History Of Deep Venous Thrombosis Research Articles

Occlusion of the fistula in a dialysis patient-is it always a common reason?

A 67-year-old man with chronic glomerulonephritis and end-stage renal disease (ESRD), on maintenance haemodialysis for 1 year, had a history for failure of a right radiocephalic fistula, a right radiocephalic graft, a right subclavian permanent catheter and a left radiocephalic fistula due to refratory thrombosis. He presented to our hospital with intermittent gross haematuria for 9 months and swelling over the right arm and left hand for 1 month. On further questioning, he also reported a history of deep venous thrombosis over bilateral lower legs, 3 months earlier. He had no local cutaneous erythema and heat, fever or flank pain. His blood pressure was 130/70 mmHg. Physical examination identified pale appearance and swelling over right arm and left hand. On admission, pre-dialytic blood creatinine was 7.2 mg/dL, urea nitrogen 75.4 mg/dL, albumin 3.5 g/dL, haemoglobin 9.0 g/dL, platelet 100 k/μL, cholesterol 68 mg/dL, triglycerate 98 mg/dL, sodium 138 mmol/L, potassium 4.3 mmol/L, calcium 10.0 mg/dL and phosphate 5.1 mg/dL. Pro-thrombin time was 11.6 s (normal 10.7–13 s, control 12.15 s), INR 1.1 and activated partial thromboplastin time 25 s (normal 20–36 s, control 31.1 s). Fibrinogen was 800 mg/dL (200–400), fibrinogen degradation products >20 μg/mL ( 1μg/mL (<0.5). Lupus anticoagulants, anti-thrombin III, protein C, S and other plasma coagulation factors were negative or within normal limits. Urinalysis showed macroscopic haematuria 40–60 per high power field. Prostate sonography (Figure 1) displayed a prostate tumour. Prostate specific antigen (PSA) was 38.94 ng/mL. Transurethral radical prostatectomy was done, and the pathology reported prostate adenocarcinoma without local invasion.

A trapped thrombus in the right ventricle

A 29-year-old female patient, with a history of deep venous thrombosis followed by uncomplicated pulmonary embolism 10 months before, presented in our out-patient clinic for further cardiologic evaluation. An underlying illness, ulcerative colitis, was currently treated with corticosteroids and immunosuppressants. Oral anticoagulation was paused due to exacerbation of colitis with lower gastrointestinal bleeding a few weeks before. She described no cardiac complaints such as dyspnea or effort angina.

Azathioprine induced warfarin resistance: case reports and potential interaction mechanism

Case reports of azathioprine-induced warfarin resistance resulting in 3–4 fold increases in warfarin requirements have been reported in the literature. We describe two cases in which this interaction occurred, and others in which azathioprine had no effect on warfarin dose requirements. A 44-year-old male with lupus nephritis was treated with chronic warfarin for history of deep venous thrombosis (DVT). Addition of azathioprine titrated to 200 mg per day resulted in warfarin dosage requirements increasing from 75 mg per week to 190 mg per week to obtain therapeutic International Normalized Ratios (INRs). A 47-year-old female with autoimmune hepatitis treated with azathioprine 200 mg daily was treated with warfarin for a renal infarct. She required 165 mg of warfarin per week to obtain therapeutic INRs. Both patients were positive for lupus anticoagulant and anticardiolipin antibodies. Other patients in whom this interaction did not occur are described, including a 61-year-old female with autoimmune hepatitis and DVT/Pulmonary Embolism (PE) receiving warfarin and azathioprine 100 mg daily, who required only 8.75 mg of warfarin per week to obtain therapeutic INRs. No change in warfarin dose requirement was seen when her azathioprine dosage was reduced. Postulated mechanisms for this interaction include reduced warfarin bioavailability, enhanced warfarin metabolism, and increases in clotting factor activity resulting from the addition of azathioprine. As the interaction only occurs in occasional patients, genetic variations in warfarin metabolism are a possibility. We plan to obtain samples to evaluate whether mutations in CYP 2C9 or Vitamin K epoxide reductase genes occur in patients with this interaction.

