement

Femoral vein thrombosis and total hip replacement

Femoral vein thrombosis and total hip replacement.

Of 160 patients who underwent total hip replacement, 81 developed venographic evidence of thrombi in the operated leg. In 46 cases (57%) the thrombus originated from the femoral vein, and in 43 of these the exact site of origin was defined by venography. In 34 cases (74%) the thrombus arose from the wall of the femoral vein at the level of the lesser trochanter. This region was studied by intraoperative venography in eight patients undergoing total hip replacement, and in every case severe distortion of the common femoral vein was observed, producing almost total occlusion. We suggest that intraoperative damage to the femoral vein results from manipulation of the leg, and that this is one reason why the operation is followed by a high incidence of deep vein thrombosis in the upper femoral region.

Arteriovenous Fistula After Femoral Vein Catheterization

<h3>To the Editor.—</h3> Percutaneous femoral vein catheterization is a relatively safe and rapid means of obtaining a blood access route for hemodialysis.¹It is especially useful in emergency situations or when existing sites for arteriovenous (AV) prosthetic shunts are exhausted. Reported complications include inadvertent puncture of the femoral artery resulting in a periarterial hematoma,²femoral vein thrombosis, and retroperitoneal bleeding.³To our knowledge, the development of an AV fistula following femoral vein catheterization for hemodialysis has not previously been reported. <h3>Report of a Case.—</h3> A 29-year-old woman with chronic renal failure secondary to chronic glomerulonephritis underwent a cadaveric renal transplant Jan 15, 1976. Her immediate postoperative course was complicated by two rejection episodes; she was treated with methylprednisolone intravenously. At discharge on Feb 11, 1976, the patient had a serum creatinine value of 1.2 mg/100 ml and was taking 100 mg azathioprine (Imuran) and 30 mg prednisone.

Thrombolytic activity of terrilytin and its effect on the blood clotting system

In experimentsin vitro after preliminary incubation of fibrinogen with terrilytin clot formation was retarded and subsequent lysis accelerated. Terrilytinin vitro lengthened the recalcification time, reduced thromboplastic activity and fibrinase activity and, at the same time, increased the fibrinolytic activity of blood plasma. In experiments on dogs roentgenovasography revealed considerable thrombolytic activity of terrilytin when injected intravenously into animals with experimental thrombosis of the femoral veins.

Prevention of Venous Thrombosis With Small, Subcutaneous Doses of Heparin

The effect of low-dose heparin prophylaxis on venous thrombosis and bleeding after major elective surgery was studied in a prospective controlled study of 820 patients. The total incidence of venous thrombosis detected with leg-scanning using fibrinogen labeled with radioactive iodine (125I) was reduced from 16.0% in the control group to 4.2% in treated patients. More important, the incidence of popliteal or femoral vein thrombosis was reduced from 2.9% to 1.0%. Prophylaxis resulted in a slight increase in bleeding-minor wound hematoma, mean volume of blood transfused, and a post-operative hematocrit fall in treated patients. However, increased bleeding was clinically minor, and prophylaxis was well tolerated.

Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis.

Impedance plethysmography using the cuff technique has been compared with venography in 346 consecutive patients with suspected venous thromboembolism. The limbs were classified according to the venographic results as no thrombosis, proximal (popliteal, femoral, or iliac) vein thrombosis, and calf thrombosis. A discriminant analysis was performed. The impedance plethysmographic result was normal in 386 of 397 limbs which were normal on venography, a specificity of 97%, and abnormal in 124 of 133 limbs which showed proximal vein thrombosis, a sensitivity of 93%. Seventy-three of 88 limbs with calf vein thrombi and a normal impedance plethysmographic result. The sensitivity in 29 limbs with asymptomatic proximal vein thrombosis was 83%. Impedance plethysmography is an accurate method for detecting proximal vein thrombosis but has limitations which include the possibility of false positive results due to arterial insufficiency and muscle tension.

THE PAINFUL DEEP-VEIN SYNDROME

Six patients are described presenting with pain and tenderness in the calf and popliteal fossa, and along the course of the superficial femoral vein, and with mild ankle œdema— physical signs usually associated with femoral-vein thrombosis. Objective studies failed to reveal any deep-vein thrombosis, and it is suggested that these were patients with " painful deep veins ". No other cause of the symptoms was found.

Relationship of the hind-limb lymphatic system to experimental femoral vein thrombosis

Relationship of the hind-limb lymphatic system to experimental femoral vein thrombosis

Lodging of an Embolus in a Patent Foramen Ovale

A 77 year old man developed severe chest pain and collapsed seven days after prostatectomy and died three days later. Necropsy revealed thrombosis of right femoral vein, complete embolic obstruction of the primary branches of the pulmonary artery, and an embolus, 10 cm. long and 0.5 cm. in diameter, lodged in the foramen ovale. Although no systemic arterial emboli were found, it can be readily seen how such emboli could have developed.