ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied. The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured, furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%, 66.7%, 97.0%, 100%, and 97.1%, and 98.4%, 83.3%, 98.4%, 83.3%, and 97.1%, respectively. The plasma D-dimer in acute phase 〔(6 451±4 012.22) μg/L〕 and subacute phase 〔(2 063±1831.35) μg/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310±66.70) μg/L〕, Plt;0.01 and Plt;0.05, which was not different from that in chronic phase 〔(466±350.52) μg/L〕. Meanwhile, the plasma D-dimer in mixed limb venous thrombosis group 〔(4 464±3 753.16) μg/L〕 and central limb venous thrombosis group 〔(2 149±1 911.53) μg/L〕 were significantly higher than that in control group (Plt;0.05 and Plt;0.01), which was not different from that in peripheral limb venous thrombosis group 〔(560±315.62) μg/L〕. Conclusion Color Doppler ultrasonography is an optimal method and the plasma D-dimer is a predictive index in diagnosis of lower limb DVT.
ObjectiveTo investigate the effects of intraoperative intermittent pneumatic compression (IPC) treatment on coagulation and fibrinolysis, lower extremity venous blood flow velocity, and deep venous thrombosis (DVT) in patients with gastric cancer (GC) after radical gastrectomy. MethodsThe patients with GC who underwent radical gastrectomy at Hebei Provincial People’s Hospital from July 2021 to July 2024 were retrospectively enrolled, then the patients were assigned into control group (the patients who did not receive intraoperative IPC) and study group (the patients who received intraoperative IPC), and the propensity score matching (PSM) method was used to conduct 1∶1 matching based on the basic characteristics such as age, gender, body mass index, comorbidities to ensure baseline comparability between the two groups. The incidences of postoperative DVT and lower extremity swelling, and coagulations [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT)] and fibrinolysis [D-dimer (D-D), fibrinogen (FIB), and fibrin degradation products (FDP)], as well as lower extremity venous blood flow velocity were analyzed after PSM. The locally weighted regression was used to analyze the correlation between the coagulation and fibrinolytic functions indexes and the lower extremity venous blood flow velocity. ResultsA total of 120 patients were matched (60 cases per group). The baseline characteristics of both groups were comparable (P>0.05). The incidences of DVT on day 7 and lower extremity swelling on day 1, 3, and 7 after surgery in the study group were significantly lower than those in the control group (P<0.05). The results of repeated-measures analysis of variance showed that there were statistically significant differences in the inter-group, time-related, and group-by-time interaction effects of coagulation and fibrinolysis indexes as well as lower extrimety venous blood flow velocities (P<0.05). The impact of the time factor on coagulation and fibrinolysis indexes and lower extrimety venous blood flow velocities varied with intraoperative IPC intervention measures. After surgery, the PT, TT, APTT, and lower extrimety venous blood flow velocities in the study group first decreased and then increased as compared with those before surgery, and the decrease degree was smaller and the increase degree was larger than those in the control group. After surgery, the D-D, FIB, and FDP in the study group first increased and then decreased as compared with those before surgery, and the increase degree was smaller and the decrease degree was larger than those in the control group. Both PT and TT were significantly positively correlated with femoral vein blood flow velocity (r=0.21, P=0.042; r=0.22, P=0.040), and both also showed significant positive correlations with popliteal vein blood flow velocity (r=0.25, P＜0.001; r=0.20, P=0.032). APTT was only significantly positively correlated with popliteal vein blood flow velocity (r=0.33, P＜0.001). D-D was negatively correlated with the flow velocities of the femoral vein, external iliac vein, and popliteal vein (r=–0.23, P=0.012; r=–0.22, P=0.047; r=–0.37, P<0.001). Both FIB and FDP were negatively correlated with the flow velocity of the femoral vein (r=–0.23, P=0.036; r=–0.27, P=0.002). FIB was also negatively correlated with the flow velocity of the popliteal vein (r=–0.26, P=0.038), and FDP was negatively correlated with the flow velocity of the external iliac vein (r=–0.31, P<0.001). ConclusionBased on the results of this study, intraoperative IPC treatment could improve coagulation and fibrinolytic functions of patients with GC after surgery, and has a certain preventive effect on occurrence DVT of lower extremity.
