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Alshalawi M, Almoamary A, Alrajhi S, Alkanhal R, Alsogair R, Albarrak D. Facial vein thrombophlebitis post facial skin infection: a case report and review of the literature. SAGE Open Med Case Rep 2024; 12:2050313X241283265. [PMID: 39314216 PMCID: PMC11418322 DOI: 10.1177/2050313x241283265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
This case report presents a rare instance of facial vein thrombophlebitis, a potentially serious complication, following a facial skin infection. A 33-year-old man known to have cerebral palsy, epilepsy on ventriculoparietal shunt, and kyphoscoliosis presented to the emergency department complaining of small facial wound and swelling for 1 week. The wound failed topical management and fever started to develop. His medications included quetiapine and levetiracetam. Investigations, including computed tomography, were carried out to rule out an extension to deep tissue. Management in the emergency department involved initial resuscitation with 500 mL of 0.9% normal saline and 1 L of lactated ringers, antibiotic coverage with piperacillin/tazobactam and vancomycin was given, and analgesia for pain control. This case highlights the potential for facial vein thrombophlebitis as a complication of facial skin infections. Early diagnosis and prompt initiation of appropriate management are crucial to prevent potentially fatal consequences.
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Affiliation(s)
- May Alshalawi
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amal Almoamary
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sulaiman Alrajhi
- Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raghad Alkanhal
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Reema Alsogair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Danah Albarrak
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Balahura AM, Florescu AG, Barboi TM, Weiss E, Miricescu D, Jurcuț C, Jinga M, Stanciu S. Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1466. [PMID: 39336507 PMCID: PMC11434259 DOI: 10.3390/medicina60091466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/27/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024]
Abstract
Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger's disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno-femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.
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Affiliation(s)
- Ana-Maria Balahura
- Department of Cardiology, “Carol Davila” University of Medicine and Pharmacy, “Prof. Dr. Theodor Burghele” Clinical Hospital, 010024 Bucharest, Romania;
| | | | - Teodora-Maria Barboi
- Emergency Institute of Cardiovascular Diseases Prof. Dr. C.C. Iliescu, 022328 Bucharest, Romania;
| | - Emma Weiss
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, Clinical Emergency Hospital Bucharest, 050474 Bucharest, Romania;
| | - Daniela Miricescu
- Department of Biochemistry, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ciprian Jurcuț
- Dr. Carol Davila University Central Military Emergency Hospital, 010825 Bucharest, Romania;
| | - Mariana Jinga
- Dr. Carol Davila University Central Military Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Calea Plevnei 134, 010825 Bucharest, Romania; (M.J.); (S.S.)
| | - Silviu Stanciu
- Dr. Carol Davila University Central Military Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Calea Plevnei 134, 010825 Bucharest, Romania; (M.J.); (S.S.)
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Bontinis A, Pouliopoulou I, Bontinis V, Liakopoulos V, Giannopoulos A, Chatzimpalasi T, Ktenidis K. Anticoagulants for the treatment of isolated lower limb superficial vein thrombosis a Bayesian network meta-analysis of randomized controlled trials. Thromb Res 2024; 241:109101. [PMID: 39047307 DOI: 10.1016/j.thromres.2024.109101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Assess the safety and efficacy of anticoagulants in treating isolated superficial vein thrombosis (iSVT). MATERIALS AND METHODS A systematic review was conducted according to PRISMA 2020 guidelines, for randomized controlled trials (RCTs) investigating anticoagulants in the treatment of iSVT. The primary endpoint of thrombotic complications encompassed any incident of iSVT progression/recurrence and the development of new-onset (deep vein thrombosis) DVT or (pulmonary embolism) PE. RESULTS Eight RCT's and 4721 patients treated once daily with either fondaparinux 2.5 mg, rivaroxaban 10 mg, therapeutic, intermediate, and prophylactic low molecular weight heparin (LMW) were included. While all anticoagulants displayed a statistically significant risk reduction compared to placebo in terms of thrombotic complications and iSVT progression/recurrence, only fondaparinux reduced the risk for DVT/PE. Additionally, fondaparinux exhibited enhanced efficacy in decreasing DVT/PE events relative to prophylactic and therapeutic LMWH. Furthermore, rivaroxaban and fondaparinux demonstrated superior outcomes in terms of preventing thrombotic complications compared to all three dosing regimens of LMWH without significant differences between the two, risk ratio RR 1.00(95%CI:0.51-1.92). SUCRA identified fondaparinux as the most effective treatment regarding thrombotic complications, (SUCRA,91.6) and DVT/PE, (SUCRA,96) and rivaroxaban in terms of iSVT progression/recurrence (SUCRA,94.68). Ultimately and despite certain model limitations, meta-regression analysis suggested a possible trend towards improved outcomes with longer treatment durations for thrombotic complications β = -0.34(95%CI:-16.39to12.23). CONCLUSIONS Despite inherent limitations such as variations in treatment durations and follow-up periods, this review displayed the efficacy of fondaparinux, rivaroxaban and LMWH in treating iSVT. The improved efficacy of fondaparinux over therapeutic LMWH in terms of DVT/PE outcomes necessitates cautious interpretation underscoring the need for further investigation through adequately powered RCTs.
