彩色超声引导下腔静脉滤器置入术30例临床分析

目的介绍超声引导下腔静脉滤器置入新方法及其对深静脉血栓形成后肺栓塞的预防作用。方法 2 0 0 2年 5月至 2 0 0 3年 7月对 30例下肢深静脉血栓形成 (其中 4例入院时出现肺栓塞 )患者在彩色超声引导下实施下腔静脉滤器置入术 ,其中 15例在滤器置入术后立即实施下肢深静脉取栓术 ,另外 15例行保守治疗。结果本组 30例均获成功 ,经 1～ 14个月平均 6个月的随访 ,除 1例出现滤器闭塞外 ,余无任何并发症及肺栓塞的发生 ,曾出现肺栓塞者滤器置入后未再发生肺栓塞。结论彩色超声引导下腔静脉滤器置入术可有效地预防深静脉血栓形成后肺栓塞的发生     

Graduated compression stockings (20-30 mmHg) do not compress leg veins in the standing position

BACKGROUND: Since graduated compression stockings (GCS) reduce the risk of deep venous thrombosis (DVT) in both hospital and ambulant patients, we checked the compressive efficiency of 20-30 mmHg GCS in the standing position. METHODS: In 30 volunteers (17 normal legs, 13 varicose legs), duplex ultrasound was used to measure the internal diameters of the long saphenous vein, posterior tibial veins, peroneal veins, and soleal veins in the lying and standing position and with and without 20-30 mmHg GCS. RESULTS: Graduated compression stockings effectively compressed both superficial and deep veins in supine individuals but not the superficial or the deep veins when standing. In the varicose leg, the stockings did not compress the long saphenous vein at the mid-calf level even when supine. In the varicose leg the long saphenous vein was constricted at the upper band of the stocking, which might explain why superficial venous thrombosis is more common when compression stockings are worn. CONCLUSIONS: In the standing position, GCS did not compress the deep or superficial veins of the calf.     

Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases

Introduction

Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery.

Methods

Hospital Episode Statistics were obtained for all patients undergoing common urological procedures between April 2009 and April 2010. This cohort was followed up to identify all patients reattending with either deep vein thrombosis (DVT) or pulmonary embolism (PE) within 12 months.

Results

A total of 126,891 individuals underwent urological surgery during the study period. This included 89,628 men (70.6%) and 37,236 women (29.3%) with a mean age of 65.2 years. At the 12-month follow-up, 839 patients (0.66%) were readmitted with VTE. Of these, 373 (0.29%) were admitted with DVT and 466 (0.37%) with PE. The procedure-specific rate of VTE varied significantly between 2.86% following cystectomy and 0.23% following urethral dilatation. Procedures performed in the lithotomy position carried a significantly lower risk of VTE than those performed in the supine position (0.60% vs 1.28%, p<0.0001). Furthermore, of all procedures performed in the lithotomy position, those performed on benign conditions carried a significantly lower risk than those performed on malignant disease (0.52% vs 0.79%, p<0.0001).

Conclusions

Procedure specific rates of postoperative VTE vary widely among patients undergoing urological procedures. These findings suggest the potential benefit of prolonging the use of thromboprophylaxis in high-risk patients but also exploring the apparent lack of need for routine thromboprophylaxis in patients undergoing low-risk procedures.     

Ovine Iliac Vein Model for Endovascular Thrombectomy of Acute Deep Venous Thrombosis

An ovine iliac vein thrombosis model was devised to test a wall-contacting rotational thrombectomy device. Thrombosis was successfully induced in 9 sheep with an average clot length of 31 mm ± 12 and >60% vessel occlusion on angiography. The thrombus was subsequently removed, maintaining normal intraoperative pulmonary arterial pressure (5.9 mm Hg ± 3.6) and complete distal reperfusion after thrombectomy. Additionally, the sheep were without signs of vascular trauma or embolic complications on gross necropsy and histopathologic analysis. The findings from this study support the use of an ovine iliac deep vein thrombosis model for testing of a lower extremity thrombectomy device.     

