Application of collaborative care model in patients with postthrombotic syndrome/ / 中国实用护理杂志

Objective:To explore the application of collaborative care model on patients with postthrombotic syndrome.Methods:From March 2020 to March 2021, 98 patients with postthrombotic syndrome admitted to the vascular surgery ward of The First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenient sampling method. Among them, 49 patients were admitted to the hospital from March to August 2020 as the control group to implement routine care; 49 patients from October 2020 to March 2021 were considered as the experimental group to implement the collaborative care model. The differences in the level of postthrombotic syndrome, quality of life were compared between the two groups before and after intervention.Results:The Villalta clinical score at discharge, 1 month after discharge, and 3 months after discharge was (6.90 ± 1.39), (6.88 ± 0.67), (5.67 ± 1.44) points respectively, (7.63 ± 1.35), (7.45 ± 1.46) and (7.08 ± 1.43) points, respectively, the difference was significant ( t=2.66, 2.50, 4.87, all P<0.05); the questionnaire scores of Venous Insufficiency Epidemiological and Economic Studies-the Quality of Life/Symptom in the experimental group (VEINES-QOL/SYM) were (49.39 ± 4.00), (52.21 ± 4.64), (57.39 ± 4.44) points, higher than the control group of (46.99 ± 3.93), (48.60 ± 4.13), (51.48 ± 3.73) points, the difference was significant ( t=-2.99, -4.06, -7.14, all P<0.05). Repeated measures ANOVA results showed time, intergroup and interaction effects in 2 groups were significant ( F values were 3.53 to 73.15, P<0.05). Conclusions:The collaborative care model can improve the clinical symptoms of patients with postthrombotic syndrome, and the quality of life of patients. It has certain reference significance for the nursing of patients with postthrombotic syndrome.

Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome?

PURPOSE: The aim of this study is to identify risk factors of postthrombotic syndrome (PTS) and evaluate the efficacy of catheter-directed thrombolysis (CDT) for preventing the development of PTS in patients with lower extremity deep vein thrombosis (DVT). MATERIALS AND METHODS: From 2005 January to 2013 December, 139 limbs of 126 patients were included in this study who had the first episode of proximal DVT at the affected limb and who had visited our out-patient clinic. CDT was performed on 55 limbs (39.6%). We achieved complete recanalization in 39 limbs (70.9%) and partial recanalization (residual thrombus 0.05). CONCLUSION: We suggest that CDT is not effective in preventing PTS, while higher BMI and longer thrombotic burden are associated with the development of PTS in patients with DVT.

Progress in treatment of iliac vein stenosis and chronic total occlusion / 国际外科学杂志

The anatomical structure of the iliac vein is special,the incidence of stenosis and occlusion is high.It often causes deep venous thrombosis of the lower extremities,and then causes postthrombotic syndrome.At present,with the improvement of technology and the development of endovascular treatment instruments,endovascular treatment of iliac vein stenosis has been widely recognized and is superior to conservative treatment and traditional surgery.This article reviews the advances in endovascular treatment of iliac vein stenosis and occlusion.

Long-term clinical and ultrasonographic evaluation of thrombophilic patients with deep venous thrombosis

OBJECTIVE: The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT). METHOD: Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups. RESULTS: Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a "normal life" after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients. CONCLUSION: There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients. .

OBJETIVO: O objetivo deste estudo foi avaliar os resultados clínicos e ultra-sonográficos a longo prazo de pacientes com trombofilia com trombose venosa profunda (TVP). MÉTODO: Estudo de coorte, caso-controle retrospectivo, com análise transversal. Trinta e nove pacientes trombofilia e 25 pacientes não-trombofilia foram avaliados 76,3 ± 45,8 meses após o diagnóstico. Os dados demográficos e familiares foram coletadas, bem como dados de evolução clínica e terapêutica, e exames físicos e ultra-som dos membros foram realizados. Os grupos foram pareados por idade e sexo e as variáveis ​​estudadas foram comparadas entre os grupos. RESULTADOS: A trombose venosa profunda foi mais freqüente em mulheres. As trombofilias mais comuns foram síndrome antifosfolípide e mutação do fator V Leiden. Não houve diferença entre os grupos em termos do número de casos de gravidez ou aborto e que a maioria das mulheres não engravidar após TVP. TVP não-espontâneo prevaleceu. TVP proximal e TVP de membro inferior esquerdo foram mais freqüentes, eo principal fator de risco foi o uso de contraceptivos orais. Todos os pacientes foram tratados com anticoagulação. Houve uma maior frequência de embolia pulmonar em pacientes não-trombofilia. A maioria dos pacientes se consideravam ter uma "vida normal" depois de TVP e relatou uso de meias elásticas durante pelo menos 2 anos. Setenta e um por cento dos pacientes tiveram CEAP> 3, não havendo diferença entre os grupos. Refluxo venoso profundo foi mais freqüente em pacientes com trombofilia. CONCLUSÃO: Não houve diferenças significativas entre os grupos em relação à maioria das variáveis ​​estudadas, com exceção de uma maior frequência de embolia pulmonar em pacientes não-trombofilia e maior freqüência de refluxo venoso profundo em pacientes trombofilia.

