Venous System Of Lower Limbs Research Articles

Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment

INTRODUCTION: Lower limb varicose vein disease (LLVVD) is the most common vascular disease with a predominant lesion of the main trunks of saphenous veins. At the same time, there exist atypical variants of lesion of the venous system in LLVVD, which cause difficulties in diagnosis and treatment.
 AIM: To study the incidence rate, anatomical bases of the varicose transformation, the features of reflux formation and the results of surgical treatment in atypical forms of LLVVD.
 MATERIALS AND METHODS: The study involved 600 patients with LLVVD, C2-C3 class of clinical manifestations in CEAP classification; 82 of them had atypical forms. The mean age of patients was 40.2 ± 9.2 years, duration of disease 15.0 ± 5.6 years. Duplex scanning of the lower limb venous system was conducted according to Russian recommendations for the diagnosis and treatment of chronic venous disorders of lower limbs of 2018. Patients with atypical forms of LLVVD additionally underwent computed tomography of the venous system with contrast. Surgical treatment of 50 patients with atypical forms of LLVVD included separation of the site of opening of a tributary in the area of saphenofemoral junction after preliminary marking and isolated elimination of varicose tributaries using Muller hooks; incompetent perforating veins were ligated at the epi- or subfascial levels depending on the location. The results were considered in the periods for up to two years.
 RESULTS: According to our data, the incidence of atypical forms of LLVVD was 13.7%. Lesion of the large tributaries of the main saphenous veins accounted for the highest proportion of atypical forms of LLVVD — 68.3%. Of these, varicose transformation of the anterolateral tributary made 98.2%, and of the superficial iliac circumflex vein — 1.8%. Isolated varicose transformation of perforating veins occurred in 31.7% of cases, where transformation of perforating veins of the gluteal area made 7.7%, of perforating veins of the posterolateral surface of the thigh — 46.2%, and of perforating veins of the patella region — 46.2%. The technical success in the postoperative period in the form of elimination of varicose saphenous veins and of the source of their incompetence was achieved in 100% of cases.
 CONCLUSIONS: The incidence of atypical forms of LLVVD is 13.7%, with the main trunks of saphenous veins remaining competent. The anatomical and hemodynamic basis for such forms of LLVVD is incompetence of the deep vein valves, from where the reflux is transmitted to tributaries of the saphenofemoral junction and/or perforating veins of the gluteal region, femoral region or popliteal fossa. Precise separation of varicose tributaries and perforating veins with preservation of the main trunks of subcutaneous veins is an organ-saving method of LLVVD treatment with a good effect in the follow-up period of up to two years.

Role of Jalokaavacharana in the Management of Varicose Veins (Sirajgranthi)- A Case Study

When a vein becomes dilated, elongated and tortuous, the veins is said varicose. The common sight of varicosity are superficial venous system of lower limb effecting either long or short saphenous veins, oesophageal varices, varicosity of haemorrhoidal veins, varicosity of spermatic veins. Generally varicose veins are compared with sirajgranthi according to Ayurveda. Acharya Sushruta had described various types of granthi and its various treatment modalities among them jalaukaavacharana is one of them. Sushruta had given special chapter related to jalauka in which he had described the types, nomenclature, specific qualities of each types of jalauka, their method to apply and detach and how to do vamana of jalauka. Acharya charak also described jalauka as best amongst all anushashtras. Jalaukapossesessheet guna in nature and on the basis of sign and symptoms varicose veins can be correlated with sirajgranthi. In this case study a 36- year old woman of bilateral varicose veins was treated successfully and found symptomatic relief.
 

