Ultrasonics and deep vein thrombosis. Ilio-caval level and the lower extremities

All the important abdominal veins and limbs vein can be examined. The veins, in cross-section are rounded in repletion, (maximum normal vein caliber has reached when erect) almost flat in a state of vacuous-ness. The lumen normally echofree is limited by a wall thinner and less echogenic than the wall of adjacent artery. The parietal motions are rythmed by breathing. Venous blood flow can become echogenic, with weak echoes, as snow storm within the lumen. These phenomena are often visible in venous confluent and within the lumen below occlusion where there is sludge. In supine position deep abdominal veins, limbs veins until popliteal veins are easily seen. Below the popliteal fossa in prone position the veins are nearly empty and not visible beyond pathological circumstances. Objective studies demonstrated the inaccuracy of clinical diagnosis of deep venous thrombosis, echotomography (coupled with doppler) is among the non-invasive methods the most interesting, permitting to recognize venous occlusion complete or incomplete by clot but also compression by tumour or ganglion. The compression under the probe collapse the normal vein, but if there is clot inside, the compression become incomplete or impossible. The caliber of the vein is dilated also in supine position. The richest of venous clot in red cells in comparison with arterial thrombus make it more and earlier echogenic and more especially as the investigation is performed with high frequency probe. In the same way if the clot is floating its motions are put in evidence. Echotomography make usually difference between clot and neoplastic thrombus which is again more echogenic and also have special location. Echotomography permit to follow evolution ot venous thrombosis under treatment. The wall vein lesions after thrombosis are analysed showing thickening, destruction of the cups, dilatation of some veins while others are still obstructed.     

髂静脉支架在下肢深静脉血栓形成治疗中的应用

目的评价髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果。方法回顾性分析2016年1月至2018年1月山东省潍坊市人民医院收治并行腔内治疗的急性下肢深静脉血栓形成伴髂静脉狭窄或闭塞患者80例。根据手术是否行髂静脉支架植入治疗,分为观察组45例和对照组35例。观察组通过置入下腔静脉滤器+导管接触性溶栓(CDT)+髂静脉支架治疗;对照组采用置入下腔静脉滤器+CDT治疗。对比2组患者术后效果、患肢消肿率、静脉通畅率分别为及流行病学和经济研究-生活质量/症状(VEINES-QOL/SYM)问卷调查评分。采用SPSS 18.0统计软件进行统计分析。结果术前,2组大腿、小腿周径差比较,差异均无统计学意义(均P>0.05);术后,2组大腿、小腿周径差及消肿率比较,差异均有统计学意义(均P<0.05)。随访1、3、6、12个月后,观察组静脉通畅率分别为45例(100.0%)、43例(95.5%)、41例(91.1%)及41例(91.1%),对照组分别为29例(82.8%)、27例(77.1%)、26例(74.2%)及25例(71.4%),差异均有统计学意义(均P<0.05)。观察组与对照组的下肢深静脉血栓后遗症发生率分别为0(0.00%)与4例(11.43%),差异有统计学意义(P<0.05)。观察组与对照组的DVT复发率分别为4例(8.89%)与5例(14.28%),差异无统计学意义(P>0.05)。治疗前,2组患者VEINES-QOL/SYM评分比较,差异均无统计学意义(均P>0.05);治疗后,2组患者VEINES-QOL/SYM评分比较,差异均有统计学意义(均P<0.05)。结论髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果优于单纯置管溶栓。     

下肢深静脉血栓形成的治疗现况

下肢深静脉血栓形成是常见的周围血管疾病,如果患者得不到及时、有效的治疗,将导致下肢淤肿、色素沉着,严重者可引起股青肿、肢体缺血坏死,患者丧失部分或全部劳动力。还有部分患者可随病情发展出现血栓脱落,引起肺栓塞,重者危及生命。目前下肢深静脉血栓形成的治疗分为非手术方法和手术方法,本文对近年治疗下肢深静脉血栓形成的方法进行综述。     

急性下肢深静脉血栓形成腔内治疗的疗效分析

目的:探讨腔内治疗急性下肢深静脉血栓形成的疗效。方法:分析2009年1月年至2011年5月,采用导管溶栓和支架治疗16例急性下肢深静脉血栓形成的临床资料,采用静脉节段性病变评分和静脉临床程度评分评估手术疗效。结果:16例患者中,中央型静脉血栓14例,混合型下肢深静脉血栓形成2例。合并髂静脉压迫综合征11例。病史中位数为5 d(范围1～14 d)。患者均行静脉导管溶栓,其中12例接受髂静脉支架。随访中位数为6个月(范围1～24个月),术后30 d静脉通畅程度评分平均(1.38±0.90)分,低于术前〔(5.5±2.6)分;P=0.001〕,术前静脉临床程度评分平均(4.69±0.7)分,术后1个月、6个月静脉临床程度评分分别为(1.44±1.27)分、(1.42±0.9)分,低于术前(P=0.001,P<0.01)。术后1个月,6个月髂静脉支架通畅率均为83%。结论:选择性腔内治疗急性下肢深静脉血栓可显著改善患者临床症状,远期疗效有待进一步确定。     

Frequency of malignant diseases in deep venous thrombosis of the lower extremities.

