Long-term Results after Transfemoral Venous Thrombectomy for Iliofemoral Deep Venous Thrombosis

ObjectiveIn patients presenting with extensive venous thrombosis affecting the pelvic veins, transfemoral venous thrombectomy has been suggested as an effective treatment in selected patients. We present our experience of this technique as well as its long-term results.Patients and methodsBetween January 1998 and January 2008, a total of 83 patients underwent transfemoral venous thrombectomy in our Department of Vascular Surgery. In 22 cases, this was combined with angioplasty and stenting of an iliac vein stenosis. Isolated intra-operative thrombolysis was performed in eight cases to treat deep venous thrombosis (DVT) affecting veins distal to the common femoral vein. All patients suffered from a DVT involving the pelvic veins. A DVT involving all venous segments from the pelvis to the calf was present in 63% of cases. Patients were followed up at 3 months, 6 months and yearly thereafter by clinical and duplex ultrasound examination.ResultsIn all patients, the procedure was successful in achieving re-canalisation of the pelvic veins at the end of the operation. Perioperatively, there was no mortality and there was no case of clinically detected pulmonary embolism. Life-table analysis showed that, after a mean duration of 60 months following treatment, ～75% of the treated venous segments remained patent. Moderate post-thrombotic syndrome (PTS; clinical severity, etiology, anatomy and pathophysiology (CEAP) C2–C4) was present in 20% of cases; severe PTS (CEAP C5 and C6) did not occur in any of the treated patients.ConclusionsIt is safe and effective to treat extensive iliofemoral DVT using transfemoral venous thrombectomy and this prevents the development of severe PTS in the long term. The procedure is only feasible in a subset of patients with DVT, depending on the extent and the age of the thrombosis.     

下肢深静脉血栓形成的外科治疗

深静脉血栓形成（DVT）大多数发生在下肢。DVT治疗方法包括：药物治疗、手术治疗、介入治疗等，治疗中应根据患者的分型及病程采用一种或几种方法的联合应用。药物治疗基本规范，这里主要讨论一下手术和介入治疗。     

Portal Venous Thrombosis After Distal Pancreatectomy: Clinical Outcomes

Aim

Outcomes of patients developing portal vein (PV) thrombosis (PVT) after distal pancreatectomy (DP) are unknown. The goal of this study was to identify risk factors for PVT and describe the long-term outcomes in these patients.

Methods

Patients undergoing DP without repair or reconstruction of the PV between 2001 and 2011 were included. Patients that showed evidence of PVT on pre-operative imaging were excluded from the study. Location and extent of thrombosis was determined by post-operative computed tomography or ultrasound imaging in all patients. Evidence of systemic thrombosis (if present) in addition to PVT was also documented.

Results

In the study period, 991 patients underwent DP and 21 (2.1 %) patients were diagnosed with PVT. Pancreatic neoplasm was the most frequent indication for operation (n?=?11). Thrombus occurred in the main PV in 15 and the right branch of the PV in 8 patients. Complete PV occlusion occurred in nine patients with a median time to diagnosis of 16 days (range 5–85 days). Seventeen patients were anticoagulated for a median duration of 6 months (range 3.3–36 months) after the diagnosis of PVT. Over a median follow-up of 22 months, resolution of PVT occurred in seven patients. Predictors of non-resolution of PVT included anesthesia time >180 min (p?=?0.025), DM type II (p?=?0.03), BMI?>30 Kg/m² (p?=?0.03), occlusive PVT (p?<?0.001), or thrombus in a sectoral branch (p?=?0.02). Anticoagulation therapy did not influence the frequency of thrombus resolution and was complicated by gastrointestinal hemorrhage in four patients. There was no mortality as a direct result of PVT or anticoagulation.

Conclusion

PVT after distal pancreatectomy is a rare complication. Serious complications as a direct result of PVT in this setting are uncommon and are not dependent on thrombus resolution. Although anticoagulation does not appear to influence the rate of PVT resolution in this small retrospective series, we support the use of anticoagulation until larger, controlled studies define clear advantages or disadvantages.     

急性下肢深静脉血栓形成71例病因分析

目的:探讨急性下肢深静脉血栓形成的发病原因.方法:回顾分析71例病人临床资料.结果:43例(60.56%)病人病因明确(手术后20例,外伤5例,孕、卧床13例,家族性5例).结论:手术、创伤、长期卧床、遗传因素是深静脉血栓形成的主要危险因素,早期对其干预对预防急性下肢深静脉血栓形成的发生极为关键.     

深静脉血栓治疗的商榷

<正>深静脉血栓形成(deep venous thrombosis,DVT)在临床常见,不恰当的治疗常导致血栓后综合征(post-thrombosis syndrome,PTS),少数DVT可致肺栓塞(pulmonary embolism,PE)甚或死亡,显著影响患者生活质量。目前,国内、外对于DVT的治疗尚缺乏统一认识,临床疗效差异较大。对于DVT溶栓和     

Characterization and Probability of Upper Extremity Deep Venous Thrombosis

The objective of this study was to characterize patient demographics, risk factors, and anatomic distribution of upper extremity deep venous thrombosis (UEDVT) to develop a probability model for diagnosis. A retrospective review of all patients who underwent color-flow duplex scanning (CDS) for clinically suspected acute UEDVT over a 5-year period was performed. Patient risk factors and clinical symptoms were evaluated as predictors. Technically adequate complete CDS of 177 upper extremities (UEs) of arms were reviewed. CDS scanning identified acute UE venous thrombosis in 53 (30%) of the arms examined with deep system involvement in 40 (23%). Of the UEs affected, the subclavian was involved in 64%, the axillary in 25%, the internal jugular in 32%, the brachial in 36%, the cephalic in 32%, and the basilic in 47%. Multivariate analysis identified limb tenderness (odds ratio 9.3), history of central venous catheterization (odds ratio 7.0), and malignancy (odds ratio 2.9) as positive predictors for UEDVT. Erythema (odds ratio 0.12) and suspected pulmonary embolism (odds ration 0.06) were identified as negative predictors. A predictive model was designed from these variables. The anatomic distribution of UEDVT obtained from this study is consistent with previous reviews. Potential positive and negative risk factors can be identified from which a predictive model can be designed. Use of this model can help focus clinical suspicion, improve color-flow duplex utilization, and provide timely treatment with anticoagulation.