How to initiate aspirational embolectomy program for pulmonary embolism: single centre initial experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Recent advances in percutaneous mechanical thrombectomy provide lytic-free methods for treatment of pulmonary embolism (PE). Although guidelines recommend aspirational embolectomy only for high-risk PE patients with contraindication to or failed fibrinolysis, the method is currently being used in treatment of intermediate-high risk PE patients. We present our initial experiences with large bore percutaneous aspirational embolectomy catheter. Methods Patients with intermediate-high risk PE and at least one clinical feature (persistent hypoxemia, tachycardia, hypotension without shock, or dyspnoea on minimal exertion) were considered eligible for the method. Positive high-sensitive troponin was obligatory. PE was diagnosed by computed tomography. Echocardiography and doppler ultrasound of lower limbs venous system were performed upon admission. All procedures were performed by interventional cardiologist in cardiology suite. Light sedation with dexmedetomidine and/or midazolam was used. Ultrasound guided right or left femoral approach was used in all patients. A 7F balloon tipped catheter was used to cross the tricuspid and pulmonary valves and engage pulmonary artery (PA). After exchanging for 6F pigtail catheter an angiography was performed. Then, via multipurpose 6F catheter an extra-stiff wire was introduced distal to the thrombus. Over the wire a 20F or 24F aspirational embolectomy catheter was placed in front of the thrombus followed by the aspiration with 60 ml syringe. Up to 10 aspirations were allowed. Unfractionated heparin was used for periprocedural anticoagulation followed by apixaban or rivaroxaban as soon as hemostasis was achieved. Patients outcomes were recorded prospectively. Results From March to October 2022 a total of 10 patients were treated with aspirational embolectomy (6 females, median age 68.5 years (interquartile range 53.25-74)). Only the first case was performed with 20F catheter. In 9 patients sheathless approach was used due to material unavailability. In one case switching to left-side access was required due to inability to introduce the catheter in common femoral vein. In two cases a "lollipop" phenomenon occurred, one of which was a thrombus-in-transit (TIT) case. This case was complicated with TIT fragmentation on exit and re-embolism with circulatory arrest requiring veno-arterial extracorporeal circulatory support. Procedural success was achieved in all cases (in TIT patient two procedures were needed). All patients reported improvements in dyspnea levels. One patient required oxygen supplementation beyond 24h (TIT patient). Average PA systolic and diastolic blood pressure drop was 24.3±11.0 and 12.3±4.9 mmHg. Nine patients were alive at discharge, while TIT patient was still requiring hospitalisation. Conclusion Aspirational embolectomy can provide sufficient drop in PA pressures and symptom relief. Randomised trials are needed to determine the long term outcomes of the procedure.

A case of deep vein thrombosis of a 42 years old male patient healed successfully using Yoga Prana Vidya (YPV) healing protocols

Introduction: Deep vein thrombosis (DVT) is a medical condition leading to pulmonary embolism in most cases. DVT occurs usually in lower limb venous system. Studies in India found that DVT is as prevalent as it exists in the West. Anti-coagulation is the common treatment modality. This paper presents a case of DVT of a 42 years old male patient who was successfully healed using Yoga Prana vidya (YPV) healing protocols as complementary medicine. Method: This is a case study method going through patient’s medical reports, YPV healer’s records and patient feedback. YPV intervention consisted of self-practice modules of physical exercises, Rhythmic Yogic breathing and Forgiveness Sadhana. Additionally, the YPV healer conducted healing sessions. Results: Within 5 weeks of healing, all symptoms of DVT disappeared. The patient was able to recover from fear of the disease completely. The patient continued practicing Rhythmic Yogic Breathing and Forgiveness Sadhana regularly to maintain wellness with self-care. He resumed working from office as usual. Conclusion: Yoga Prana Vidya System is an integrated and versatile system of treatment and healing which has treated the DVT condition as a complementary medicine with speedy recovery in this case. Further research is recommended using appropriate sample and methodology. It will be beneficial to train the frontline health care workers such as doctors and nurses in the application of YPV techniques as complementary to their individual specialties.

Peripheral nerve sheath tumour mimicking deep calf thrombus: An incidental finding during lower limb venous Doppler ultrasound

Introduction: Peripheral nerve sheath tumours are neurogenic neoplasms that arise from the nerve sheath which are not within the central nervous system. While most of these lesions may be benign, some of them may undergo malignant transformation, establishing why it is imperative for ultrasound practitioners to familiarise themselves with ultrasound presentations of this lesion to facilitate early and effective diagnosis, which would in turn positively impact patient management. Case report: We present an incidental finding of a thrombus-mimicking peripheral nerve sheath tumour in a female patient who came to the ultrasound department for a left leg deep vein thrombosis scan. Discussion: This case study demonstrates a peripheral nerve sheath tumour which by virtue of its location (very closely adjacent the deep calf veins) and appearance (incompressible, heterogeneous, minimal colour flow), mimicked a deep calf vein thrombus on ultrasound. Careful surveillance of the area on ultrasound revealed the lesion was distinct from the calf vasculature, and further imaging was advised. A magnetic resonance imaging was conducted confirming the diagnosis of a peripheral nerve sheath tumour. Conclusion: In addition to assessing the lower limb venous system during deep venous thrombosis scans, sonographers should be mindful that other soft tissue lesions such as peripheral nerve sheath tumour may be present with symptoms that mimic those of a thrombotic leg, and therefore check to exclude or confirm the presence of any adjacent soft tissue lesions, especially at the symptomatic site indicated by the patient.

