Veins Of Lower Extremities Research Articles

A systematic review and Meta-analysis on risk factors of delayed healing of venous leg ulcer

Objective To systematically review the risk factors of delayed healing of leg ulcer (VLU) so as to provide a guide for developing the personalized nursing strategies. Methods The Cochrane Library, PubMed, Web of Science, ScienceDirect, Clinicaltrials.gov, ProQuest and Open Grey was retrieved with the English keywords of varicose ulcer/venous ulcer, non-healing/delayed healing/poor healing, factor/risk factor/influence factor; the China Biological Medicine (CBM) , Chinese National Knowledge Infrastructure (CNKI) , WanFang Data and VIP was retrieved with the English keywords of venous leg ulcer/venous ulcer, delayed healing/refractory, risk factors/influencing factors; the retrieval time ranged from building database to 1st April 2019. Two researchers independently screened literatures, extracted data and assessed the quality of included literatures. The RevMan 5.3 was used to the meta-analysis. Results Finally, a total of 11 literatures were included and involved 3 894 subjects, 520 cases lost to follow up, 914 cases in case group and 2 460 in control group. Meta-analysis showed that there were 7 risk factors related to delayed healing of VLU including the ages [OR=1.02, 95%CI (1.01, 1.03) , P 50% wound covered with fibrin [OR=1.88, 95%CI (0.99, 3.57) , P=0.06], diabetes mellitus [OR=1.10, 95%CI (0.70, 1.75) , P=0.67], history of hip or knee replacement [OR=1.73, 95%CI (0.50, 6.00) , P=0.39]. Conclusions Evidence shows that the independent risk factors of delayed healing of VLU include the ages, range of motion of ankle, size of ulcer, duration of ulcer, history of DVT, ankle-brachial index<0.8 and rheumatoid arthritis. Those evidences can help to identify the clinical high-risk population of delayed healing of VLU and provide targeted nursing intervention to reduce the healing time of VLU and improve patients' quality of life. Key words: Meta-analysis; Varicose ulcer; Lower extremity veins; Delayed healing; Risk factors

Analysis of patent, unstented lower extremity vein segment diameters in 266 patients with venous disease

ObjectiveThe objective of this study was to characterize the average maximum diameters of widely patent lower extremity vein segments in patients with underlying venous disease and the demographic factors that affect these diameters. MethodsMaximum axial diameters of each deep vein segment from the diaphragm to the knee were measured from computed tomography venography studies for all patients who underwent venous stent placement during a 20-year period at a single quaternary venous referral institution. Limbs containing only widely patent, unstented vein segments without variant anatomy were identified for inclusion. The final analysis involved diameter measurements from 870 imaging studies of 266 patients. Multivariate linear regression was used to identify factors associated with vein segment diameters. ResultsAverage vein segment diameters ranged from 7.8 mm for the left and right femoral veins to 27.9 mm for the long axis of the suprarenal inferior vena cava. Multivariate linear regression demonstrated that women had larger IVC, common iliac vein, and external iliac vein diameters, whereas men had larger common femoral veins. Laterality, height, weight, and sex also had statistically significant associations with the diameters of select vein segments. ConclusionsThis study provides an estimate of the average diameters of widely patent deep vein segments in the lower extremities from the diaphragm to the knees in patients with underlying venous disease and characterizes covariates that significantly affect vein diameter. These findings may help interventionalists better select devices for endovascular intervention.

Modern views on the development of varicose and post-thrombotic diseases

Chronic diseases of the veins of the lower extremities include vascular pathologies within the venous system and exclude those, in which the veins suffer secondarily (chronic heart failure, iatrogenic damage, tumour occlusion). The main clinical and morphological forms of chronic diseases of the veins of the lower extremities include: varicose veins, post-thrombotic disease and phlebodysplasia. Moreover, according to publications, varicose disease accounts for the main percentage of occurrence, i.e. from about 70 to 86 %. Post-thrombotic disease occurs from 14 to 29 % of cases and develops, as a rule, during the first two years after an episode of deep vein thrombosis of the lower extremities in 20–50 % of patients. These two diseases are the main reason for the development of chronic venous insufficiency with a significant decrease in working capacity and quality of life under the age of 60. Despite the achievements of modern science, the ethiopathogenesis of these diseases is yet to be understood. Instrumental diagnostics allows a pathological retrograde blood fl ow due to the failure of the valves of the venous system of the lower extremities to be determined. However, the issue of what is primary — valvular insufficiency or venous wall deformation — remains open at the present time. This article is devoted to a review of modern theories about the mechanisms underpinning the formation of valvular insufficiency in varicose and post-thrombotic diseases. The review also addresses systemic hemodynamic disorders (heart morphology and hemodynamics) against the background of chronic diseases of the veins of lower extremities.