CT Venography and Compression Sonography Are Diagnostically Equivalent: Data from PIOPED II

The purpose of this study was to compare the clinical value of CT venography (CTV) after MDCT angiography (CTA) with venous compression sonography for the diagnosis of venous thromboembolism (VTE). The Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) showed that lower extremity imaging detects about 7% more patients requiring anticoagulation than CTA alone. PIOPED II was a prospective multicenter study investigating the accuracy of CTA alone and CTA and CTV together. A composite reference standard was used to confirm, or rule out, pulmonary embolus. Adequate quality CTV and sonographic images were obtained in 711 patients. There was 95.5% concordance between CTV and sonography for the diagnosis or exclusion of deep venous thrombosis (DVT); the kappa statistic was 0.809. The sensitivity and specificity of combined CTA and CTV were equivalent to those of combined CTA and sonography. Diagnostic results in subgroups, including patients with signs or symptoms of DVT, asymptomatic patients, and patients with a history of DVT, were similar whether CTV or sonography was used. Patients with signs or symptoms of DVT were eight times more likely to have DVT, and patients with a history of DVT were twice as likely to have positive findings. CTV and sonography showed similar results in diagnosing or excluding DVT. The incidence of positive studies in patients without signs, symptoms, or history of DVT is low. In terms of clinical significance, CT venography and lower extremity sonography yield equivalent diagnostic results; the incidence of positive studies in patients without signs, symptoms, or history of DVT is low; thus the choice of imaging technique can be made on the basis of safety, expense, and time constraints.

Nephrogenic systemic fibrosis: Center case review

To retrospectively analyze nephrogenic systemic fibrosis (NSF) cases at our center, to determine prior gadolinium based contrast agent (GBCA) administration and to evaluate possible common risk factors for the development of NSF by reviewing laboratory data and concurrent medications. A total of four data bases (pathology, MRI, dialysis, and medical records) were cross-referenced for identification and evaluation of NSF patients. Medical history of NSF patients was assessed as for previous deep venous thrombosis (DVT), surgery, or infections. Laboratory data (creatinine, anion gap, calcium, phosphorus, and albumin) as well as concurrent medication were evaluated. Findings were compared to those of a control group of non-NSF dialysis patients. Between October 2003 and February 2007 a total of nine NSF cases were identified. All patients had undergone contrast-enhanced MRI prior to the diagnosis of NSF. Only one gadolinium chelate had been used at our MRI center (Omniscan, gadodiamide; GE Healthcare). Of nine patients, eight were receiving dialysis at the time of the MRI scan. During the same time 312 dialysis patients received gadodiamide. Thus, the prevalence of NSF within dialysis patients exposed to gadodiamide was 2.6%. NSF patients presented with a higher creatinine and anion gap than the control patients. Other laboratory values as well as medication did not show a significant difference. There were no patterns regarding previous history of DVT, surgery, or infection in the NSF group. Our findings are consistent with the previously reported association between gadodiamide exposure and NSF. All NSF patients had severe renal insufficiency with glomerular filtration rate (GFR) < 30 (highest GFR = 25 mL/minute) at the time of last gadodiamide administration, and on average had received 71 mL of gadodiamide over an average of 2.9 administrations.

Superficial venous thrombosis associated with congenital absence of the inferior vena cava and previous episode of deep venous thrombosis

Congenital malformations of the inferior vena cava (IVC) are uncommon and may be associated with an increased risk of venous thrombosis. We report the case of a man with congenital absence of the IVC and remote history of deep venous thrombosis who now presents with severe abdominal wall superficial thrombophlebitis. To our knowledge, this is the first report of a patient with IVC absence who has developed both deep and superficial venous thromboses.

Hypertension portale chez un malade coinfecté par le virus de l’immunodéficience humaine et le virus de l’hépatite C

The case of a human immunodeficiency virus (HIV) and hepatitis C virus (HCV)-coinfected patient with a medical history of deep venous thrombosis is presented. A liver biopsy, performed for unexpected portal hypertension, showed vascular lesions presenting as nodular regenerative hyperplasia. Vascular liver diseases seem to be a new cause of chronic liver disease in HIV-infected patients receiving combined antiretroviral therapy. The syndrome of HIV-associated liver vasculopathy is discussed.