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Affiliation(s)
- Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Ioanna Pouliopoulou
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argirios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | | | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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Nguyen AT, Curtis KM, Tepper NK, Kortsmit K, Brittain AW, Snyder EM, Cohen MA, Zapata LB, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-126. [PMID: 39106314 PMCID: PMC11315372 DOI: 10.15585/mmwr.rr7304a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
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Affiliation(s)
- Antoinette T. Nguyen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kathryn M. Curtis
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Anna W. Brittain
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Zhang Y, Zhou W, Zhou J, Chu W, Fan J, Lu H. Superficial thrombophlebitis in the forearm leading to entrapment of the radial nerve branch: a first case report and literature review. BMC Musculoskelet Disord 2024; 25:429. [PMID: 38824539 PMCID: PMC11144313 DOI: 10.1186/s12891-024-07545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.
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Affiliation(s)
- Yinwei Zhang
- Department of Orthopedics, Jinyun People's Hospital, No.299 Ziwei Nouth Road, Lishui, Zhejiang Province, 321400, People's Republic of China
| | - Weijie Zhou
- Department of Orthopedics, No., 903 Hospital of PLA Joint Logistic Support Force, #40 Airport Road, Hangzhou, 31003, People's Republic of China
| | - Jun Zhou
- Department of Orthopedics, Jinyun People's Hospital, No.299 Ziwei Nouth Road, Lishui, Zhejiang Province, 321400, People's Republic of China
| | - Weitao Chu
- Department of Orthopedics, Jinyun People's Hospital, No.299 Ziwei Nouth Road, Lishui, Zhejiang Province, 321400, People's Republic of China
| | - Jun Fan
- Department of Orthopedics, Jinyun People's Hospital, No.299 Ziwei Nouth Road, Lishui, Zhejiang Province, 321400, People's Republic of China.