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

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

Evaluation of anomalies of major veins of the superficial venous system of lower limb in adults on color doppler: An observational study.

To evaluate the incidence of anomalies in the superficial venous system in lower limb. Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research.

The Application of MEVEC 3D Doppler Ultrasound Technique for a New Classification of Morpho-Functional Phenotypes in Lower Limbs Venous Diseases.

IntroductionMEVEC 2.1 is a novel 3D mapping software dedicated to the evaluation of the venous vascular three of the lower limbs. It has already proven as a sensitive, specific, and accurate technique able to provide better morphologic and functional details of the lower limb venous system than standard reports. The aim of this study was to identify specific morpho-functional graphic phenotypes in lower limb venous diseases by means of MEVEC 2.1.MaterialsThree-hundred eleven consecutive outpatients underwent lower limb Doppler ultrasound examination by means of the MEVEC 2.1 technique. All of them showed at least one among these pathological findings: venous insufficiency, thrombosis, incompressibility, and/or incompetent.ResultsWe tried to evaluate possible clusters among the different morpho-functional findings from the venous maps in order to outline reproducible phenotypes. Correlation indexes allowed us to provide a classification in morpho-functional phenotypes in order to standardize the data from examinations performed by different physicians. Twelve phenotypes had been proposed.ConclusionThe study showed that the MEVEC 2.1 technique provides a standardized classification that allows physicians identifying phenotypes yielded by 3D mapping of the veins of the lower limbs.

Ayurvedic management of multiple varicose ulcers due to incompetent perforator veins in lower limb-A case report

This case report is the description of multiple varicose ulcers of a 31 years old male, working as police constable. The ulcers were painful with serous discharge. In Doppler study of venous system of lower limbs, incompetent perforators were noted and condition was diagnosed as varicose ulcers. As no relief was obtained from external application of medicines as suggested by conventional treatment, patient came to the Out Patient Department (OPD) of Regional Ayurveda Research Institute, Thiruvananthapuram, Kerala. In Ayurveda, varicose ulcers can be considered as Siragranthijanya vran. Internal medications used have raktashodhak, krimighn, soolahar, vranashodhak and vranaropan properties. Leech therapy was also done. The case is unique in the sense that ulcers were in multiple sites and healed completely after 3 weeks with cost effective and non surgical measures. The presented combination of leech therapy and Ayurvedic medications was found to be a good alternative therapy in the management of nonhealing varicose ulcers.

Role of physiotherapy interventions in treating varicose veins

The lower limb venous system is responsible for returning blood from the foot, leg, and thigh toward the heart. Chronic venous disease occurs by an inability of the blood to completely return due to structural or functional abnormalities of the veins of the lower limbs. Varicose veins are enlarged veins that have become tortious and abnormally swollen. This study was taken to evaluate, diagnose, and rehabilitate varicose veins by physiotherapy interventions. The patient presented at our outpatient department with severe varicose veins. She was assessed, and a patient-specific 2-month rehabilitation program was formulated. This study helps us to understand various aspects involved in the condition, its prognosis, and management by physiotherapy interventions.

Usefulness of D-dimer and Ultrasonography Screening for Detecting Deep Vein Thrombosis in Patients with Spinal Cord Injury Undergoing Rehabilitation.

Patients with spinal cord injury (SCI) are at an increased risk of deep vein thrombosis (DVT). This study aims at assessing usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. One-hundred forty-five patients were divided into three groups based on time elapsed since SCI: I (≥3 weeks to 3 months), II (≥3 to 6 months), and III (≥6 months). On admission, D-dimer plasma level measurement and CDUS of the lower limbs venous system were performed. DVT was diagnosed using CDUS in 15 patients (10.3% of entire group), more frequently in group I (22.2% of group) and II (11.7%) compared to group III (1.5%). Most DVT patients received thromboprophylaxis (80%) and were asymptomatic or mildly symptomatic (60%). Median D-dimer was elevated in patients with DVT from all groups, and also patients without DVT from groups I and II, but not group III. D-dimers were higher in patients with DVT than without DVT in the entire group (p = 0.001) and group I (p = 0.02), but not in groups II and III. The risk of DVT in SCI patients undergoing rehabilitation and thromboprophylaxis including asymptomatic or mildly symptomatic cases, is high within 6 months post-injury, and especially within 3 months. Measurement of D-dimer level should be complemented by routine CDUS for detecting DVT within 6 months post-SCI. Over 6 months, the usefulness of D-dimer screening alone is better for DVT detection.

