急性DVT股静脉取栓治疗32例

目的总结急性期单侧下肢深静脉血栓形成股静脉取栓的治疗效果及应用Aegisy可回收下腔静脉滤器预防肺动脉栓塞的效果。方法选择32例急性期单侧下肢深静脉血栓形成患者,通过放置Aegisy可回收下腔静脉滤器后,行股静脉切开取栓,于术后12～16d取出滤器。术后维持抗凝治疗1年。结果32例患者滤器成功置入,股静脉取栓顺利;术后30例成功取出滤器,取出滤器中有20例捕捉到血栓。全组治疗过程中无肺动脉栓塞发生,肢体肿胀明显缓解;随访1—8个月,彩色多普勒超声检查未见下肢深静脉血栓复发。结论股静脉取栓是治疗急性期下肢深静脉血栓形成的有效手段,术中放置可回收下腔静脉滤器能有效预防肺动脉栓塞发生,滤器的置入和取出安全、可行。     

Epidemiology of acute deep vein thrombosis

Although the factors leading to venous thrombosis have been known for over a century, Virchow's initial model of thrombosis has been extensively refined. Activated coagulation is now recognized to be of primary importance in venous thrombogenesis; the concept of venous injury has been expanded to include molecular changes in the endothelium; and stasis has been redefined as a largely permissive factor. Furthermore, it is now clear that venous thrombi undergo a dynamic evolution beginning early after their formation. The natural history of acute deep venous thrombosis (DVT) is a balance between recurrent thrombotic events and processes that restore the venous lumen, both of which have important implications for the development of complications. Although pulmonary embolism (PE) is clearly the most life threatening complication of acute DVT, the long term socio-economic consequences of the post thrombotic syndrome (PTS) have perhaps been underemphasized in clinical trials. The development of post-thrombotic manifestations is related to both residual venous obstruction and valvular incompetence. Recognition of the factors contributing to a poor outcome, including recurrent thrombotic events, the rate of recanalization, the global extent of venous reflux, and the anatomic distribution of reflux and obstruction is important, as there may be therapeutic alternatives to alter the natural history of acute DVT. The treatment alternatives will continue to expand with the introduction of new therapeutic drugs, for both systemic and catheter-directed therapy, and mechanical thrombectomy devices. The primary care physician is challenged with the task of correctly evaluating deep vein thrombosis and providing his patient with access to the most clinically appropriate, and cost-effective, diagnostic and management options available. This article will review the epidemiology of DVT, its risk factors and major complications.     

Deep vein thrombosis following calf strain: a case study

Deep vein thrombosis (DVT) has been the subject of considerable media attention after a number of deaths and scares in apparently low risk individuals following long haul flights. While many contributory factors have been put forward for the development of DVT, few cases have been reported following muscle strain. The recent publicity surrounding the calf strain sustained by Steve Waugh, the Australian cricket captain, during the Ashes series was initially unremarkable. The case was however, subsequently complicated by the development of DVT following his return (long haul) flight to Australia. Latest reports indicate that following anticoagulant treatment he has made a full recovery and returned to playing. This case could easily be dismissed as a ‘one off’ or an unusual set of circumstances. The following case report illustrates that DVT following calf strain is by no means unique. The ramifications of these cases may have serious implications for Physicians and manual therapists working in sports medicine.     

Pseudoaneurysm and deep vein thrombosis complicating femoral osteochondroma: multimodality imaging

A case of a femoral osteochondroma complicated by pseudoaneurysm and deep venous thrombosis is presented. Multimodality imaging contributed crucial information to allow successful diagnosis and preoperative planning.     

Delayed femoral vein thrombosis after ultrasound-guided thrombin injection of a postcatheterization pseudoaneurysm

Ultrasound-guided thrombin injection is a highly effective therapy for postcatheterization pseudoaneurysm. Despite a very low complication rate, a number of severe arterial thrombotic events have been reported. We present an unusual case of acute femoral vein thrombosis occurring several hours after successful treatment of femoral artery pseudoaneurysm by ultrasound-guided thrombin injection. Pathophysiologic mechanisms are discussed. This case highlights the potential hazards of instilling such a powerful thrombogenic substance in the immediate vicinity of other vascular structures.     

Percutaneous insertion of the Kimray-Greenfield filter: incidence of femoral vein thrombosis

Venograms were obtained in 17 patients 5-8 days after percutaneous dilatation of the common femoral vein for insertion of the Kimray-Greenfield inferior vena cava filter. The venograms showed thrombosis of the common femoral vein in seven (41%) of the 17 patients, four of whom were symptomatic. Common femoral vein thrombosis can have serious clinical sequelae. The possibility of this complication should be considered before inserting the filter percutaneously via the femoral vein.     