Modified one-session endovascular treatment for deep venous thrombosis with high risk of pulmonary embolism: Short-term outcomes.

To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%-90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12-25months of follow-up, iliac vein stents and lower extremity veins maintained patent. The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.

Estrogen and estrogen receptor affects MMP2 and MMP9 expression through classical ER pathway and promotes migration of lower venous vascular smooth muscle cells.

To explore the role of estrogen and estrogen receptors in the migration of vascular smooth muscle cells in varicose lower-extremity veins. Tissue samples of normal lower extremity vein (56 cases) and varicose lower extremity vein (47 cases) were collected. Western blot and real-time fluorescent qPCR were performed to measure the expression of Estrogen receptor α (ERα) in tissues. Two cell co-culture systems were established for human umbilical vein endothelial cells (HUVECs) and human umbilical vein smooth muscle cells (HUVSMCs). One system was incubated under normal oxygen conditions (normal oxygen group), and the other was under oxygen-poor conditions (hypoxia group). The two systems were treated with 10-7 mM Estrogen E2, 10-7 mM BSA-conjugated Estrogen E2-BSA, 10-7 mM Estrogen E2+10-3 mM Tamoxifen (TAM), respectively for 24 h. The treated cells were subjected to cell scratch assay, transwell assay, and Western blot analysis of MMP2 and MMP9 protein expression. The expression of ERα in varicose lower extremity vein was significantly up-regulated compared with that in normal lower extremity vein. The cell migration rate and the number of migrating cells in untreated hypoxia group and E2-treated normal oxygen group were comparable (p>0.05) to those in untreated normal oxygen group. The cell migration rate and the number of migrating cells were significantly increased (p<0.05) in E2-treated hypoxia group, compared with E2-treated normal oxygen group and untreated hypoxia group. The cell migration rate, the number of migrating cells, and expression levels of MMP2 and MMP9 were significantly decreased in E2/TAM-treated hypoxia group, compared with those in E2-treated hypoxia group. In summary, E2 can promote the migration of vascular smooth muscle cells and induce varicose veins of the lower extremities, which may be related to the promotion of MMP2 and MMP9 expression through the classical pathway of ER.

Selection of PICC catheter location in neonates via evidence-based ACE Star model.

To explore the most suitable insertion site for neonatal placement of peripherally inserted central venous catheter (PICC) according to the evidence-based ACE Star model. This study was carried out according to the evidence-based ACE Star model in 5 steps, including discovery research, evidence summary, guidelines translation, practice integration, and outcome evaluation. Based on the results of Meta-analysis, relevant guidelines, expert recommendations, clinical experience of nurses, and characteristics of neonates, the final recommendation was formed. A total of 87 neonates in a tertiary neonatal intensive care unit in Hunan Province were integrated into practice of PICC to evaluate the incidence of catheter-related complications and one-attempt success rate of puncture. The results of Meta-analysis showed that the incidence of complications of PICC in neonates via lower limb veins was significantly lower than that of upper limb veins (OR=0.83, 95% CI 0.75 to 0.92, P<0.05). The final result of guideline translation was that PICC should be performed first through lower limb veins if the lower limb vein before PICC catheterization was not damaged.The results of integrated practice showed that the incidence of complications of PICC via lower extremity vein was 17.24%. Compared with the left lower limb catheterization, the incidence of complications and the incidence of catheter blockage of the right lower limb catheterization were significantly lower (both P<0.05). Compared with femoral vein catheterization, one-attempt success rate of puncture via the saphenous vein catheterization was higher and the incidence of complications, the incidence of catheter blockage, and the incidence of infection were lower, with significant difference (all P<0.05). Saphenous vein in right lower limb could be the most suitable insertion site for neonatal PICC.

Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities.

This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e'-wave, late diastolic annular a'-wave and systolic annular s'- wave) data of 85 patients, 133 legs with primary varicose veins. We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a'-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s'-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio -0.22 or -21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave -4.4 cm/s or -9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e'-, a'-waves and E/A ratios) in patients with chronic venous disease. Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation - right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.

P689 Surgical treatment of a right heart thrombus-in-transit with massive bilateral pulmonary embolism

Abstract Introduction Right heart thrombi are rare, found in up to 20% of pulmonary emboli (PE), and associated with significantly increased mortality(1). A thrombus entrapped in a PFO is a rare form of right heart thromboembolism. Clinical Case A 73-year-old male patient who had dyspnea for 10 days, was transferred to our hospital for the surgical treatment of a cardiac tumor. We performed TTE which revealed a free floating, huge mass( measuring more than 8 cm long) in the right atrium, that protruded in the right ventricle, with high risk of embolization. Another smaller mass, attached to the interatrial septum. Severe right ventricular dysfunction and severe pulmonary hypertension were present. Contrast-enhanced computer tomography was performed, which revealed severe bilateral pulmonary artery emboli with complete occlusion of right pulmonary artery branch. Clinical and paraclinical data strongly suggested that the huge cardiac mass was a thrombus that originated from the lower extremity veins. TEE showed that the thrombus was entrapped through the PFO, with a smaller part in the left atrium and the biggest portion in the right atrium. The patient underwent an emergent on-pump surgical cardiac and right pulmonary artery embolectomy. The right atrium was opened and a huge intracardiac thrombus with a lengh of 14 cm extending from the coronary sinus, to PFO in the left atrium and also in the right ventricle was removed. The right branch of the pulmonary artery was opened and a large volume of clot- 9 cm long- was removed. The patient was removed from cardio-pulmonary by-pass (CPB) on high doses of norepinephrine and dobutamine and necessitated initiation of venous-arterial ECMO to support the severe right heart dysfunction. He was extubated after 10 days, with little improvement in the clinical status. Transthoracic echocardiography showed smaller right heart cavities), normal left ventricular function, but persistent severe RV dysfunction and severe pulmonary hypertension. In the thirteenth postoperative day, he installed cardio-respiratory arrest and he died. Discussion In this report we describe a case of a patient with a huge intracardiac thrombus, entrapped through a PFO, associated with massive pulmonary embolism, with late presentation in our hospital and severe refractory right heart dysfunction. He underwent successful embolectomy, which is a unique procedure in the treatment of an acute pulmonary embolism and entrapped thrombus in a PFO. Conclusion The treatment of choice for emboli-in-transit is controversial. In a recent review, surgical thromboembolectomy showed a trend toward improved survival and significantly reduced systemic emboli compared to anticoagulation. Thrombolysis in these patients may cause fragmentation of thrombus and systemic embolization, resulting in increased mortality. Management decisions should be made with multidisciplinary coordination and consideration of complicating factors such as PFO. Abstract P689 Figure. Extensive biatrial thrombus

Correlation Study of Color Doppler Examination of Deep Veins of Both Lower Extremities Combined with Fibrinolysis System in Hypertension during Pregnancy

Objective: To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension. Methods: A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU), and the fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) method and automatic hemagglutination analyzer. Results: Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P the difference was statistically significant (P , while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy group, and the difference was not statistically significant (P > 0.05); FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P 0.05). Conclusion: Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.