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 31003, People's Republic of China
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van Royen FSA, van Smeden M, van Doorn S, Rutten FH, Geersing GJ. Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis. BMJ Open 2024; 14:e074818. [PMID: 38626964 PMCID: PMC11029256 DOI: 10.1136/bmjopen-2023-074818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE A subset of patients with superficial venous thrombosis (SVT) experiences clot propagation towards deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The aim of this systematic review is to identify all clinically relevant cross-sectional and prognostic factors for predicting thrombotic complications in patients with SVT. DESIGN Systematic review. DATA SOURCES PubMed/MEDLINE and Embase were systematically searched until 3 March 2023. ELIGIBILITY CRITERIA Original research studies with patients with SVT, DVT and/or PE as the outcome and presenting cross-sectional or prognostic predictive factors. DATA EXTRACTION AND SYNTHESIS OF RESULTS The CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling (CHARMS) checklist for prognostic factor studies was used for systematic extraction of study characteristics. Per identified predictive factor, relevant estimates of univariable and multivariable predictor-outcome associations were extracted, such as ORs and HRs. Estimates of association for the most frequently reported predictors were summarised in forest plots, and meta-analyses with heterogeneity were presented. The Quality in Prognosis Studies (QUIPS) tool was used for risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for assessing the certainty of evidence. RESULTS Twenty-two studies were included (n=10 111 patients). The most reported predictive factors were high age, male sex, history of venous thromboembolism (VTE), absence of varicose veins and cancer. Pooled effect estimates were heterogenous and ranged from OR 3.12 (95% CI 1.75 to 5.59) for the cross-sectional predictor cancer to OR 0.92 (95% CI 0.56 to 1.53) for the prognostic predictor high age. The level of evidence was rated very low to low. Most studies were scored high or moderate risk of bias. CONCLUSIONS Although the pooled estimates of the predictors high age, male sex, history of VTE, cancer and absence of varicose veins showed predictive potential in isolation, variability in study designs, lack of multivariable adjustment and high risk of bias prevent firm conclusions. High-quality, multivariable studies are necessary to be able to identify individual SVT risk profiles. PROSPERO REGISTRATION NUMBER CRD42021262819.
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Affiliation(s)
- Florien Sophie-Anne van Royen
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology and Health Economics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sander van Doorn
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Centre Utrecht, Utrecht, The Netherlands
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Díez Vidal A, Gómez López J, Rivera Núñez MA, Martínez Virto AM, Tung Chen Y. Risk factors and complications associated with superficial venous thrombosis. Eur J Intern Med 2024; 121:146-148. [PMID: 38129196 DOI: 10.1016/j.ejim.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Alejandro Díez Vidal
- Department of Internal Medicine, La Paz University Hospital, Paseo Castellana 261, Madrid 28046, Spain.
| | - Javier Gómez López
- Department of Emergency Medicine, La Paz University Hospital, Paseo Castellana 261, Madrid 28046, Spain
| | | | - Ana María Martínez Virto
- Department of Emergency Medicine, La Paz University Hospital, Paseo Castellana 261, Madrid 28046, Spain
| | - Yale Tung Chen
- Department of Internal Medicine, La Paz University Hospital, Paseo Castellana 261, Madrid 28046, Spain; Department of Medicine, Universidad Alfonso X El Sabio, Avenida Universidad 1, Villanueva de la Cañada, Madrid 28691, Spain
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Mangiafico M, Costanzo L. Superficial Venous Thrombosis: A Comprehensive Review. Healthcare (Basel) 2024; 12:500. [PMID: 38391875 PMCID: PMC10888259 DOI: 10.3390/healthcare12040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Superficial venous thrombosis (SVT), an inflammatory-thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives.
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Affiliation(s)
- Marco Mangiafico
- Unit of Internal Medicine, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
| | - Luca Costanzo
- Unit of Angiology, Department of Cardio-Thoraco-Vascular, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
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Mathieu ME, Duffett L, Caiano L, Scarvelis D, Code C, Wells P, Le Gal G. Management and outcomes of superficial vein thrombosis: a single-center retrospective study. Res Pract Thromb Haemost 2024; 8:102263. [PMID: 38187826 PMCID: PMC10770555 DOI: 10.1016/j.rpth.2023.102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 01/09/2024] Open
Abstract
Background Guidelines suggest but cannot recommend the optimal management of superficial vein thrombosis (SVT). Objectives To identify the prevalence of asymptomatic deep vein thrombosis (DVT) at the time of SVT diagnosis, and to report the treatment and 3-month complications of patients with only SVT more than 3 cm from deep vein junction (or unknown distance). Methods We performed a single-center retrospective review of patients referred to the Ottawa Hospital thrombosis unit with ultrasound (US)-diagnosed SVT, and followed patients with only SVT for 3 months. Results Three hundred sixteen patients with SVT were included. Of the 218 patients without DVT symptoms at presentation, 19 (8.7%; 95% CI, 5.7%-13.2%) were found to have asymptomatic concomitant DVT (11 proximal and 8 distal), and 45 (20.6%) had SVT within 3 cm of the saphenofemoral or saphenopopliteal junctions. Among the 192 patients diagnosed with SVT only, we observed 3-month thrombotic complications in 56 (29.2%; 95% CI, 23.2%-36.0%) patients, with a total of 69 events: 11 (5.7%) DVTs, 2 (1.0%) pulmonary embolisms, 37 (19.2%) SVT extensions, and 19 (9.8%) SVT recurrences. Eighty-two percent (9/11) of the 3-month DVT and pulmonary embolism events occurred in patients who initially received conservative management. Therapeutic treatment doses were most effective. Conclusion At the time of SVT diagnosis, many patients had asymptomatic DVT and SVT near the deep venous system, supporting the systematic use of initial US in patients clinically diagnosed with SVT. The observed differences in 3-month complication rates, according to the treatment provided, highlight the need for large-scale randomized controlled trials to establish optimal management.