Retrievable inferior vena cava filters may be safely applied in gastric bypass surgery

Pulmonary embolus (PE) is a potentially devastating and fatal postoperative complication in morbidly obese patients. This study was undertaken to review the safety and efficacy of retrievable prophylactic inferior vena cava (IVC) filters in high-risk morbidly obese patients undergoing gastric bypass. Patients who underwent gastric bypass surgery and preoperative insertion of retrievable IVC filters had their records reviewed. Indications for IVC filter insertion were: history of deep venous thrombosis (DVT) or PE, long-standing sleep apnea, venous stasis disease, and/or weight > 400 pounds. 24 patients underwent IVC filter placement before gastric bypass surgery. There were 10 women and 14 men with an average age of 50 +/- 6.3 years (range 39 to 59) and average body mass index (BMI) of 57 +/- 7.5 kg/m(2) (range 49 to 74). BMI greater then 50 kg/m(2) was present in 21 of 24 patients (88%). All patients had successful IVC filter placement. IVC filter retrieval postoperatively was performed in 20 of 24 patients (83%) with three left for clinical reasons and one (4%) left due to technical inability to retrieve. There was one complication directly attributable to IVC filter retrieval. There were no deaths. Five patients (21%) developed DVT or PE postoperatively. Follow-up was 16 +/- 7.6 months (range 8 to 33). Prophylactic IVC filter placement and retrieval can be safely undertaken in high-risk gastric bypass patients. We recommend preoperative IVC filter placement in selected patients.

A comprehensive analysis of 12 thrombophilic mutations and related parameters in patients with inflammatory bowel disease: data from Turkey

Possible association of inflammatory bowel disease (IBD) with the most common inherited prothrombotic conditions has been the focus of many investigations. Advance in modern molecular biology is expanding the thrombophilia evaluation steadily. We tried to put forward a comprehensive thrombophilic profile in IBD and to see the probable role of this profile in pathogenesis. A total of 60 adults (33 patients and 27 healthy controls) were included. We used the CVD-StripAssay which is based on the reverse-hybridization principle to identify a total of 12 thrombophilic gene mutations: Factor V R506Q, Factor V H1299R, prothrombin G20210A, Factor XIII V34L, beta-Fibrinogen-455 G-A, PAI-1 4G/5G, platelet GPIIIa L33P, MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q and Apo E2/E3/E4, respectively. Besides, we evaluated many related blood parameters such as protein C, protein S, AT-III, IL-6, TNF-alpha, Apo-A1, Apo-B100, homocysteine (tHcy) etc. using commercially available assays. The frequencies of genetic polymorphisms were found to be statistically insignificant among patients and controls, except for three: Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D. Two patients with a history of deep venous thrombosis had more than one polymorphism. Patients with MTHFR C677T and MTHFR A1298C gene mutations had a similar mean tHcy levels with controls. Patients with Apolipoprotein B R3500Q and Apolipoprotein E4 gene mutations had similar mean LDL-cholesterol levels. Mean total cholesterol and triglyceride levels were similar in patients and controls of Apo E2, E3, E4 alleles. Predominantly, the presence of genetic mutations that predispose to hypercoagulable states does not appear to be in correlation with IBD. There was a statistical difference between the proportions of the mutated allele frequencies of Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D in IBD.

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group.