Варикозная болезнь нижних конечностей в сочетании с Hallus valgus

Our research is dedicated to the combined pathology of musculoskeletal system – Hallux valgus with varicose veins of lower extremities that are common in the surgical practice. This study allowed us to estimate frequency of hallux valgus and varicose veins combined with each other and also to identify main factors that contribute to these diseases progression. Methods and principles of the research. To diagnose the combined pathology instrumental investigation (foot X-ray in two planes) was performed in 40 (36,7%) patients out of 109 that were under treatment in the surgical unit of the General Surgery department in “Private Healthcare Institution Clinical Hospital Russian Railways– Medicine”, Tyumen in 2019 and had varicose veins treated previously. A questionnaire was developed for conducting a sociological study. Results. The main reason of these diseases occurring is the congenital connective tissue defect and the veins wall weakening caused by the genetic predisposition. The acquired factors are: lifestyle and type of work (frequent and protracted static muscle load, wearing uncomfortable footwear), obesity. It is identified that the combined pathology (Varicose veins and Hallux Valgus) occur in every third patient, suffering from varicose veins. According to the results of the survey, 28 (70%) patients have genetic factors. Prolonged static load prevails among acquired factors, obesity takes the second position and it is diagnosed in 16 cases (11 women and 5 men). Conclusion. The frequency of these diseases occurring together was 36,7% in our study. Systemic approach allows to comprehensively assess various pathological changes in the blood and lymph circulation. “Combined pathology of musculoskeletal system” booklet was developed and implemented into the practical healthcare (among municipal polyclinics of Tyumen).

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

Effect of placement of peripherally inserted central catheter via the upper versus lower extremity veins: a Meta analysis

To investigate the effect of placement of peripherally inserted central catheter (PICC) via the upper versus lower extremity veins in neonates through a Meta analysis. CNKI, Wanfang Data, VIP Data, CBMdisc, PubMed, Web of Knowledge, Embase, Medline, Cochrane Library and Google Scholar were searched for control studies on the effect of PICC placement via the upper versus lower extremity veins in neonates. RevMan 5.3 was used to perform a Meta analysis of the studies which met the inclusion criteria. A total of 18 studies were included, among which there were 8 randomized controlled trials and 10 cohort studies, with 4 890 subjects in total. Compared with those undergoing PICC placement via the upper extremity veins, the neonates undergoing PICC placement via the lower extremity veins had significantly lower incidence rates of complications (RR=0.83, 95%CI: 0.75-0.92, P<0.05), catheter-related infections (RR=0.77, 95%CI: 0.60-0.99, P<0.05), catheter malposition (RR=0.28, 95%CI: 0.18-0.42, P<0.05), extravasation of the infusate (RR=0.52, 95%CI: 0.40-0.70, P<0.05), and unplanned extubation (RR=0.82, 95%CI: 0.69-0.98, P<0.05). They also had a significantly higher first-attempt success rate of puncture (RR=1.17, 95%CI: 1.05-1.30, P<0.05) and a significantly shorter PICC indwelling time (MD=-0.93, 95%CI: -1.26-0.60, P<0.05). The above evidence shows that PICC placement via the lower extremity veins has a better effect than PICC placement via the upper extremity veins in neonates.

Predictors for Chronic Thromboembolic Pulmonary Hypertension

Introduction - The most dangerous complication of acute venous thrombosis is pulmonary embolism (PE), which results directly in mortality in most cases. In non-fatal cases of massive pulmonary embolism, when thrombolytic therapy or embolectomy is not possible or ineffective, there is severe chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of our study was to develop clinical, laboratory and instrumental criteria to characterize the development of varying CTEPH intensity after the earlier is PE. Methods - The study is based on a retrospective material comprising 26 patients with the pulmonary embolism arteries and survived it. At different times (1-5 years) after the event and discharge from the hospital, the patients were summoned and examined. All patients were performed to an ultrasonography of the lower limbs, echocardiography, and some patients had pulmonary perfusion scintigraphy and CT angiography. In case of high pulmonary hypertension, which was detected with echocardiography, the right heart catheterization was used for the immediate detection of pulmonary pressure. In the course of our study, we compared the patients' findings received in the initial hospital admissions with the findings of clinical and instrumental methods we had received in the long term after the pulmonary embolism (PE). Results - According to our study, there is a certain trend towards the development of severe CTEPH forms, depending on the following primary clinical and instrumental characteristics. The following factors have been recognized as favorable factors resulting in the incidence of milder CTEPH forms or its total absence in the long term: effective thrombolytic therapy, relative “freshness” of thrombotic masses, distal lesion level of the lower extremity veins (up to the popliteal veins inclusive), young age of patients. It is worth mentioning separately the adequate anticoagulant therapy, which is prescribed following the thrombolysis or in automedication. As a rule, patients followed two regimens of anticoagulant therapy after the thrombolytic therapy: unfractionated heparin during the first 24 hours, with the subsequent transition to warfarin, rivaroxaban immediately at the end of the thrombolysis. Two regimens of anticoagulant therapy: low molecular heparins followed by the transition to warfarin and rivaroxaban from the first days of treatment were also present when the thrombolytic therapy was not possible or not necessary. In the long term, we observed the best pulmonary artery recanalization by combination of the thrombolytic therapy and rivaroxaban, although there were patients who were not treated with the thrombolysis due to the developed allergic reaction in the massive PE, but on the top of administered rivaroxaban there was detected a full pulmonary channel permeability one year after the treatment onset. The effect of the pulmonary artery recanalization in the warfarin treatment was much weaker. Negative factors in the CTEPH development could include the proximal level of deep vein lesions, the elderly age of patients, not "fresh" thrombotic masses. After 10 days of their formation, each consecutive day affected negatively the efficiency forecast of the thrombolytic and anticoagulant therapy in terms of pulmonary artery recanalization. Conclusion - There are certain clinical and instrumental parameters that allow for a certain degree of prediction of the CTEPH development following the earlier PE, but further studies are required to have more reliable statistics.