ObjectiveTo analyze the therapeutic effects of open surgery and endovascular treatment for mesenteric venous thrombosis.MethodsThe clinical data of 22 patients with mesenteric venous thrombosis from March 2005 to January 2014 were analyzed retrospectively. One patient underwent open surgery including removal of necrotic small intestine and thrombectomy of superior mesenteric vein immediately admission to the hospital. Five cases were treated with simple anticoagulation and cured. Sixteen cases received thrombolytic therapy after primary anticoagulant therapy.ResultsOne case who underwent open surgery died of multiple organ failure at 72 h after the surgery. Five cases who received simple anticoagulant reached clinical relief finally. Sixteen patients who received thrombolytic therapy achieved recanalization totally or partially. Three cases died during follow-up (3 months to 7 years, average) of which 1 died of recurrence of acute superior mesenteric venous thrombosis, 1 died of myocardial infarction, and 1 died of stroke.ConclusionsFor patients with symptomatic mesenteric venous thrombosis, if there is no intestinal necrosis, there will be encouraging results by interventional thrombolytic therapy. And the treatment effect needs further experience accumulation in more cases.
OBJECTIVE: To investigate the effect of intermittent pneumatic compression on prevention of deep venous thrombosis after operation of lower limbs. METHODS: From Oct. 1997 to Aug. 1998, forty cases were received Doppler examination preoperatively, which showed no deep venous thrombosis in all the lower limbs of 40 cases. Among them, 24 cases were received total hip arthroplasties, 4 cases were received total knee arthroplasties and 12 cases were received dynamic hip screw. Postoperatively, every case were continuously received intermittent pneumatic compression for 14 to 21 days (2 hours, qid), and venography were performed on the operated lower limb on the 7th day after operation to check the presence of deep venous thrombosis. RESULTS: Among the 40 cases, there were 4 cases of deep venous thrombosis without symptom of pulmonary embolism, the incidence rate was 10%. CONCLUSION: Intermittent pneumatic compression can significantly reduce the incidence rate of deep venous thrombosis after the operation of the lower limbs.
ObjectiveTo evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. MethodsThe clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. ResultsOf the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 case complicated with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.57% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. ConclusionThe effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.
Objective To discuss the clinical effect and value of minimally invasive therapy on lower extremity deep venous thrombosis （DVT）. Methods The clinical data of 911 patients with acute lower extremity DVT from April 1998 to December 2011 were analyzed retrospectively. There were 489 males，422 females；the age ranged from 23-86 years old with （58.72±11.95） years old. Five hundred and sixty-eight patients occurred on the left leg，343 patients on the right leg. There were 487 cases of central type，166 cases of peripheral type，258 cases of mixed type. All the patients were implanted inferior vena cava filter under local anesthesia，then inserted an 8-14 F catheter via the femoral vein of the affected limbs to suck mechanically thrombus. Five hundred and twenty-seven cases of iliofemoral vein thrombus were inserted into sheathing canal with the help of technique of guide wire griped. The guide wire could be plugged into femoral vein，even more far，with the help of sheathing canal. Following the guide wire，a diameter-10 mm balloon catheter was used to pull the thrombus to iliac vein，with the watching of DSA，so it could be sucked from iliac vein. Before sucking thrombus，a diameter-12 mm balloon was put into the confluence of inferior vena cava and iliac vein，in case of thrombus fall off with blood flow to block inferior vena cava. Results Among 911 patients，423 cases were only treated by sucking thrombus，275 cases sucking thrombus plus endovascular thrombolysis，91 cases sucking thrombus plus endovascular thrombolysis plus percutaneous transluminal angioplasty （PTA），122 cases sucking thrombus plus endovascular thrombolysis plus PTA plus stenting，the average hospital stay was 7.5 d. ① Discharge success rate：907 （99.56%） cases were successful by interventional therapy，4 （0.44%） cases were failed. Nine hundred and eleven patients were performed mechanical thrombus suction，which was 556 cases of gradeⅢ，142 cases of gradeⅡ，213 