Catheter-directed thrombectomy and thrombolysis for acute renal vein thrombosis

PURPOSE: To evaluate the technical success and clinical outcome of the percutaneous treatment of acute renal vein thrombosis (RVT). MATERIALS AND METHODS: Retrospective review was conducted of all patients with acute RVT treated with percutaneous catheter-directed thrombectomy with or without thrombolysis at one institution between 2000 and 2004. Demographics, comorbid conditions, and clinical outcomes associated with therapy were assessed. RESULTS: Seven thrombosed renal veins in six patients (mean age, 51.5 +/- 18.8 years) were treated with percutaneous catheter-directed thrombectomy/thrombolysis. Thrombosed renal veins included two allografts and five native veins, and diagnosis was confirmed in all cases by direct renal venography. Inferior vena cava thrombosis was the cause of RVT in one patient, and glomerulopathy was the cause in the remaining patients. Percutaneous mechanical thrombectomy was performed in all cases, and five renal veins were additionally treated with thrombolysis for a mean duration of 22.1 +/- 21.0 hours. Restoration of flow to renal veins was achieved in all thrombosed renal veins. Clinical improvement occurred in all patients: the mean serum creatinine level improved from a preoperative level of 3.3 +/- 1.92 mg/dL to a postoperative level of 1.92 +/- 1.32 mg/dL (P = .008). Mean glomerular filtration rate improved from a preoperative level of 30.8 +/- 23.0 mL/min per 1.73 m(2) to 64.2 +/- 52.4 mL/min per 1.73 m(2) (P = .04). There were no pulmonary emboli or hemorrhagic complications, and no RVT recurrence was documented during a median follow-up of 22.5 months. CONCLUSIONS: Percutaneous catheter-directed thrombectomy with or without thrombolysis for acute RVT is associated with a rapid improvement in renal function and low incidence of morbidity. It is feasible for native and allograft renal veins and should be considered in patients with acute RVT, particularly in the setting of deteriorating renal function.     

Atypical presentation of lymphangioleiomyomatosis as jugular vein thrombosis

Lymphangioleiomyomatosis is a rare disorder of unknown origin that almost exclusively affects women of childbearing age. It is characterised by proliferation of abnormal smooth muscle cells (lymphangioleiomyomatosis cells) in the pulmonary interstitium and along the thoracic and abdominal lymphatics. Lymphangioleiomyomatosis may be associated with tuberous sclerosis complex. The most common manifestations of lymphangioleiomyomatosis are pulmonary symptoms, including progressive dyspnoea, recurrent pneumothoraces and chylous effusions. Extrapulmonary lymphangioleiomyomatosis as the initial presentation of the disease is highly unusual. We describe a patient with extrapulmonary lymphangioleiomyomatosis presenting as jugular vein thrombosis related to lower neck lymphangioleiomyoma. CT study showed bilateral lung cysts with left-sided hydropneumothorax and retroperitoneal lymphadenopathy. A left lower neck cystic lesion was seen with thrombosis of the adjacent left subclavian and internal jugular veins.Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease that affects women exclusively, typically during their reproductive years. A small percentage of patients have LAM in association with tuberous sclerosis complex (TSC). LAM is characterised by the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs and in the thoracic and retroperitoneal lymphatics. Affected patients are at risk of developing renal hamartomas or angiomyolipomas. Patients with LAM characteristically present with chronic dyspnoea and cough and less commonly with spontaneous pneumothorax.At radiography, LAM manifests with normal-to-large lung volumes and interstitial reticular opacities that may be subtle. Unilateral pneumothorax and unilateral or bilateral pleural effusions are frequent radiographic findings. CT and high-resolution CT demonstrate bilateral diffuse thin-walled cysts surrounded by normal lung parenchyma. CT may also demonstrate associated pleural effusion or pneumothorax, thoracic or abdominal lymphadenopathy and other abdominal abnormalities, including angiomyolipomas, lymphangioleiomyomas and ascites.Manifestation of extrapulmonary LAM as an initial presenting symptom is rare. The most common forms of extrapulmonary LAM include renal angiomyolipoma, enlarged abdominal lymph nodes and lymphangioleiomyoma. Less commonly, ascites and hepatic angiomyolipoma may be present. If the diagnosis of extrapulmonary LAM precedes that of pulmonary LAM, the patient usually develops chest symptoms within one to two years.     