Acute Pulmonary Embolism

Case presentation : A 66-year-old man with a history of deep venous thrombosis (DVT) presented with acute dyspnea. He was normotensive, with a resting tachycardia of 110 beats per minute and an oxygen saturation of 76% on room air. The only electrocardiographic abnormality was sinus tachycardia. His brain-type natriuretic peptide (BNP) and cardiac troponin levels were elevated. Chest computed tomography (CT) with contrast demonstrated a large saddle pulmonary embolus and increased diameter of the right ventricle (RV) compared with the left ventricle (LV). The patient received intravenous bolus followed by continuous infusion unfractionated heparin. Within several hours, the patient became progressively more hypotensive and hypoxemic. Bedside transthoracic echocardiography (TTE) showed RV dilatation and hypokinesis. He then received intravenous fibrinolysis, with rapid improvement in hemodynamics and oxygenation. What were the clues that he was likely to suffer from progressive hypotension and hypoxemia? Pulmonary embolism (PE) represents a spectrum of syndromes ranging from small peripheral emboli causing pleuritic pain to massive PE resulting in cardiogenic shock or cardiac arrest. Most patients with PE present with normal blood pressure. However, some may rapidly deteriorate and manifest systemic hypotension, cardiogenic shock, and sudden death despite therapeutic levels of anticoagulation. Risk stratification to identify such patients has emerged as a critical component of care. The history and physical examination provide the starting point for risk stratification. The International Cooperative Pulmonary Embolism Registry (ICOPER) identified age >70 years, cancer, congestive heart failure, chronic obstructive pulmonary disease, and systolic blood pressure less than 90 mm Hg as significant predictors of increased mortality.1 Elevated cardiac biomarkers correlate with the presence of RV dysfunction, a powerful independent predictor of early mortality.2 Whereas cardiac troponins are released as a result of microinfarction due to RV pressure overload, BNP is secreted from cardiac myocytes in response to RV shear …

Efficacy of Combined Modality Prophylaxis Including Short-Duration Warfarin to Prevent Venous Thromboembolism After Total Hip Arthroplasty

This study reviewed the effectiveness of a trimodality deep venous thrombosis (DVT) prophylactic regimen after primary and revision total hip arthroplasty. Seven hundred five patients were treated with pneumatic compression, adjusted dose warfarin (7 days), and early mobilization. Bilateral lower extremity venous ultrasonography was obtained on postoperative day 3 or 4. The incidence of asymptomatic DVT, symptomatic DVT/pulmonary embolus events within 90 days of surgery, and potential influence of risk factors was retrospectively assessed. Deep venous thrombosis incidence was 4.4% with one (0.1%) nonfatal pulmonary embolus. Increased age, male sex, and DVT history were significant risk factors for thromboembolic events within 90 days of hip arthroplasty. The combination of short-duration warfarin and mechanical prophylaxis with predischarge ultrasound screening was safe and effective in limiting the occurrence of venous thromboembolism.

False‐negative factor V Leiden genetic testing in a patient with recurrent deep venous thrombosis

False-negative genetic testing of the factor V Leiden (fVL) mutation is unusual. We report a case of a young woman with a history of deep venous thrombosis tested for the fVL at four separate laboratories on four separate dates. Two laboratories reported the patient to be heterozygous for the fVL, while the other two reported no evidence of a mutation. Testing methods of the various laboratories were reviewed, and additional testing was performed on stored and newly drawn DNA samples, including sequencing of the fVL gene segment. The preponderance of evidence indicates the patient to be heterozygous for the fVL mutation. Dissection of data suggests that either sample misidentification or faulty allele specific amplification methods could have led to false-negative results in two laboratories. In one of the two laboratories, misinterpretation of results and clerical error could not be excluded. There is a need for standardization of optimized fVL genetic testing methods. Further education of ordering physicians on the limitations of genetic testing is necessary.

Risk of thromboembolism after cerebral venous thrombosis

The outcome of cerebral venous thrombosis (CVT) has been studied infrequently. We assessed the frequency of recurrence of cerebral or systemic thromboembolism and factors influencing recurrence. We performed a retrospective study of consecutive patients with CVT in the period 1985-2002 who were admitted to the University Hospital Gasthuisberg. We performed a chart review and a semi-standardized telephone interview that focused on recurrent CVT or systemic thromboembolism. Fifty-four CVT patients with a mean age of 42 years were followed up for a mean of 3.5 years. Eighty percent were women. Coagulation disorders were found in 17 patients (31%). One patient (1.9%) had recurrent CVT and seven patients (12.9%) suffered systemic thromboembolism after a median of 2.5 months. Patients with recurrent thromboembolism more often had coagulopathies (P = 0.04) or a history of deep venous thrombosis (P = 0.007). Patients with early recurrent venous thromboembolism often were not treated with oral anticoagulants (P < 0.001). It was evident from the above study that a substantial number of patients suffer recurrent thromboembolism after CVT.

