Correlative factors analysis of diffuse axonal injury patients with deep veins thrombosis in lower limbs / 中国综合临床

Objective To investigate the risk factors and preventive strategies of patients with diffuse axonal injury(DAI) with deep veins thrombosis in lower limbs (LDVT).Methods One hundred and thirty cases of diffuse axonal injury patients with lower limb vascular were divided into LDVT group(22 cases) and non LDVT group(108 cases) based on ultrasound.The information including long-term bed,plasma fibrinogen level,varicose veins,hypertention,sex,age,smoking,alcohol drinking,diabetes,obesity,Glasgow Coma Scale (GCS) were collected.Results There were significant different between LDVT and non-LDVT group in terms of longterm bed time,hypertension,smoking,diabetes,high plasma fibrinogen,age,low GCS score correlated with LDVT (x2 =7.08,5.99,5.17,4.70,3.55,12.72,t =27.80,P ＜ 0.05).Gender,drinking,obesity,varicose vein factors had no correlation with LDVT(P ＞ 0.05).Conclusion Diffuse axonal injury in patients with LDVT is more common in patients with older age,hypertension,low GCS score,the higher the plasma fibrinogen.

Retrograde Tempofilter II(TM) Placement within the Superior Vena Cava in a Patient with Acute Upper Extremity Deep Venous Thrombosis: the Filter Stands on Its Head

The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofilter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis.

Clinical analysis of mesenteric venous thrombosis in 31 cases / 中国综合临床

Objective To analyze the clinical characteristics and determine the early diagnosis and treatment of mesenterie venous thrombosis (MVT). Methods Clinieal data of 31 cases with MVT were analyzed retrospectively. Results Of all 31cases,19 patients presented acute MVT. Abdominal pain was the first onset symptom and then progressively exacerbated; peritoneal irritation and ascites developed in 57.9% and 68.4 % patients with sign of ascites respectively. 13 patients were diagnosed by abdominal CT scan or selective mesenterie angiography; the detectable rate of CT for acute MVT was 83.3%. The level of plasma D-Dimer was increased in 93.3% patients with acute MVT. 13 patients underwent surgical treatment, among them,6 cases received anticoagnlafion treatment,4 cases recrudersced and 3 died. 12 chronic MVT patients had no symptoms and were identified through abdominal CT 8 cases developed upper gastrointestinal hemorrhage and 2 died. Conclusion The nonspecifie nature of the abdominal symptoms often delays the diagnosis of MVT and leads to high mortality. Abdominal CT is valuable diagnosis method for MVT and anticongulation treatment and operation are effective managements.

Evaluation of Deep Vein Thrombosis with Multidetector Row CT after Orthopedic Arthroplasty: a Prospective Study for Comparison with Doppler Sonography

OBJECTIVE: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement. MATERIALS AND METHODS: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference. RESULTS: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively. CONCLUSION: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.

Radiologic Findings of Neonatal Cerebral Infarction related with Portal Vein Thrombosis: Case Report

A cerebral infarction in a newborn infant is not uncommon and is major cause of neonatal seizure. The author encountered one case of cerebral infarction that was assumed to be related to a portal vein thrombosis, and reports the radiology findings of a neonatal cerebral infarction and portal vein thrombosis.

Budd-Chiari Syndrome Caused by Diaphragmatic Hernia of the Liver: A Case Report

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous outflow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases (1-3). We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Budd-Chiari Syndrome Caused by Diaphragmatic Hernia of the Liver: A Case Report

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous outflow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases (1-3). We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Lemierre Syndrome: A Case Report

Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis.