Features of structural and functional parameters of superficial veins of lower extremities in men with arterial hypertension

The aim of the work was to assess the structural and functional parameters of the superficial veins of the lower extremities in men with arterial hypertension. A comparative analysis of the results of the angioscanning of the superficial veins of the lower extremities between 60 men with arterial hypertension and 27 men with normal blood pressure at the age of 30–50 years was performed. In hypertension, an increased rate of venous blood flow and signs of chronic vein diseases are recorded — an increased diameter and area of the lumen of the veins; abnormal venous reflux marked in 10 % of men; in 3 % — varicose veins and thrombotic masses, signs of postrombotic lesion of the superficial veins.Conclusion. For men with hypertension aged 30–50 years, there is an increased rate of venous blood flow and signs of chronic venous disease of the lower extremities: chronic venous insufficiency, varicose and postrombotic venous disease, which must be considered when stratifying cardiovascular risks and treating hypertension.

Vasculo-Behcet's Disease: Profile and Management - Single Center Experience

Background Behçet's disease (BD) is a multisystem vasculitis characterized by exacerbations and remissions with unknown etiology. Males are more affected than females with the usual onset in the third decade. Vascular involvement can occur in up to 40% of cases of BD. BD is unique among the vasculitides that it may involve all sizes and types of vessels. Objectives 1. To study the pattern of vascular involvement of Behçet's disease (BD) in the Saudi population; use of anticoagulation and its duration, thromboembolic, and major bleeding complications during anticoagulant therapy. 2. The effect of combined immunosuppression and anticoagulation treatment approach in reducing the risk of venous and arterial thromboembolism. 3. The role of vascular surgery for peripheral arterial and abdominal aortic aneurysms (AAA), and the role of immunosuppression in the treatment of pulmonary artery aneurysm (PAA) without the need for surgical intervention. Methods Twenty-three patients with confirmed vasculo-BD attending the thrombosis clinics at our tertiary care center between 2010 and 2015 were studied retrospectively and analyzed through descriptive statistics SPSS version 22. Results Demographics and pattern of vascular involvement are shown in tables 1 and 2. HLA-typing was performed for 13 patients, and HLA- B51 was positive in 7 (54%) patients tested. The acute phase reactants (ESR and CRP) were high in all 23 (100%). Hereditary and acquired thrombophilia workup was performed for all patients and only 1 (4.3%) was positive for antiphospholipid antibodies. Oral ulcers were present in all the patients, genital ulcers in 12 (52%), ocular involvement in 8 (35%), skin manifestations in 3 (13%), and arthritis in 1 (4.3%). Lower extremity vein thrombosis is the most frequent manifestation of Vasculo-BD in Saudi Arabia, followed by CVT, PAI, SVT/Budd-Chiari syndrome, IVC thrombosis, peripheral artery aneurysms, and AAA. Peripheral arterial and abdominal aortic aneurysms in 3 (13.6%), all of whom had successful vascular surgery for aneurysm repair. Inferior vena cava filter was inserted in 3 (13.6%). One patient was admitted to the intensive care unit with fulminant hepatic failure due to bilateral hepatic vein thrombosis and subsequently died. The vascular thrombosis recurrence was in 11 patients (48%, all venous) despite adherence to the prescribed anticoagulant therapy and lack of any provocation. These patients were initially treated with anticoagulant monotherapy. After combining immunosuppressive therapy to the pre-existing anticoagulant therapy, none had thrombosis recurrence. There was a complete resolution of the two patients with PAA with mono-immunosuppressant therapy and no surgical intervention. The most commonly prescribed initiation anticoagulant therapy was low molecular weight heparin (87%). Conclusion BD with vascular involvement continues to pose a major diagnostic and therapeutic challenge to physicians due to the heterogeneity of the clinical presentation and lack of the diagnostic laboratory test. Therefore, we must have a low threshold for BD in any patient with vascular thrombosis or aneurysm. Combined immunosuppressive therapy is essential in suppressing and preventing the venous and arterial recurrence attacks. Disclosures No relevant conflicts of interest to declare.