Ultrasonographic investigation of the effect of Reverse Trendelenburg on the cross-sectional area of the femoral vein

Emergency physicians often obtain central venous access via the femoral vein in critically ill patients or patients with difficult peripheral access due to chronic intravenous drug use. Previous studies using two-dimensional ultrasonography have demonstrated that the Trendelenburg position increases the cross-sectional area of the internal jugular vein. This study is designed to determine the effect of the Reverse Trendelenburg position on femoral vein dimensions using bedside ED ultrasonography. A prospective, non-randomized observational study was conducted that enrolled subjects at an urban Level I Trauma Center and an affiliated School of Medicine over a 2-month period. Informed consent was obtained from 52 adult subjects with no history of deep venous thrombosis or vascular surgery in the lower limbs. Using two-dimensional ultrasound with a 7.5-MHz linear transducer, femoral vein cross-sectional areas on the right and left sides were measured with subjects supine, and in approximately 15 degrees reverse Trendelenburg. The data was analyzed using a two-tailed Student’s t test. The mean cross-sectional area of the femoral vein with subjects supine was 0.85 cm 2 (SD ± 0.41 cm 2), and 1.22 cm 2 (SD ± 0.51 cm 2) with subjects in reverse Trendelenberg. The cross-sectional area of the femoral vein increased significantly ( p < 0.001) with the reverse Trendelenburg position [55.2% ± 9.1% (95% CI)]. In conclusion, a significant increase in femoral vein cross-sectional area can be achieved with the reverse Trendelenburg position. This maneuver may increase the rate of successful femoral vein catheterization.

Epidemiology of chronic venous ulcers

A metropolitan population of 238,000 in Perth, Western Australia, was screened for chronic ulceration of the leg. Patients with a chronic leg ulcer and a venous abnormality comprised 57 per cent of all patients with a chronic leg ulcer, giving a prevalence of 0.62 per 1000 population. There was an increasing prevalence with age; 90 per cent of patients were 60 years and older. This group comprised 16.7 per cent of the population, and had a prevalence of 3.3 per 1000. Although chronic venous ulcers were more common in women there was no difference in age related prevalence. In 36 per cent of patients with a venous abnormality, there was at least one other aetiological factor contributing to chronic ulceration of the leg; 96 per cent had either a history of deep venous thrombosis or a condition known to predispose to deep venous thrombosis.

Sonography for Deep Venous Thrombosis

Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly.

Incidence, Timing of Onset and Severity of Post-Thrombotic Syndrome after Acute Symptomatic Deep Vein Thrombosis: Two-Year Results from a Canadian Multicenter Prospective Cohort Study (The VETO Study).

Background and Objectives: The post thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT). It is difficult to provide DVT patients with long-term prognostic information as there is little longitudinal data on the occurrence of PTS after DVT. We performed a prospective multicenter study of long-term outcomes after DVT (the Venous Thrombosis Outcomes [VETO] Study) to determine the incidence, timing of onset and severity of PTS.Methods: Consecutive patients with objectively diagnosed acute DVT were recruited at 7 participating hospital centres from April 2001-July 2002. Patients attended study visits at Baseline, 4, 8, 12 and 24 months. Clinical data were recorded and standardized assessments for PTS (using Villalta scale) were performed by trained study personnel at each follow-up visit. Patients were classified as having developed PTS if the ipsilateral Villalta score was ≥ 5 on at least 2 visits or at the final follow-up visit, and having severe PTS if a score of >14 or a venous ulcer was documented on any one occasion. The Kaplan-Meier survival method was used to estimate the cumulative probability of PTS and of severe PTS over time.Results: The study cohort consisted of 359 patients. The mean age was 56 years, 50% were male, 2/3 were outpatients, 55% had proximal DVT and 20% had previous DVT. The Kaplan-Meier estimates of cumulative risk of PTS were 29% at 4 months, 33% at 8 months, 35% at 12 months and 37% at 24 months. Corresponding risks of severe PTS were 6.6%, 6.9%, 6.9% and 6.9%, respectively. When the analysis was stratified according to history of DVT, the cumulative incidence of PTS in patients without previous DVT was 25%, 28%, 30% and 31% at 4, 8, 12 and 24 months. Corresponding rates of PTS in patients with previous DVT were 45%, 51%, 53% and 57%.Conclusions: More than one third of patients in our cohort developed PTS within 2 years of DVT, and of these, 1 in 6 was classified as severe. Most cases of PTS and of severe PTS were apparent by 4 months after DVT. Patients with previous DVT had a higher frequency of PTS and of late onset PTS. Our study provides longitudinal data on prognosis that is relevant both to patients with DVT and their treating physicians.