The Effect of Aspirin and Enoxaparin on the Prevention of Venous Thromboembolism in Patients With Ankle Sprain and Cast Immobilization: A Randomized Clinical Trial

Background: The incidence of Venous Thromboembolism (VTE) and its prophylaxis in patients with an ankle injury and cast immobilization are controversial. Objectives: This study aimed to investigate the effect of aspirin and enoxaparin on VTE prevention in patients with an ankle sprain and cast immobilization. Methods: In a double-blind, randomized clinical trial, 90 eligible patients were divided into three groups: patients who did not receive the drugs (the control group), patients who received aspirin (325 mg/d) for 3 weeks (the ASA group), and patients who received enoxaparin (40 mg/d subcutaneously) for 3 weeks (the enoxaparin group). After 3 weeks, the plaster was opened, and the D-dimer level was measured if there was a VTE symptom during the study. Otherwise, at the end of the study, the bilateral lower-limb Complete Compression Ultrasonography (CCUS) and color Doppler ultrasound were used to image the lower limb venous system. Results: Sixty-eight patients completed the study. The mean±SD values of D-dimer in the control, ASA, and enoxaparin groups were 0.33 (0.47) μg/dL (Median=0.18 μg/dL), 0.32 (0.14) μg/dL (Median=0.3 μg/dL) and 0.32 (0.25) μg/dL (Median=0.21 μg/dL), respectively (P>0.05). The positive D-dimer was seen in 2 patients (8%) of the control group, 2 patients (8.3%) of the ASA group, and 2 patients (10.5%) of the enoxaparin group (P>0.05). The color Doppler ultrasound was negative in all patients. Conclusion: Because none of the 68 patients in the current study developed VTE during our 30 days follow-up period, it seems that prophylaxis treatment is unnecessary in patients with an ankle sprain and cast immobilization. Further studies on more patients with a longer period of follow-up are recommended.

How to properly examine the veins of the lower limbs: lying, sitting or standing?

The article is a discussion of the advantages of a patient’s position during an ultrasound examination of the lower-limb venous system. The presented material is intended to objectively assess the advantages of this or that position of an examined patient in order to obtain necessary information about the state of the veins of the lower limbs from the position of doctors who have years of experience in diagnostics and treatment of acute and chronic diseases of the lower-limb venous system. The material of the article is primarily designed for doctors who, in addition to the ability to use an ultrasound scanner to some extent, know about venous hemodynamics and can afford to think outside the generally accepted concepts and clinical recommendations.The characteristics of the state of the lower-limb venous system at vertical and horizontal position of the patient are given. Schemes of venous pressure distribution in the system of the inferior vena cava in the horizontal and vertical position of the patient are presented. Methods of manual compression of the muscular mass and straining at different patient positions are described.The vertical position of the patient (or sitting position) is the most reliable way to identify the peculiarities of anatomical structure and pathological changes of the subcutaneous vein walls, which may be of great importance for planning and carrying out subsequent invasive manipulations, but there is a question about the expediency of making linear measurements in this position, if the invasive intervention is carried out while lying down. Carrying out compression ultrasound, assessment of hemodynamic parameters of venous blood flow, including the use of samples with straining and manual compression of muscle masses of the limb, it is much more convenient to perform in the lying position.

To study the clinico-radiological profile of patients of pulmonary tuberculosis with deep vein thrombosis.

The objective of the study was to study the clinico-radiological profile of patients of pulmonary tuberculosis (TB) with deep vein thrombosis (DVT). This is a prospective cross-sectional observational study from September 2017 to March 2019 on diagnosed patients of pulmonary TB who attended the outpatient department or presented with signs and symptoms of DVT. A total of forty patients were included, out of them 57.5% were males. Nearly 45% of the patients belonged to the upper lower class. Nearly 77.5% of cases were undernourished and did not have any comorbid conditions. Sputum smear was reported positive in 92.5% of cases. Bilateral disease was seen in 95% of cases. Far advanced chest X-ray involvement was seen in 72.5% of cases. Newly diagnosed cases of TB were 87.5%. Maximum thrombus formation was seen 97.5% in superficial femoral vein and 92.5% in the common femoral and popliteal vein. Hypoxia was reported in 62.5% of cases. Interval between diagnosis of TB and the development of DVT was 2-3 weeks in a maximum of 35% of cases. The clinical profile of TB with DVT shows a male predominance with upper lower class more prone to develop disease and its complications. Poor physical built is seen in the majority of patients with TB and DVT. New cases of TB are still on rise. Single comorbid condition cannot define the increased risk of DVT in TB. Superficial venous system of lower limb is more prone to develop thrombus. Time interval between TB and development of DVT is variable and cannot be predicted.