A retrospective investigation was carried out in a total of 200 patients (100 women, 100 men) with an average age of 61.0 years (19-97 years) with a phlebographically verified deep vein thrombosis of the lower limbs. It was examined whether and how frequently acute phlebothromboses are associated with a malignant underlying disease not detected up to that time. Specific diagnostics showed that a malignancy could be detected in 11.5% of all patients. As expected, the number of freshly discovered malignant diseases rose with increasing age. Seventy-one percent of all patients with a phlebothrombosis and a simultaneous tumor condition were more than 60 years old. The results clearly show that screening for occult malignant diseases should be carried out systematically and routinely in patients with etiologically unclear acute deep vein thromboses, at least from the 50th year of life onwards.     

下肢深静脉血栓介入治疗观察与护理

目的观察我院下肢深静脉血栓介入治疗的效果,并对其实施的护理模式进行探析。方法选取我院2012年1月至2013年12月期间收治的46例下肢深静脉血栓的患者为研究对象。将其分为两组,即试验组与对照组。两组患者均采用相同的治疗方法进行治疗,其中对照组患者在治疗的过程中采用传统的护理模式,而试验组患者在对照组的基础上实施综合护理干预。对比两组患者的临床效果,主要包括:护理满意度、患者治疗前后不良情绪评分等。结果试验组患者对护理的总满意率为95.65%,对照组患者对护理的总满意率为69.57%。试验组患者的护理满意程度要高于对照组患者,两组患者比较情况具有统计学差异(P0.05)。同时护理后试验组患者的不良情绪评分要优于对照组患者,两组患者比较情况具有统计学差异(P0.05)。结论通过加强基础护理,注重心理护理、健康教育以及病情观察,对下肢深静脉血栓介入治疗患者恢复起到重要作用。     

78例下肢深静脉血栓形成的临床分析

静脉血栓症（venous thromboembolism）包括肺栓塞（pulmonary thromboembolism,PTE）和深静脉血栓形成（deep vein thrombosis,DVT）,而相当部分DVT可导致PTE,甚至是致死性的PTE。特别是近年来防治PTE的临床实践表明,防治PTE的发病源头DVT更为重要,从而使深静脉血栓形成的防治受到前所未有的重视。而DVT最常见的是下肢DVT,近年来有明显增加的趋势。为了提高DVT的防治水平,降低DVT的死亡率和致残率。     

Distal deep vein thrombosis

Received from the Section of General Internal Medicine, University of Wisconsin Medical Center, 600 Highland Avenue, Madison, Wisconsin 53792.     

Prevalence and prevention of deep venous thrombosis of the lower extremities in high-risk pulmonary patients

Information is lacking about the prevalence of, and the best method of preventing deep venous thrombosis (DVT) of the lower extremities in patients forty years or older with pulmonary disease that keeps them in bed for three consecutive days or more and who are thus at high risk of developing DVT or pulmonary embolism (PE). In this study, 192 high-risk patients, aged forty to ninety-two, received 125I fibrinogen and had daily radioactive scans, venous Doppler, and strain gauge plethysmography. Four preventive methods were used until patients became ambulatory: graded compression stockings (GCS) in 39, elastic bandages (EB) in 33, subcutaneous administration of 5,000 USP units of heparin (HEP) bid in 39, and oral administration of 0.5 g of acetylsalicyclic acid (ASA) bid in 35. Results were compared with those in 46 patients in a control group (CG). Twelve patients in CG, none in GCS, 4 in EB, 1 in HEP, and 2 in ASA developed DVT proved by contrast venography. There was a statistically significant difference between GCS and CG (P less than 0.0003), HEP and CG (P less than 0.0022), and ASA and CG (P less than 0.0148) but not between EB and CG (P greater than 0.10); no significant differences were found between any pair of prophylaxis groups. The significant differences could not be attributed to differences in age, sex, or length of stay in bed. PE occurred in 3 patients in CG and 1 in EB. Hemorrhagic complications occurred in 7 patients in HEP and 4 in ASA, requiring exclusion of 2 patients and 1 patient, respectively, from the study.(ABSTRACT TRUNCATED AT 250 WORDS)