Trapping of Massive Thrombus in an Inferior Vena Cava Filter: Treatment with Additional Filter Placement and Aspiration Thrombectomy

For the patients suffering from extensive deep vein thrombosis (DVT), the placement of an inferior vena cava (IVC) filter in conjunction with anticoagulant therapy has been used to prevent pulmonary embolisms. However, for the patients who anticoagulant is contraindicated or if this is complicated, the use of an IVC filter without concurrent anticoagulation may become the sole treatment for pulmonary embolisms. In this situation, the thrombi trapped in the IVC filter may cause significant clinical problems. We report here on a case of IVC filter thrombosis that was successfully treated by aspiration thrombectomy after placing another filter proximal to the previous filter.

Adventitial Cystic Disease of the Left External Iliac Vein: A Case Report

Adventitial cystic disease (ACD) is a rare, but well-characterized vascular disease. It is most commonly seen in the popliteal artery, but it has also been reported in the venous system. The most commonly involved segment has been the common femoral vein; the disease resulted in luminal compromise and extremity swelling. We report here on a case of adventitial cystic disease of the left external iliac vein that was initially misdiagnosed as deep vein thrombosis in a 68-year-old man who presented with a painless swelling of his left leg.

Endovascular Management of Deep Venous Thrombotic Diseases of the Lower Extremity

Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

Efficacy and Safety of Rotating Pigtail Catheter: Lower Extremity Deep Vein Thrombosis of May-Thurner Syndrome

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of mechanical fragmentation of iliofemoral deep vein thromboses (DVTs) with a rotating pigtail catheter followed by aspiration thrombectomy. MATERIALS AND METHODS: Ten patients (eight females, two males, 56.8 +/- 21.37 years) with iliofemoral DVT underwent treatment for a total of ten affected limbs. Approximately 5-10 min after infusing 400,000-700,000 IU urokinase (UK) into the thrombosed deep veins, the thromboses were fragmented by the mechanical action of the rotating pigtail catheter tip. Following their fragmentation, the fragmented thromboses were aspirated. After completion of the above procedure, a stent was inserted if iliac vein stenosis was demonstrated. We evaluated the total procedure time, volume of thrombolytic agent (urokinase), valvular injury, symptom-free time interval and success rate (primary patency rate). RESULTS:In all 10 patients, the iliofemoral deep vein thrombosis was successfully fragmented and aspirated using the combination method of a rotating pigtail catheter and aspiration thrombectomy (clinical and technical success rate, 100%). The thromboses were declotted by means of a rotating pigtail catheter with an average treatment time of 5.7 minutes. The average duration of the total intervention was 108 min. The mean primary patency was approximately 4 months with no recurrence. The total UK dose was 890,000 IU on average. There were no major complications, such as pulmonary embolism or cerebral hemorrhage, while performing the thrombus-fragmentation procedure using the rotating pigtail catheter. CONCLUSION: The combination method of a rotating pigtail catheter and aspiration thrombectomy for the treatment of iliofemoral deep vein thrombosis was found to be rapid, safe and effective for accomplishing recanalization in all cases without complication. Therefore, this procedure constitutes a potential treatment option in patients presenting with iliofemoral vein thrombosis.

Efficacy and Safety of Rotating Pigtail Catheter: Lower Extremity Deep Vein Thrombosis of May-Thurner Syndrome

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of mechanical fragmentation of iliofemoral deep vein thromboses (DVT) with rotating pigtail catheter followed by aspiration thrombectomy. METHOD: Thirteen patients (nine females, four males, 59.9+/-21.37 years old) with iliofemoral DVT underwent treatment for thirteen affected limbs. About 5~10 min after infusing 400,000~700,000 IU urokinase into the thrombosed deep veins, thromboses were fragmented by the mechanical action of the rotating pigtail catheter tip. After fragmentation of the thromboses, we aspirated the fragmented thromboses. Stent insertion or balloon angioplasty was applied if iliac vein stenosis was demonstrated after the above procedure was completed. We evaluated the total procedure time, volume of thrombolytic agent (urokinase), valvular injury, symptom-free time interval and success rate (primary patency rate). RESULT: In all 13 patients, iliofemoral DVT was successfully fragmented and aspirated using a combination method of rotating pigtail catheter and aspiration thrombectomy (clinical and technical success rate, 100%). The thromboses were declotted by rotating pigtail catheter in an average time of 5.7 minutes. Average duration of the total intervention was 108 min. Mean primary patency was about 4 months and there was no recurrence. Total UK average dose was 890,000 IU. There was no major complication such as pulmonary embolism or cerebral hemorrhage while the thrombus-fragmentation procedure was performed using rotating pigtail catheter. CONCLUSION: The combination method of rotating pigtail catheter and aspiration thrombectomy for treatment of iliofemoral DVT achieved rapid, safe, and effective recanalization in all cases without complication. Therefore, this procedure is a potential option in patients presenting with iliofemoral vein thrombosis.