新疆克州静脉血栓栓塞症的危险因素及发病特征分析

目的研究克州静脉血栓栓塞症（VTE）的危险因素和发病特征。 方法分析我院近3年收治的VTE患者的临床资料。根据是否与住院及手术相关,分为医院相关性VTE（HA VTE）和社区相关性VTE（CA VTE）。调查患者的VTE危险因素,分析不同部位类型的下肢深静脉血栓形成（DVT）合并下腔静脉血栓或肺血栓栓塞症（PTE）的差异。 结果共纳入81例VTE患者,其中CA VTE 63例,HA VTE 18例,前者是后者的3.5倍。CA VTE的危险因素以肥胖（28.57%）、创伤或骨折（19.05%）、卧床（17.46%）为主,尚有15.87%的病例未能明确危险因素。HA VTE的危险因素以外科手术（66.67%）为主,其中又以骨科（6例）、妇产科手术（2例）最为常见。左下肢、右下肢、双侧下肢DVT的构成比分别为62.96%、34.57%、2.47%,差异有统计学意义（P < 0.05）。合并PTE的概率,双侧下肢DVT为100%,右下肢为32.14%,左下肢为13.72%,差异有统计学意义（P < 0.05）。 结论克州地区CA VTE较HA VTE常见,前者的主要危险因素是肥胖、创伤或骨折、卧床,后者为外科手术,并以骨科、妇产科手术最为常见。     

Utilization of and Outcomes Associated with Intravascular Ultrasound during Deep Venous Stent Placement among Medicare Beneficiaries

PurposeTo evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries.Materials and MethodsAll lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis.ResultsAmong the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%–99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69–0.76; P < .001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27–0.39; P < .001) composite end points.ConclusionsIntravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.     

超声诊断易漏诊高位下肢深静脉血栓1例

患者男,47岁,因左腿肿痛2周就诊。查体见左大腿肿胀,内侧压痛明显,延续至内踝处,肤色正常,无毛孔粗大表现。外院下肢静脉超声检查报告：左侧股总静脉分叉处、股深静脉、股浅静脉管腔血流充盈良好,无血栓回声。我院超声检查：大隐静脉全程低絮状新鲜血栓回声,股总静脉在大隐静脉入口处部分血栓形成,向上延续至髂外静脉,     

Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass

Objective:

To compare the rates of venous thromboembolism (VTE) by using routine postoperative enoxaparin versus early ambulation, SCDs, hydration, and selective prophylactic pharmacologic anticoagulation.

Methods:

1,692 patients undergoing laparoscopic gastric bypass from October 2001 to October 2008 were included and divided into 2 groups based on when they were operated upon. Group A (435 patients) received routine enoxaparin 12 hours after surgery. Group B (1,257 patients) received selective pharmacologic anticoagulation, in high-risk patients only.

Results:

Mean operating time was 144±26 minutes (Group A) and 126±15 minutes (Group B). Mean length of stay was 2.3±1.5 days for Group A and 1.4±1.2 for Group B. Intraluminal bleeding occurred in 21 patients (4.8%) in Group A and 5 (0.9%) in Group B; none required intervention. Five pulmonary embolisms occurred in Group A (1.1%) and none in Group B. Seven patients in Group A (1.7%) and 6 (0.47%) in Group B had clinically evident DVT. Two non-VTE related deaths occurred in Group A.

Conclusions:

Adequate VTE prophylaxis is achieved using SCDs, early ambulation, emphasis on hydration, and shorter operating times. Bariatric surgery can be safely performed without pharmacologic VTE prophylaxis in all but the high-risk population. Fewer bleeding complications occur without the use of anticoagulants.     

腔内治疗髂静脉梗阻合并急性深静脉血栓的临床经验

目的探讨腔内治疗髂静脉梗阻合并急性深静脉血栓(deep vein thrombosis,DVT)的临床效果。方法 2008年10月～2011年9月,19例急性DVT接受手术取栓联合同侧髂静脉腔内支架置入术。DVT位于左髂-股静脉及下腔静脉3例,双侧髂-股静脉2例,其余14例均在左髂静脉。均有患肢明显肿胀,其中12例伴患肢疼痛。DVT发病时间(3.2±1.3)d。取栓前均先置入下腔静脉滤器,取栓后即刻静脉造影发现髂静脉狭窄者先行球囊扩张再置入自膨式支架。结果 18例取栓后造影示髂静脉狭窄,其中髂静脉压迫综合征(iliac vein compression syndrome,IVCS)15例(78.9%),残留狭窄3例;1例未发现髂静脉狭窄。18例有狭窄者共置入22枚自膨式支架,手术均获成功。1例术后伤口血肿。随访16例,随访时间2～26个月(平均10.3月),疼痛症状均消失,2例行走后下肢轻度肿胀,均未出现血栓复发。结论腔内治疗髂静脉梗阻合并急性DVT安全、有效,早期临床结果满意。