cases of gradeⅠ. Among 213 cases of gradeⅠ，there were 91 cases only underwent PTA treatment for economic reasons or advanced stage malignant tumors，122 cases underwent PTA plus stenting. The circumferences of affected limb and the differences of circumference of healthy and affected limbs knees above and below 15 cm at discharge were significantly smaller than those at admission （P＜0.01）. Twenty-seven cases underwent anticoagulation and thrombolytic therapy after operation，which occurred mild subcutaneous bleeding，gum bleeding，epistaxis，hematuria，and the symptoms were disappearance after adjusting drugs. All the patients did not appear to complications such as bleeding，vessel dissection. ② Follow-up effective rate：After 6 to 12 months follow-up，there were 714 （78.38%） cases of excellent，136 （14.92%） cases of good，57 （6.26%） cases of middle，4 （0.44%） cases of poor. After 13 to 24 months follow-up，there were 691 （76.18%） cases of excellent，151 （16.65%） cases of good，65 （7.17%） cases of middle；65 cases occurred restenosis that the PTA and stent placement was underwent again， blood flow of 58 cases completely restored，blood flow of 7 cases partly recovered，and the contrast agent didn’t retent. After 25 to 36 months follow-up，there were 681 （75.08%） cases of excellent，128 （14.11%） cases of good，98 （10.81%） cases of middle；98 cases of limb swelling were not satisfied，and the patients still had a sense of pain after walking，but the symptoms obviously improved as compared with preoperative symptoms，the patients were advised to wear stretch socks with no further interventional therapy. Conclusions Minimally invasive therapy on lower extremity DVT can eliminate thrombus from venous cavity more early，restore the unobstructed flow instantly，preserve the function of venous valve in a greater degree. It has an advantage of minimally invasive，less complications，and notable clinic effect of short-term and medium-term follow-up.
ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
ObjectiveTo summarize strategy of diagnosis and treatment of thrombotic iliac vein stenosis in recent years.MethodThe relevant literatures in recent 5 years on the current status and trend of diagnosis and treatment of the thrombotic iliac vein stenosis were reviewed.ResultsAt present, the diagnostic methods of thrombotic iliac vein stenosis mainly included that the multi-slice spiral CT, venography, intracavitary ultrasound, magnetic resonance imaging, color Doppler ultrasound and other imaging examinations, each of which had its advantages and disadvantages. There were still no uniform criteria whether a filter should be placed, whether the stents should and how to be placed, and when to intervene in the patients with acute thrombotic iliac vein stenosis. There was no definite conclusion when and how to effectively intervene in the patients with chronic thrombotic iliac vein stenosis.ConclusionsIncidence of thrombotic iliac vein stenosis is high and sequela is severe. Early diagnosis and reasonable treatment are very important. Only strictly grasping indications, combining medical technology and patient’s condition, and adopting appropriate treatment strategy, can make patients’ maximal benefit.
ObjectiveTo evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome（IVCS）with acute lower extremity deep venous thrombosis (DVT).MethodsThe clinical data of 57 patients with IVCS and lower extremity DVT, who undergoing with stent implantation, balloon expansion and Angiojet rheolytic thrombectomy from June 2015 to June 2018, were retrospectively analyzed. The effect of treatment was evaluated by the changes of thigh circumference difference between the affected side and the healthy side, and the thrombosis clearance rate in the operating. In addition, the incidence of post-thrombotic syndrome (PTS) and stent patency rate were analyzed after long-term follow-up based on the change of Villaita scale score and ultrasound examination of lower extremity veins.ResultsThe success rate of surgical technique was 100%, and there was no pulmonary embolism during operating and postoperative. Lower extremity deep vein thrombosis clearance levels Ⅲ 48 cases (84.2%), Ⅱ 9 cases (15.8%), the changes of thigh circumference difference between the affected side and the healthy side from preoperative (5.8±1.7) cm to (3.7±1.0) cm. One year follow-up after operation, the primary patency rate of stent was 86.0% and PTS occurred in 8 patients (14.0%).ConclusionStent implantation, balloon expansion and Angiojet rheolytic thrombectomy for IVCS with acute lower extremity DVT is a safe, effective with low incidence of complications and efficient thrombus clearance.