Popliteal vein thrombosis after radiofrequency ablation of greater saphenous vein for varicose vein

Percutaneous endovenous techniques, such as radiofrequency ablation (RFA), have become the preferred method for treatment for varicose veins associated with great saphenous vein (GSV) insufficiency. Reports have shown safety and efficacy of these techniques with relatively few complications. Deep venous thrombosis after RFA is rare and usually involves extension of thrombus from great saphenous vein to common femoral vein, hence the requirement for postoperative ultrasound. We report a case of symptomatic popliteal vein thrombosis after RFA of GSV requiring anti-coagulation.     

Portal vein thrombosis after radiofrequency ablation for recurrent hepatocellular carcinoma

Recurrent hepatocellular carcinoma (HCC) deserves multidisciplinary treatment in addition to surgical resection. Radiofrequency ablation (RFA) is an evolving, localized, thermal ablative treatment for unresectable hepatocellular carcinoma (HCC). Though the preliminary results of RFA in clinical studies are encouraging, its serious complications should not be underestimated. Portal vein thrombosis as a result of direct blood vessel injury by RFA is rarely reported and is potentially fatal in patients with limited liver reserve due to underlying liver cirrhosis. We present a case of portal vein thrombosis as a complication of RFA treatment for recurrent HCC and illustrate its underlying possible mechanism.     

肝移植术后迟发性门静脉血栓形成12例

目的 总结肝移植术后迟发性门静脉血栓形成的治疗方法,并分析其预后.方法 单中心3100例次尸体全肝移植中发生迟发性门静脉血栓形成12例,发生时间平均为移植术后29.8个月.12例中,2例合并严重胆道并发症(肝内胆道狭窄),2例表现为移植肝功能衰竭,1例影像学检查可见肝门部肿物致门静脉受压,均接受再次肝移植;2例表现为急性上消化道出血,分别行经胃镜下套扎、注射硬化剂治疗;余5例无任何临床表现,口服抗凝或抗血小板药物治疗.结果 12例中,除1例失访外,其他患者至随访结束时存活8例,包括2例行再次肝移植者.存活者肝功能检查结果均正常.结论 肝移植术后发生迟发性门静脉血栓形成,应根据患者的临床表现不同采用不同的治疗方法.

Abstract：

Objective To summary therapeutic method for delayed portal vein thrombosis after liver transplantation. Methods In 3100 cases undergoing cadaveric whole liver transplantation in a single center, there were 12 cases of delayed portal vein thrombosis after liver transplantation.Average occurring time was 29. 8 months after liver transplantation. Among these 12 patients, 2 cases were complicated with severe biliary complication (intrahepatic stricture) , 2 cases presented with liver failure of transplanted liver, and one case had portal vein compression by hepatic hilum tumor under the image examination, who received liver re-transplantation; two patients presented upper gastrointestinal bleeding, and they experienced endoscopic ligation and sclerotherapy respectively; the rest five patients without any clinical presentation were subjected to anticoagulation and antiplatelet therapy. Results Among 12 cases, 8 patients survived by the time of follow-up, including two patients undergoing re-transplantation; one patient lost follow-up. The liver function tests of the patients who survived were all normal. Conclusion The individualized therapeutic methods should be adopted for the patients with delayed portal vein thrombosis after liver transplantation.     

Selective portal vein clamping for radiofrequency ablation of hepatocellular carcinoma with portal vein invasion

Surgical resection provides potential cure for patients with hepatocellular carcinoma. Unfortunately, resection is suitable in only about 10-37% of patients because of the limited hepatic functional reserve from the underlying chronic liver disease in the majority of patients. Survival of patients with unresectable diseases, especially those with portal vein tumor invasion, remains very poor. Radiofrequency ablation (RFA) is a form of locoregional therapy that allows a selected group of previously inoperable patients to be treated. However, problems with RFA leading to induced portal vein thrombosis have been reported in the literature. Nevertheless, patients with portal vein tumor invasion may be considered for radiofrequency tumor ablation to improve survival. We report the case of a patient with hepatocellular carcinoma with left portal vein invasion. Complete tumor ablation was achieved after RFA with left portal vein clamping. He remained disease free both radiologically and biochemically 6 months after the operation. Supported by a grant from Sun C.Y. Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong.     

Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution

PURPOSE: Radiofrequency ablation (RFA) of the greater saphenous vein (GSV; "closure") is a relatively new option for treatment of venous reflux. However, our initial enthusiasm for this minimally invasive technique has been tempered by our preliminary experience with its potentially lethal complication, deep venous thrombosis (DVT). METHODS: Seventy-three lower extremities were treated in 66 patients with GSV reflux, between April 2003 and February 2004. There were 48 (73%) female patients and 18 (27%) male patients, with ages ranging from 26 to 88 years (mean, 62 +/- 14 years). RFA was combined with stab avulsion of varicosities in 55 (75%) patients and subfascial ligation of perforator veins in 6 (8%) patients. An ATL HDI 5000 scanner with linear 7-4 MHz probe and the SonoCT feature was used for GSV mapping and procedure guidance in all procedures. GSV diameter determined the size of the RFA catheter used. Veins less than 8 mm in diameter were treated with a 6F catheter (n = 54); an 8F catheter was used for veins greater than 8 mm in diameter (n = 19). The GSV was cannulated at the knee level. The tip of the catheter was positioned within 1 cm of the origin of the inferior epigastric vein (first GSV tributary). All procedures were carried out according to manufacturer guidelines. RESULTS: All patients underwent venous duplex ultrasound scanning 2 to 30 days (mean, 10 +/- 6 days) after the procedure. The duplex scans documented occlusion of the GSV in 70 limbs (96%). In addition, DVT was found in 12 limbs (16%). Eleven patients (92%) had an extension of the occlusive clot filling the treated proximal GSV segment, with a floating tail beyond the patent inferior epigastric vein into the common femoral vein. Another patient developed acute occlusive clots in the calf muscle (gastrocnemius) veins. Eight patients were readmitted and received anticoagulation therapy. Four patients were treated with enoxaparin on an ambulatory basis. None of these patients had pulmonary embolism. Initially 3 patients with floating common femoral vein clots underwent inferior vena cava filter placement. Of the 19 limbs treated with the 8F RFA catheter, GSV clot extension developed in 5 (26%), compared with 7 of 54 (13%) limbs treated with the 6F RFA catheter (P =.3). No difference was found between the occurrence of DVT in patients who underwent the combined procedure (RFA and varicose vein excision) compared with patients who underwent GSV RFA alone (P =.7). No statistically significant differences were found in age or gender of patients with or without postoperative DVT (P = NS). CONCLUSION: Patients who underwent combined GSV RFA and varicose vein excision did not demonstrate a higher occurrence of postoperative DVT compared with patients who underwent RFA alone. Early postoperative duplex scans are essential, and should be mandatory in all patients undergoing RFA of the GSV.     

Right portal vein thrombosis after splenectomy for trauma

Portal vein thrombosis may complicate splenectomy in patients with hemolytic anemia and myeloproliferative disease, whereas the frequency of portal vein thrombosis in case of trauma is not defined. A case of right portal vein thrombosis after splenectomy for trauma is reported in this paper. Hematologic workup did not reveal an underlying platelet or coagulation disorder. The patient was promptly anticoagulated with complete recanalization of the portal vein. We conclude that mild symptoms, like abdominal pain and fever, after splenectomy should be investigated with a color Doppler ultrasonography to confirm or rule out a diagnosis of portal thrombosis and to anticoagulate the patient with thrombosis, thus preventing bowel infarction and secondary portal hypertension. Routine postoperative color Doppler might also be justified in all postsplenectomy patients (without hematologic diseases) for early detection of a portal vein thrombosis.     

脾切除术后门静脉系统血栓形成的临床分析

目的探讨脾切除术后门静脉血栓形成（portal vein thrombosis,PvT）和肠系膜静脉血栓形成（mesenteric venous thrombosis,MVT）的成因及诊治策略。方法回顾性分析2000年以来脾切除术后门静脉血栓形成及肠系膜静脉血栓形成12例的临床资料。结果280例脾切除后血栓发生12例（4．3％）,其中发生PVT9例（3．2％）,发生MVT3例（1．1％）。9例经积极的全身抗凝、祛聚、溶栓治疗1～2周后好转出院。血栓形成病人均出现白细胞增多,血小板计数升高,D-二聚体检测和凝血功能异常,与治疗后1周相比,差异均有统计学意义（P〈0．05）。2例行小肠切除肠吻合术。1例死于肝功能衰竭。结论脾切除后动态检测血常规、凝血功能等相关指标是预防静脉血栓形成的有效措施,及早诊断和治疗对病人康复起关键作用。     

门静脉高压症断流术后门静脉血栓形成的预防

对36例门静脉高压症患者行脾切除断流术后，经脾静脉残端插管，外接给药泵固定于体外。术后每天经药泵注入抗凝药物，2周后拔管。结果示全部患者在术后3个月内随访无血栓形成。提示经脾静脉插管注入抗凝药物是预防门静脉高压症断流术后门静脉血栓形成的有效而可行的方法.     