CT findings in acute thrombosis of superior mesenteric vein aneurysm

The CT findings in a case of surgically proven thrombosed aneurysm of the superior mesenteric vein are described. The location of the aneurysm and recognition of the CT features of venous thrombosis may allow preoperative diagnosis.     

急性肠系膜上静脉血栓形成26例围手术期护理

急性肠系膜上静脉血栓形成约占肠缺血疾病的15%~20%[1],因其临床症状及体征无特异性,误诊率高达90%~95%[2],病死率高达30%~60%[1]。因此,近早确诊挽救患者的同时,实施积极有效的护理尤为重要。现将我院收治的急性肠系膜血栓形成26例手术患者护理体会报告如下。1临床资料1.1一般     

Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis

PURPOSE: The purpose of this study was to evaluate the utility of transcatheter thrombolytic therapy in 20 patients with acute or subacute (symptoms <40 days) portal and/or mesenteric vein thrombosis with severe symptoms, deteriorating clinical condition, and/or persistent symptoms despite anticoagulation. MATERIALS AND METHODS: This retrospective study examined 12 male patients and eight female patients seen over a period of 11 years. The average age was 37.6 years. Four of the patients had previously undergone liver transplantation. An anatomic classification system was established to describe the extent of thrombus at the time of diagnosis. Patients were treated with thrombolytic therapy via the transhepatic route, common femoral vein route, and/or superior mesenteric artery route. Improvement in symptoms, avoidance of bowel resection, complications, and radiographic evidence of clot resolution were the main clinical outcomes. RESULTS: Fifteen of the 20 patients exhibited some degree of lysis of the thrombus. Three patients had complete resolution, 12 had partial resolution, and five had no resolution. Eighty-five percent of patients (n = 17) had resolution of symptoms. Sixty percent of patients (n = 12) developed a major complication. No patients required bowel resection after thrombolytic therapy. One patient died with gastrointestinal hemorrhage and septic shock 2 weeks after thrombolytic therapy. Other major complications included bleeding and conditions requiring transfusion. No patients developed new portal or mesenteric thromboses. Two of the patients who received transplants eventually required repeat transplantation. CONCLUSIONS: Transcatheter thrombolysis was beneficial in avoiding patient death, resolving thrombus, improving symptoms, and avoiding bowel resection. However, there was a high complication rate, indicating that this therapy should be reserved for patients with severe disease. Further evaluation of these techniques and outcomes should continue to be pursued.     

Ovarian vein thrombosis

Ovarian vein thrombosis is a well-known but rare entity, which can occur during the post-partum period. This condition has also been associated with inflammatory and malignant processes within the pelvis. Untreated, complications of ovarian vein thrombosis can be significant due to the associated sepsis and risk of pulmonary embolism. Diagnosis can be made with confidence using ultrasound, computed tomography or magnetic resonance imaging. Treatment of ovarian vein thrombosis is particularly important in the post-partum patients, with anticoagulation therapy being the current recommendation.     

Predicting hamstring strain injury in elite athletes

INTRODUCTION: Eccentric exercise, where the contracting muscle is lengthened, produces microscopic damage in muscle fibers, and sensations of stiffness and soreness, the next day. These normally resolve within a week. A more major sports injury is the muscle strain. Because strain injuries are known to occur during eccentric contractions, it is hypothesized that the microscopic damage from eccentric exercise can, at times, progress to a muscle strain. As the amount of microscopic damage depends on the muscle's optimum length for active tension, it is further proposed that optimum length is a measure of susceptibility for muscle strains. The athletes most at risk of a hamstring strain are those with a previous history of such injuries. Here the prediction is tested that optimum lengths of previously injured hamstrings are shorter and therefore more prone to eccentric damage than uninjured muscles. METHODS: Mean optimum angle for peak torque in a previously injured muscle of nine athletes with a history of unilateral hamstring strains was compared with the uninjured muscle of the other leg and with muscles of 18 uninjured athletes. Optimum angle was determined with isokinetic dynamometry. RESULTS: In previously injured muscles, torque peaked at significantly shorter lengths than for uninjured muscles. Peak torque and quadriceps:hamstrings torque ratios were not significantly different. CONCLUSIONS: The shorter optimum of previously injured muscles makes them more prone to damage from eccentric exercise than uninjured muscles and this may account for the high reinjury rate. The shorter optimum may reflect the muscle's preinjury state or be a consequence of the healing process. To reduce the incidence of strain injuries, it is recommended that a combined program of eccentric exercise and muscle testing be carried out.