Duplex Ultrasound of Lower Limbs Venous System. Russian Phlebology Association Expert Panel Report

Duplex Ultrasound of Lower Limbs Venous System. Russian Phlebology Association Expert Panel Report

Variants of Localization and Extension of Hypo- and Aplasia of the Great Saphenous Vein in Patients with Primary Varicose Great Saphenous Veins

The objective of the research was to improve the diagnostics and treatment of patients with primary varicose great saphenous veins by studying their frequency and systematizing the variants of localization and extension of great saphenous vein hypoplasia and aplasia in its trunk.
 Materials and Methods. The study included 560 patients with varicose veins of the lower limbs and pathological refluxes in different segments of the great saphenous vein. All the patients underwent triplex ultrasound scan of the lower limb venous system.
 Results. Among the patients with pathological reflux in a certain GSV segment, hypo- and aplasia of its segments were observed in 32.5% of the cases (95% CI 28.6-36.6%). Aplasia of this vein was observed twice as less frequently than hypoplasia (p<0.05). In 2.3% of the cases (95% CI 1.2-3.9%), hypoplasia of a certain GSV segment evolved to aplasia, or vice versa. It was found that the GSV trunk may have several hypo- or aplastic regions separated by its normal or varicose segment – bi-level hypo- or aplasia that was observed in 3.8% of the patients with hypo- or aplasia (95% CI 1.6-7.8%). In bi-level hypo- or aplasia, 2 hypoplastic regions were detected in 85.7% of the cases (95% CI 42.1-99.6%) and 2 aplastic regions were found in 14.3% of the cases (95% CI 0.4-57.9%). There were proposed to distinguish the following variants of GSV hypo- and aplasia: 1) simple: total, proximal, segmental and distal; 2) bi-level: proximal segmental, distal segmental and bi-segmental. In addition, for every dysplastic vein segment, the type of malformation should be indicated, namely hypoplasia, aplasia, or hypo/aplasia.
 Conclusions. The study conducted allowed assessing the relationship between the variants of GSV hypo- and aplastic segment localization and extension and different variations of pathological refluxes of the GSV in its trunk for further choice of surgical tactics.

Incidence of Silent Thrombosis in Patients Younger Than 60 Years With Myeloproliferative Neoplasms: Single-Center Egyptian Study

BackgroundIdentification of janus kinase 2 (JAK2) mutation even in absence of myeloproliferative disorders (MPNs) was found to be related to venous thromboembolism occurrence. Venous thrombosis screening is not routinely requested in patients with myeloproliferative neoplasms unless the patient is symptomatic. It has been reported that the incidence of thrombosis in elderly patients is much higher than in young patients. The aim of this work was to screen MPN patients for venous thrombosis and study its correlation with JAK2 allele burden and with MPN 10 score. Patients and MethodsWe enrolled 73 patients with JAK2-positive MPN from our Hematology Clinic in the period August 2015 to Feb 2017. All patients had been screened for thrombosis in the venous system in lower limbs (LLs), upper limbs, portal, and mesenteric systems using color Doppler ultrasound imaging. ResultsFifty-three (72.6%) patients were younger than 60 years. Twenty-two (30%) had essential thrombocytosis, 35 (47.9%) had polycythemia rubra vera, and 16 (22%) had idiopathic myelofibrosis. Twenty-seven venous thrombotic attacks were reported in 22 (30.1%) patients. Five (6.8%) had thrombosis in 2 sites. Seventeen (23%) had superior mesenteric and portal vein thrombosis. Six (8%) had iliofemoral (8%) and 4 (5%) had combined LL and portal thrombosis. Eight (10.8%) had active thrombosis at screening. Only 3 patients (4%) were symptomatic with abdominal pain during screening. Pruritis (P = .02) and abdominal pain (P = .039) were significantly different between cases with and without thrombosis. There was no significant difference in MPN 10 score between cases with active or previous thrombosis. ConclusionWe recommend routine screening for venous thrombosis in any case of MPN when diagnosed and screening for MPNs in any patient with venous thrombosis especially of the portal vein or atypical sites. If MPN patients present with increasing pruritus or abdominal pain, they also should be screened for venous thrombosis. Further research on a large scale in MPN age groups younger than 60 years regarding pathogenesis of thrombosis is highly recommended.

