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 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 A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group (n=39), high-dose TXA (HD) group (n=39), and placebo-controlled (PC) group (n=38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups (P>0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups. Results There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups (P>0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group (P<0.05), and TBL and HBL in HD group were significantly lower than those in LD group (P<0.05); the decreased value of HGB between LD group and HD group showed no significant difference (P>0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group (P<0.05); there was no significant difference between LD and HD groups (P>0.05). There was no significant difference in other hematological indexes between groups (P>0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups. ConclusionIntravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.
Objective To establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). MethodsA retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital from December 2017 to June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at the Xuzhou Cancer Hospital were included as an external validation set to assess the reliability of the model. ResultsAmong the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. ConclusionsThe risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.
ObjectiveTo systematically evaluated the efficacy of AngioJet mechanical thrombectomy and catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity deep venous thrombosis (LEDVT).MethodsAccording to the retrieval strategy of Cochrane collaboration network, the relevant literatures in CNKI, WangFang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science at home and abroad up to March 25, 2020 were collected, and the meta analysis was performed by using Review Manager 5.3 software.ResultsA total of 20 observational studies were included in the meta analysis. The total number of patients was 1 566, which 799 cases in the AngioJet group and 767 cases in the CDT group. The results showed that the AngioJet group had a higher patency rate of deep vein ［MD=11.34, 95%CI (6.16, 16.51), P<0.000 1］, lower or shorter Villalta score ［MD=–1.90, 95%CI (–2.71, –1.10), P<0.000 01］, incidence of post-thrombotic syndrome［PTS, OR=0.42, 95%CI (0.23, 0.77), P=0.005］, rate of clot reduction grade Ⅰ events ［OR=0.40, 95%CI (0.24, 0.67), P=0.000 5］, incidence of bleeding complication ［OR=0.32, 95%CI (0.21, 0.49), P<0.000 01］, and hospital stay ［MD=–2.96, 95%CI (–3.69, –2.22), P<0.000 01］.ConclusionsIn the early efficacy, AngioJet mechanical thrombectomy has better patency rate of deep vein and thrombolysis, shorter hospital stay, and lower risk of bleeding than CDT. In the mid-term effect, AngioJet mechanical thrombectomy could reduce the incidence and the severity of PTS.
Objective
To summarize the clinical features, diagnosis, and treatment of acute deep venous thrombosis (DVT) at lower extremity of aged patients.
Method
Clinical data of 98 aged patients with acute DVT at lower extremity who got treatment in our hospital from Junuary 2012 to December 2014 were analyzed retrospectively.
Results
Of 98 aged patients with acute DVT at lower extremity, the time from disease developed to treatment was 1 day to 10 days with an average of 4 days. The main symptom was low limb swelling progressively. All the patients were treated by the comprehensive treatment based on individual anticoagulation. A total of 96 patients (98.0%) were followed up, and the follow-up period ranged from 12 months to 24 months (average of 18 months). Of 96 patients followed-up, we found a statistically significant difference between lower extremities before treatment and those at 3 months after treatment in venous clinical severity score (VCSS) and the change of lower extremity circumference (P<0.001). Of 96 patients, 9 patients were cured, 81 patients had markedly effective results, and 6 patients had effective results. None of the patients suffered from fatal pulmonary embolismin in duration of hospital day and follow-up period, and no one suffered form DVT recurrence.
Conclusions
The aged patients with acute DVT at lower extremity usually see a doctor lately. The comprehensive treatment based on individual anticoagulation is safe and effective in treatment of acute DVT at lower extremity of aged patients.
Objective
To summarize the research about the stability of deep venous thrombosis (DVT) of the lower extremity in recent years.
Methods
The literatures about the stability of DVT of lower limbs at home and abroad in recent years were reviewed.
Results
There are few studies on the stability of DVT at home and abroad, which limited on the floating thrombus.
Conclusion
The stability of DVT can be effectively evaluated by SOMATOM Force CT (The third generation dual source CT).
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.