Etiology of Cryptogenic Stroke

Ischemic stroke is a heterogeneous syndrome with a plurality of potential etiological factors. The routine diagnosis does not always allow the cause of acute cerebrovascular accident to be found, in such cases we talk about cryptogenic ischemic stroke, which incidence is 20-40%. The category of patients with cryptogenic stroke was first characterized and assigned to a separate group in the database of the National Institute of Neurological Diseases and Stroke in the USA, and later in the TOAST study. The diagnosis of cryptogenic stroke is usually based on the exclusion of well-known causes of acute cerebrovascular accidents, such as atherosclerosis, cardiac arrhythmias, arterial hypertension. Due to the considerable variability of concepts for cryptogenic stroke, the term ESUS (Embolic Stroke of Undetermined Source) appeared in 2014 and formulated criteria which accurately characterized these patients: non-lacunar cerebral infarction by CT and/or MRI, no atherosclerotic lesion stenosing a stroke-associated artery of more than 50%, no sources of high-risk cardioembolism, no other causes of stroke such as dissection of the artery supplying the area of infarction in the brain, migraine, arteritis. Among the potential causes and sources of cerebral embolism in patients with cryptogenic stroke are heart, veins of lower extremities and pelvis, nonstenosing atherosclerosis of brachiocephalic artery, atheroma of aortic arch, paradoxical embolism non-atherosclerotic vasculopathy, monogenic diseases, hypercoagulable states, and others. We should note that there is a lot of studies on the possible causes of cryptogenic stroke in the available literature, but no common approach to classification of etiologic factors and examination algorythms were developed. The high incidence of cryptogenic stroke, the significant heterogeneity of its etiopathogenetic mechanisms and the need for differentiated approaches to the secondary prevention of this type of acute cerebrovascular accident determine the relevance of further studies in this field.

Application of 16 cases of ECG localization in positioning specific signals at the tip of PICC catheter in lower limbs

Objective Electrocardiographic (ECG) localization was used to guide the placement of peripherally inserted central catheters (PICC) catheter in the lower extremity. In clinical practice, the interference factors that may affect the localization results were further analyzed to reduce the interference factors. Methods From August 2016 to October 2018, Zhejiang Provincial People's Hospital implanted PICC catheter into the great saphenous vein of the lower extremity in 16 patients who had been placed into the central vein in advance because the upper extremity could not be placed into the PICC catheter. Based on the principle of ECG and the morphological change of P wave of ECG, the accuracy of the tip location of PICC guided by ECG was observed, and the possible interference factors in the process of ECG location were analyzed comprehensively, coping measures were implemented as well. Results 16 patients were guided by ECG to locate the tip of lower extremity PICC, 14 patients showed inverted P wave in ECG location, 16 patients showed the tip of catheter in the best position recommended by the guide on abdominal plain film, which was effective after targeted treatment of possible interference factors considered in the practice. Conclusions It is simple, safe and effective to use the ECG localization to locate the tip of PICC in lower extremity. It has better clinical practicability and popularization value. Key words: Electrocardiography; Positioniny technology; PICC; Tip

The Analysis of Long-Term Results and Quality of Life in Patients with Massive Pulmonary Embolism in the Course of Treatment with Thrombolytic and Anticoagulant Drugs