Индивидуальный подход к послеоперационной профилактике тромбозов в онкологии

Цель исследования: повысить эффективность профилактики венозных тромбоэмболических осложнений (ВТЭО) у онкологических больных на хирургическом этапе лечения. Материалы и методы. Проанализированы результаты антикоагулянтной профилактики ВТЭО в послеоперационном периоде у 216 больных с высоким риском тромбоза, обусловленным злокачественными новообразованиями (ЗНО) желудочно-кишечного тракта. В динамике сравнивали результаты показателей коагулограммы, нового глобального теста оценки гемостаза и ультразвукового исследования триплексного сканирования венозной системы нижних конечностей в течение 1 месяца. Результаты. Наибольшее количество ВТЭО зарегистрировано в группе без использования медикаментозной профилактики (26,9%) после оперативного вмешательства. Наименьшая частота ВТЭО отмечена в группе с индивидуальным подбором дозы антикоагулянта (4,9%) на основании глобального теста оценки гемостаза. Заключение. Полагаем, что в послеоперационном периоде у больных со ЗНО желудочно-кишечного тракта необходима комплексная оценка состояния свертывающей системы с коррекцией режима антикоагулянтной профилактики на основании динамики показателей гемостаза, что позволяет снизить частоту ВТЭО. Aim: to increase prophylaxis eff ectiveness of venous thromboembolic complications (VTE) in cancer patients under surgery. Materials and methods. We analyzed the results of anticoagulant postoperative VTE prophylaxis in 216 patients with high risk of thrombosis due to malignant neoplasms of gastrointestinal tract. In dynamics we compared coagulogram parameters, the results of new global hemostatic assessment test, and ultrasound triplex scan of lower limbs venous system during 1 month. Results. Most VTE cases were registered in patients without medicamentous prophylaxis (26.9%) after surgery. The lowest VTE frequency was observed in patients with individual anticoagulant dose selection (4.9%) based on the global hemostatic assessment test. Conclusion. We consider that in postoperative period in patients with malignant neoplasms of gastrointestinal tract integrated assessment of coagulation system and correction of anticoagulant prophylaxis regimen based on the dynamics of hemostasis parameters are required that allows to reduce VTE frequency.

PATHOGENETIC APPROACHES AND WAYS OF PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN TRAUMA PATIENTS

Background. The study of thromboembolic complications prevention in trauma patients, who underwent surgery, is presented in the research.Objective. Patients were examined in the Department of Traumatology of Ternopil Municipal Hospital. The first group, 263 people, (18.6 %) consisted of patients with polytrauma and unfavorable prognosis and significant disease severity. The second group comprised patients with combined trauma, 462 people (32.8 %) – a doubtful prognosis for life. The third group, 685 people (48.6 %) involved patients with isolated trauma and positive treatment outcome.Methods. All patients, besides general clinical examination, underwent evaluation of the number of platelets, clotting time, duration of bleeding and study of coagulation (prothrombin index, prothrombin activity thrombotest, total fibrinogen, fibrinogen A, activated recalcification time). The venous system of lower limbs was examined using distal ascending phlebography, color Doppler and duplex ultrasonography SIMENS ACUSSON X 300.Results. A comprehensive prophylaxis of thromboembolic complications was carried out using low-molecular weight heparin as well as essential complex kinetic treatment. Bemiparin in an appropriate dose was administered once a day for 10-14 days of postoperative stay in the hospital. For the patients with moderate risk and high surgery risk (major surgery, over 40 years old in age, obesity, and serious comorbidities) Bemiparin was administered at a dose of 5000-7500 IU per day during patients’ stay in the hospital. In individuals with sub-acute and chronic thrombophlebitis of subcutaneous veins the surgical prophylaxis of thromboembolic complications was performed.Conclusions. The combination of physical, drug and surgical prophylaxis prevented the thromboembolic complications in trauma patients.

Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis.

This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT).The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations.Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram.Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system.