A Case of May-Thurner Syndrome with Systemic Lupus Erythematosus in Antiphospholipid Syndrome / 대한내과학회지

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

A Case of May-Thurner Syndrome with Systemic Lupus Erythematosus in Antiphospholipid Syndrome / 대한내과학회지

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

Extrinsic compression of left iliac vein does not predict the development of post thrombotic syndrome in left side deep venous thrombosis / 대한외과학회지

PURPOSE: Left side deep venous thrombosis (DVT) is associated with May-Thurner's anatomical variation and is often instigated by invasive treatment. The aim of this study is to analyze the influence of left iliac vein narrowness on incidence of post thrombotic syndrome (PTS) that developed after left side DVT. METHODS: Forty-one left side DVT cases that were followed up for more than 1 year were enrolled. The iliac vein narrowness was measured by the shortest distance from the right iliac artery to the 5th lumbar vertebra overlying left iliac vein in computed tomography (CT) scan. The incidence of PTS was measured by phone-call history taking for specific symptoms of PTS. The means of the shortest distance were compared by independent t-test. RESULTS: The number of PTS cases was eleven (26.8%). The level of thrombus, demographic data and other risk factors were similar in both PTS and non-PTS groups except the mean risk factor score. The mean of the shortest distance of PTS group and non-PTS group were 5.56 mm and 5.89 mm, respectively. CONCLUSION: The degree of left iliac vein narrowness measured by the shortest distance from the right iliac artery and the 5th lumbar vertebral body was not a predictive factor for PTS.

Clinical significance of recurrent venous thromboembolism

Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40 percent at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.

O tromboembolismo venoso recorrente é um problema importante que leva ao aumento da morbimortalidade. Impõe forte impacto à qualidade de vida dos pacientes e grande carga financeira para a sociedade. Acredita-se que a recorrência cumulativa atinja 40 por cento em 10 anos, enquanto que a chance de desenvolver sinais e sintomas pós-trombóticos nas extremidades inferiores quase quadruplica no caso de trombose ipsilateral. Há também uma maior chance do desenvolvimento de hipertensão pulmonar. Fatores importantes para a recorrência são: episódios não provocados de trombose venosa profunda, malignidade e idade avançada. As evidências relacionadas a outros fatores são controversas. Diagnóstico preciso e tratamento adaptado ao histórico dos pacientes, aos eventos trombóticos e aos fatores de risco são necessários para otimizar o manejo e prevenir a recorrência.

Iliac vein intervention with arteriovenous fistula in treatment of lower extremity postthrombotic syndrome / 中华普通外科杂志

Objective To discuss a new method of interventional and surgical therapy for the lower extremity postthrombotic syndrome (PTS). Methods 35 PTS cases were enrolled in our group. Dilation and stent placement in stenosis of iliac veins were performed in all cases, then temporary femoral arteriovenous fistula was established. After two weeks, 15 cases with varicosity underwent high ligation of the great saphenous vein and stripping, 5 cases with leg ulcers (ulcers diameter>3 cm) underwent skingrafting. After operation, patients took warfarin orally for 6 months and wear elastic compression stockings. Results Procedures were successful in all cases. Thrombectomy extracted only a few old thrombus. Before discharge, limb swelling subsided in 26 cases while 4 remain light swelling and 5 had no obviously relief. Twenty-six cases were followed-up for 3～24 monthes. Limb swelling subsided in 22 cases but still exist in 4. Limb ulcers were healed in 11 cases and the area of pigmentation were diminished. Limb ulcer recurred 12 months after skingrafting and healed finaly after perforator veins clipping with second skingrafting. Color Doppler was used in follow-up to check the potency of affected deep veins, good outcome was found in 20 cases and rough intima with stenosis of iliac veins was found in 2, no flow signal in 4. Conclusions Stenosis of iliac veins in PTS are common, the pathological changes could be treated by interveional method combined with temporary arteriovenous fistula. The degree of recanalization of femoral-popliteal veins determined the results.