RelevanceChronic post-embolic pulmonary hypertension (CPEPH) is a complication of pulmonary thromboembolism found almost in every 10th patient. A special risk group consists of patients with a moderately high risk of pulmonary embolism associated death according to stratification of the probability of early death of the European Society of Cardiology. The development of this condition is potentially preventable with timely and adequate therapy in these patients. We have improved the approach to the treatment of pulmonary embolism patients, which allows indications for thrombolytic therapy to be clarified and expanded. The aim of the study is to evaluate its effectiveness in the long-term period, as well as analyze the qualities of life of patients with massive pulmonary embolism, who underwent thrombolytic and anticoagulant therapy.Material and methodsThe treatment, as well as the analysis of long-term results and quality of life of 71 patients aged 29 to 88 years with diagnosed pulmonary embolism with a moderately high risk of early death were performed. All patients underwent general clinical and biochemical blood tests, D-dimer, ECG, echocardiography, ultrasound of the lower extremities veins, CT angiopulmonography. We registered the dynamics of echocardiographic symptoms of the right heart overload over 6 months (right ventricle size, pulmonary hypertension, the degree of tricuspid regurgitation), and assessed the quality of life based on a survey with the establishment of the appearance of shortness of breath, tachycardia, hospitalizations for heart failure during the study period. Depending on the type of therapy, the patients were divided into two groups: 38 patients with thrombolytic therapy and 33 patients with anticoagulant therapy. Subsequently, their comparative analysis was carried out.Results and conclusionIn patients with pulmonary embolism of moderately high risk of early death, who underwent thrombolytic therapy, chronic postembolic pulmonary hypertension developed 2.9 times less and a higher quality of life retained in these patients than in patients treated with anticoagulant drugs.

Choice of the method of surgical treatment for ectasias of saphenofemoral and saphenopopliteal junctions

Objective. Analysis of results of radiofrequency laser ablation and crossectomy with stripping in patients, suffering varicose disease of the lower extremities veins in ectasias, sizing more than 14 mm in saphenofemoral and saphenopopliteal junctions.&#x0D; Materials and methods. Analysis of the treatment results was conducted for 66 patients, among whom there were 46 women. Average age of the patients have constituted 54.7 yrs. The patients were divided into three groups: the first - 22 patients, in whom crossectomy with stripping was accomplished, the second - 21 patients, in whom endovenous laser ablation was done, and the third - 23 patients, in whom radiofrequency ablation was performed. Level of the pain intensity was estimated during 7 days, dynamics of severity of chronic venous insufficiency, presence of complications and recurrences half a year postoperatively.&#x0D; Results. Severity of chronic venous insufficiency have reduced in 6 mo in all the groups under the influence of treatment: in the first group - by 63.8%, in second - by 50.1%, in the third - by 65.3%. The most reduction of the pain level (by 50%) on the second day postoperatively were registered in patients of the third group. Half a year before a recurrence in the first group have occurred in 4 (18.2%) patients, in the second - in 3 (14.3%), and in the third - in 1 (4.3%) patients.&#x0D; Conclusion. The selected methods of surgical treatment for varicose disease of the lower extremities are effective. In presence of ectasias of saphenofemoral and saphenopopliteal junctions the morbidity and recurrence rates were lowered, the pain indices reduced after the radiofrequency ablation application, comparing with endovenous laser ablation and crossectomy with stripping.

Repeated venous duplex ultrasound examination when the initial study is incomplete

What do you do when you order a venous duplex ultrasound study to determine whether your patient has a deep venous thrombosis and the examination is incomplete? Do you assume that because most of the examination findings were negative that the study probably was overall negative? Alternatively, do you insist that the study be repeated? If the latter, when do you order the new study, immediately or some days later? Is there anything else that you can request to achieve a final valid diagnosis? Prospective study comparing the rate of deep venous thrombosis of complete and incomplete lower extremity venous duplex ultrasound examinationsJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 7Issue 6PreviewA lower extremity venous duplex ultrasound (LEVDUS) examination positive for deep venous thrombosis (DVT) is an indication for anticoagulation. Incomplete examinations that fail to examine all lower extremity veins in patients not otherwise indicated for anticoagulation may be followed by repeated examination to exclude missed or progressing DVT. This study examined the frequency of incomplete LEVDUS studies, reasons for incomplete studies, veins incompletely examined, and follow-up LEVDUS after incomplete LEVDUS. Full-Text PDF