Outcome of Tunneled Infusion Catheters Inserted via the Right Internal Jugular Vein

PURPOSE: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. MATERIALS AND METHODS: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. RESULTS: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. CONCLUSION: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

Titanium Greenfield Inferior Vena Cava Filter: Effectiveness of Percutaneous Placement for Prevention of Pulmonary Embolism

PURPOSE: To evaluate the effectiveness of percutaneous placement of a Greenfield titanium filter in the inferior vena cava (IVC) for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT). MATERIALS AND METHODS: Twelve patients with DVT underwent percutaneous Greenfield titanium filter placement. The indications included recurrent pulmonary embolism or failed anticoagulation therapy in six patients, extensive PE in three, and prophylaxis for high risk of PE in the remaining three. In all cases the filter was positioned after confirming the anatomy, patency, and presence of thrombosis of the IVC and renal veins by inferior vena cavography. Long-term follow-up study involved clinical evaluation, plain radiography, Doppler ultrasonography and CT scanning. RESULT: Filter placement [infrarenal in ten patients (83%) and suprarenal in two (17%)] was technically successful in all cases (100%). The venous approach involved the right femoral vein in eight patients (67%) and the right internal jugular vein in four (33%). Complications included overlapping of the filter legs in three patients (25%), and misplacement in one (8%). After filter placement, no further PE developed. In all of five patients followed up for two years, the IVC maintained patency without evidence of caval perforation or occlusion. CONCLUSION: In patients with DVT, percutaneous placement of a Greenfield titanium filter is a safe and effective method for the prevention of PE.

Doppler US Findings of Vascular Complication after Liver Transplantation

Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombisis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and pronpt di-agnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non-invasive method of diagnosing the vascular complications which may arise from liver transplantation.

Deep Cerebral Venous Thrombosis Associated with Oral Contraceptives: A Case Report

Deep cerebral venous thrombosis(DCVT) is a rare category of stroke that can be caused by various conditions.We report a case of spontaneous DCVT in a 34-year-old female using oral contraceptives; clinical and radiologicmanifestations were characteristic.

Study on coagulant state in deep vein thrombosis patients with low level of coagulant factor Ⅻ / 临床检验杂志

Ojective To study the coagulant state in the patients with deep vein thrombosis(DVT)caused by low level of coagulant factor Ⅻ.Methods Blood samples were obtained from 125 patients with deep veins thrombosis and 32 normal people(control group).Before thrombolysis the following parameters were tested:thrombolysis Ⅻ:C coagulant activity(FⅫ:C),prothrombin time(PT),activated prothrombin time(APTT),thrombin time(TT),fibrinogen(FIB),antithrombin activity(AT:A),D-dimer(D-D),plasminogen activity(PLG:A),lupus anticoagulant(LAC),protein C(PC),tissue plasminogen activator antigen(t-PA:Ag),plasminogen activator inhibitor-1 antigen(PAI:Ag).According to the activity of FⅫ:C,the patients were divided into 2 groups:normal Ⅻ:C group and low FⅫ:C group.Results The PLG:A,PC,AT:A,t-PA:Ag in the low FⅫ:C group was lower evidently than those in normal group(P0.05).Compared to the FⅫ:C normal group,t-PA:Ag in the low FⅫ:C group decreased(P