Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis.

BACKGROUND: Isolated distal deep vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism) represents half of all cases of lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence. METHODS: Using data from the OPTIMEV (OPTimisation de l'Interrogatoire dans l'évaluation du risque throMbo-Embolique Veineux) study, a prospective, observational, multicenter study, we compared, 3 years after an index VTE event and after discontinuation of anticoagulants, (i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal DVT (iPDVT) and (ii) predictors of recurrence after iDDVT. RESULTS: Compared with patients with iPDVT (n = 259), patients with an iDDVT (n = 490) had a lower annualized incidence of overall VTE recurrence (5.2% [95% confidence interval 3.6-7.6] vs. 2.7% [1.9-3.8], respectively; P = 0.02) but a similar incidence of pulmonary embolism recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6], respectively; P = 0.83). An age of > 50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, with the latter then being ≥ 3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence. CONCLUSIONS: After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than did patients with iPDVT but a similar risk of serious recurrent VTE. Age > 50 years, unprovoked iDDVT, and number of thrombosed veins (more than one) influenced the risk of recurrence and may help to define patients at significant risk of recurrence.

Treatment of low-flow vascular malformations by ultrasound-guided sclerotherapy with polidocanol foam: 24 cases and literature review.

OBJECTIVES: Treatment by sclerotherapy has been suggested as a first-line treatment of low-flow vascular malformations. This study reports our experience in treating low-flow vascular malformations by ultrasound-guided sclerosis with polidocanol foam at the Vascular Medicine Department in Grenoble, France. DESIGN: Retrospective single-centre consecutive series. MATERIALS AND METHODS: Between January 2006 and December 2009, we analysed the complete records of patients with symptomatic low-flow vascular malformations of venous, lymphatic or complex type (Klippel-Trenaunay syndrome, KTS) treated by ultrasound-guided sclerosis. The therapeutic indication was always validated by the Consultative Committee for vascular malformations of the University Hospital of Grenoble. All vascular malformations were classified according to the Hamburg Classification. The sclerosing agent was polidocanol used as foam. RESULTS: A total of 24 patients between 7 and 78 years were treated (19 venous malformations, three KTSs and two venous-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25% to 3%. The average number of sessions was 2.3 (1-16). After a median follow-up at 5 months after the last session, 23 out of 24 patients reported a decrease in pain; in nine cases (37.5%), over 50% reduction in size was observed, and in 14 cases (58.3%), a reduction of less than 50% of the original size was obtained. Two minor side effects were reported. CONCLUSIONS: Treatment by ultrasound-guided sclerosis using polidocanol foam seems to be well tolerated and can improve the symptoms of low-flow malformations without the risks of more aggressive sclerosing agents, such as ethanol.

Ultrasound-guided sclerotherapy of the great saphenous vein with 1% vs. 3% polidocanol foam: a multicentre double-blind randomised trial with 3-year follow-up.

OBJECTIVES: The aim of this study was to compare the efficacy and side effects of ultrasound-guided foam sclerotherapy of the great saphenous vein using 1% and 3% polidocanol foam with a 3-year follow-up. DESIGN: A multicentre prospective double-blind randomised clinical trial comparing the efficacy of 1% vs. 3% polidocanol sclerosant foam. MATERIALS AND METHODS: Patients with incompetence of the great saphenous vein (GSV) in CEAP clinical classes C2-5 (CEAP, Clinical-Etiology-Anatomy-Pathophysiology), with or without incompetence of the sapheno-femoral junction, were included. The Turbofoam method was used to create 1% and 3% polidocanol foam, which was injected into the GSV under ultrasound guidance, with a volume not exceeding 10 ml. Further foam sclerotherapy was carried out at 6 weeks, 3 and 6 months if required to abolish persistent venous reflux. The main outcome measure was the absence of saphenous reflux as assessed by ultrasound imaging at 6 months, 1, 2 and 3 years. Clinical severity (Venous Clinical Severity score (VCSS)) and quality of life (the Chronic Venous Insufficiency Questionnaire (CIVIQ)) scores were assessed. RESULTS: A total of 143 patients were included; 1% group men = 18, women = 55, 3% group men = 19, women = 51. The abolition of venous reflux was: 1% group, 69% and 3% group, 85% at 6 months; 1% group, 79% and 3% group, 78% at 3 years (including additional injections at 6 months). Three asymptomatic thrombo-embolic events (2%) occurred. Local side effects (principally pigmentation and matting) were 9% in the 3% group and 6% in the 1% group at 3 years (N.S.). Clinical severity and quality of life scores improved by more than 20% at 6 months in both the groups, with no difference between the groups. CONCLUSIONS: This is the first randomised clinical trial of ultrasound-guided foam sclerotherapy which is a 3-year follow-up and shows equivalent efficacy of 1% and 3% sclerosant foam. CLINICAL TRIAL REGISTRATION NUMBER: 2006-07-05.