Determinants of Health-Related Quality of Life after Deep Venous Thrombosis: Two-Year Results from a Canadian Multicenter Prospective Cohort Study (The VETO Study).

Background and Objectives: The long term effects of deep venous thrombosis (DVT) on health-related quality of life (QOL) have not been prospectively evaluated. During a Canadian multicentre cohort study of health and economic outcomes after DVT (the Venous Thrombosis Outcomes [VETO] Study), we measured QOL during the 2 years after DVT and evaluated the influence of development of post-thrombotic syndrome (PTS) and other determinants on QOL.Methods: Consecutive patients diagnosed with acute DVT at seven participating hospital centres were recruited from April 2001-July 2002. During study visits at Baseline, 1, 4, 8, 12 and 24 months, clinical data were collected, a standardized assessment for PTS was performed and QOL questionnaires were self-completed. Generic QOL was measured using the SF-36 Health Survey questionnaire. Venous disease-specific QOL was measured using the VEINES-QOL questionnaire. For both questionnaires, lower scores indicate poorer QOL. Mean QOL at each time point and change in QOL scores over 24 months follow-up were quantified. The influence of PTS and other clinical or demographic characteristics on QOL was evaluated using multivariate regression analyses.Results: Of the 359 patients recruited, 49% were male, average age was 56 years, 2/3 were outpatients and 55% had proximal DVT. The cumulative incidence of PTS during follow-up was 37%. On average, QOL scores in the cohort improved during follow-up (mean improvement from Baseline to 24 months: 7.2 points for SF-36 mental component summary (MCS), 7.5 points for SF-36 physical component summary (PCS) and 4.7 points for VEINES-QOL). Patients who developed PTS, compared with those who did not, had significantly lower PCS scores and VEINES-QOL scores at all 5 follow-up visits (differences for PTS vs. no PTS ranged from 2.4-9.0 points for PCS and from 4.5-6.0 points for VEINES-QOL), and significantly lower MCS scores at the 1, 4, 8 and 12 month visits (differences ranged from 3.7–4.7 points). Multivariate regression analyses adjusted for age, sex and comorbidity showed that PTS and proximal (vs. distal) location of initial DVT were strong independent predictors of lack of improvement of PCS scores (p=.003 and .02, respectively) and VEINES-QOL scores (p=.006 and .009, respectively) during follow-up, but not of MCS scores (p=0.054 and 0.86, respectively). Variables such as body mass index, concurrent pulmonary embolism at time of DVT diagnosis and previous history of DVT did not influence change in scores for any QOL measure.Conclusions: The principal determinants of quality of life after DVT are development of PTS and proximal (vs. distal) location of initial DVT. Our study provides valuable prognostic information on health outcomes after DVT.

CT Angiography of Pulmonary Artery Aneurysms in Hughes-Stovin Syndrome

2Department of Medicine, Vera Moulton Wall Center for Pulmonary Vascular Disease, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA. ughes-Stovin syndrome is a rare disorder of unknown cause that is characterized by the combination of multiple pulmonary artery aneurysms and deep venous thrombosis. We present a case of a middle-aged man with a 2-year history of deep venous thrombosis who developed multiple pulmonary artery aneurysms at sites of earlier endoluminal thrombi. We briefly consider the pathogenesis of Hughes-Stovin syndrome and show the additional insights offered by 3D volume rendering to visualize the presence of an increased number of morphologically abnormal bronchial arteries even before aneurysm formation.