Delayed colonic perforation after percutaneous radiofrequency ablation of hepatocellular carcinoma

Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma. Colonic perforation secondary to RFA of the liver is an uncommon complication that has been reported to have an incidence between 0.1% and 0.3%. Lesions adjacent (within 1 cm) to the colonic wall and those in patients with history of upper abdominal surgery or chronic cholecystitis are particularly at risk. More importantly, thermal injury leading to colonic perforation has proved to have a fatal outcome. We present a case of percutaneous RFA in a patient with hepatocellular carcinoma that was abutting the colonic hepatic flexure. Colonic perforation was diagnosed on the eighth day postablation when the patient was readmitted with peritonitis.     

Incidence of portal vein thrombosis after laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy has become an important therapeutic option in the management of diverse hematologic disorders. However, the incidence of important complications, such as portal vein thrombosis, remains poorly understood. We set out to study the incidence of this complication over a 14-month period. METHODS: All adult patients who underwent laparoscopic splenectomy between July 2001 and April 2002 at McMaster University Medical Centre in Hamilton, Ont., were approached postoperatively and offered duplex ultrasonography of the portal vein to look for thrombosis. RESULTS: During the study period 17 patients underwent laparoscopic splenectomy. Two patients declined to participate, and in 1 patient the ultrasonography was technically inadequate. Of the 14 remaining patients, 2 (14%) were found to have portal vein thrombosis. In 1 other patient, the investigation was suggestive, but not conclusive, of a clot in the portal system. CONCLUSIONS: Portal vein thrombosis in this series was a relatively common complication of laparoscopic splenectomy. Further research is needed to confirm our findings.     

可溶性P-选择素对肝硬化门静脉高压术后门静脉血栓形成的影响

目的探讨可溶性P-选择素对肝硬化门静脉高压症术后门静脉血栓形成的影响。方法检测乙肝肝硬化患者在门静脉高压症围手术期血小板的数量及反映血小板功能的可溶性P-选择素水平的动态变化,比较其在有门静脉血栓形成组患者及无血栓形成组患者间的差异。结果血栓形成组患者及无血栓形成组患者间,血小板数量无显著差异,而可溶性P-选择素水平在术后第4～6天有显著性差异(P<0.05)。结论乙肝肝硬化患者在行门静脉高压症手术后,血小板功能的变化对门静脉血栓形成可能起着重要的作用。     

腔内射频消融治疗下肢静脉曲张后静脉内热诱导血栓形成患者的临床特征及其治疗情况

目的 探讨射频消融术(RFA)治疗下肢静脉曲张后静脉内热诱导血栓形成(EHIT)患者的临床特征及其治疗情况.方法 选取2019年9月至2020年9月于首都医科大学宣武医院341例因下肢静脉曲张接受RFA治疗的患者,统计RFA术后出现EHIT的患者,分析其临床特征、大隐静脉直径、Carprini评分、治疗方式及预后情况....     

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

Purpose  

Idiopathic portal hypertension (IPH) is considered to be closely related to portal vein thrombosis (PVT). The aim of this study was to clarify the incidence, clinical characteristics, and outcomes of PVT in patients with IPH after splenectomy.     

D-二聚体对门静脉高压症术后门静脉血栓形成的早期预测价值

目的评价D-二聚体对乙肝肝硬化门静脉高压症术后门静脉血栓形成（PVT）的早期预测价值。方法用快速、半定量检测方法动态检测门静脉高压症围手术期D-二聚体浓度，同时于术前及术后7～14d内检查彩色多谱勒以观察PVT的发生情况。据不同诊断标准，计算灵敏度、特异度、阳性预测价值、阴性预测价值并进行ROC分析。结果乙肝肝硬化门静脉高压症手术后发生PVT的血栓组D-二聚体水平明显高于非血栓组（P〈0．01），ROC分析半定量D-二聚体标准及D-二聚体的定性标准对PVT均具有中等预测价值（半定量Az=0．794；P〈0．01；定性标准：Az=0．739；P〈0．01）。结论门静脉高压症术后动态检测D-二聚体水平将有助于PVT的早期诊断，如手术3d后D-二聚体水平持续升高者及手术3d后D-二聚体≥16mg／L，PVT发生的可能较大，应加强抗凝等预防和治疗。