[Deep venous thrombosis (DVT) after hip or knee prosthesis. Evaluation of practices for prevention and prevalence of DVT on doppler ultrasonography]. / Thromboses veineuses profondes (TVP) après prothèse de hanche ou de genou. Evaluation des pratiques de prévention et de la prévalence des TVP en écho-Doppler.

PURPOSE: Duplex ultrasound scanning was performed to detect deep venous thrombosis (DVT) after hip or knee arthroplasty and evaluate application of the postoperative thromboprophylaxis consensus. PATIENTS AND METHODS: A prospective multicenter study was conducted between April 1995 and April 1996 in 16 centers. Thirty angiologists included 505 patients (370 in private clinics and 135 in university hospitals). Mean patient age was 71 years. There were 288 women. Hip arthroplasty was performed in 396 patients (78%) and knee arthroplasty in 109 (22%), under general anesthesia in 323. The postoperative thromboprophylaxis consensus was recalled prior to study onset and DVT was detected 8 and 10 days after surgery by duplex ultrasonography. RESULTS: Thromboprophylaxis was prescribed by the anesthesiologist (57%), the surgeon (23%) or an angiologist (20%). Anticoagulation dosage was lower than the recommended dosage in 181 patients (36%). The prevalence of detected deep venous thrombosis was 14% (range 11-17%), including 21 cases of proximal DVT (4.2%), 33 of distal DVT (6.5%) and 17 of distal muscular DVT (3.4%). The risk of having a DVT was 1.6-fold higher in patients over 70 years of age (p = 0.04), 2.2-fold higher in case of general anesthesia (p = 0.03) and 2.1-fold higher in case of reduced mobility (p = 0.01). When heparin dosage was lower than the recommended consensus dosage, prevalence of DVT was 19% compared with 11% for patients who received the right dosage (RR = 1.7, p = 0.01). CONCLUSION: Much progress is needed in the application of the postoperative consensus on thromboprophylaxis. The high prevalence of DVT despite preventive treatment indicates that systematic detection of DVT is useful, particularly in high-risk patients or when the recommended thromboprophylaxis cannot be applied.

Semiological analysis of Raynaud attacks.

Careful semiological and etiological investigations (including nailfold capillary microscopy) were performed in 120 consecutive patients with Raynaud phenomenon (RP) (December 1983-March 1984) recorded on a standardized form. Complete and reliable data were obtained in 103 cases. The functional severity of the attacks was assessed statistically, after adjusting for etiological groups. The existence of an asphyxial (cyanotic) phase was found the best single criterion for the severity of attacks, but a more complete evaluation was arrived at with the following functional severity score (FSS = 0 to 3): asphyxia (0 or 1)+summer rate of attacks higher than once a week (0 or 1)+involvement of all the fingers (0 to 1). This score was also validated through a multivariate correspondence analysis. FSS was much higher in RP associated with connective tissue diseases (1.73 +/- 0.18) than in primary RP (0.64 +/- 0.14, p less than 0.001). A careful analysis of ischemic attacks is thought to be an important part of etiological and pre-therapeutic evaluation of patients with RP.

[Erythrocyte aggregation and its repercussions on conjunctival microcirculation in man. Morphometric study and biological correlates]. / L'agrégation érythrocytaire et son retentissement sur la microcirculation conjonctivale chez l'homme. Etude morphométrique et corrélations biologiques.

This study, involving the application of morphometric techniques to the conjunctival capillary bed in man, revealed a rarefaction of functional capillary density in patients with arteriolar sludge. Overall, in the population sample studied, capillary density and the degree of erythrocyte aggregation were correlated to erythrocyte sedimentation rate, despite the existence of discordant cases. These discordances were partially reduced by taking the hematocrit into account. Furthermore, multifactorial analysis of these parameters showed that hematocrit had an inhibitory action on erythrocyte aggregation which was more marked in vitro than in the microcirculation in vivo. By contrast, in vivo aggregation was more influenced by serum albumin levels. In both cases fibrinogen appeared to be the most significant pro-aggregant factor.