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Affiliation(s)
- Marie-Eve Mathieu
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Duffett
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lucia Caiano
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dimitri Scarvelis
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Code
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philip Wells
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Xu J, Xu X, Tian J, Huang M, Xia Z, Luo X, Zheng J, Huang K. Comparison of day surgery between varicose veins with and without superficial venous thrombosis below knee: a propensity score-matched analysis. BMC Cardiovasc Disord 2023; 23:387. [PMID: 37537563 PMCID: PMC10401813 DOI: 10.1186/s12872-023-03398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES Development of endovenous treatment and sclerotherapy technology makes it feasible for clinicians to treat varicose veins (VV) through day surgery (DS). Superficial venous thrombosis (SVT) of lower extremities is a common complication of VV. This study aimed to investigate whether the existence of SVT below knee affect the safety and efficacy of DS for VV patients. METHODS This is a single-center retrospective study. Clinical data of 593 VV patients was retrospectively analyzed. Raw data were matched by the using of propensity score matching model. Operation time, technical failure, postoperative DVT, skin burns, saphenous nerve injury, subcutaneous induration, and bleeding were compared between the groups. Also, we compared VV recurrence, SVT formation, DVT events and the change of VCSS score with 12 months. RESULTS Fifty-nine patients complicated with SVT below knee were matched with 118 patients had VV only. Perioperative and follow-up outcomes were similar in both groups except for the number of incisions (median = 6 [5, 7] VS median = 4 [4, 5], P < 0.001). Both groups experienced a great decrease in VCSS score. CONCLUSION We systematically compared the clinical outcomes of DS in VV patients. Our results indicate DS is safe and effective for patients with VV, whether accompanied by SVT below the knee. TRIAL REGISTRATION The ClinicalTrials.gov identifier for this trial is NCT05380895 (retrospectively registered).
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Affiliation(s)
- Jiatang Xu
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
| | - Minyi Huang
- Operating Theatre, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Zuqi Xia
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Xianghui Luo
- Operating Theatre, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Junmeng Zheng
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China.
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China.
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China.
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China.
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Sugawara S, Sone M, Sakamoto N, Sofue K, Hashimoto K, Arai Y, Tokue H, Takigawa M, Mimura H, Yamanishi T, Yamagami T. Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version). INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:105-117. [PMID: 37485481 PMCID: PMC10359169 DOI: 10.22575/interventionalradiology.2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 07/25/2023]
Abstract
The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | | | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Japan
| | | | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
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12
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Valle A, Levy R, Tobias A, Friedman E, Hassan I. Two Cases of Venous Thromboembolism Shortly After Adenovirus-Based COVID-19 Vaccination. Cureus 2023; 15:e39609. [PMID: 37384077 PMCID: PMC10299835 DOI: 10.7759/cureus.39609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) global pandemic continues, multiple vaccines have been developed to decrease infection rate and number of deaths. Vaccine administration is especially important as new COVID-19 variants emerge. While the number of severe thromboembolic events reported after adenovirus-based vaccination has gained attention, there is little information regarding the presentation and management of post-vaccination venous thromboembolism (VTE). Here, we present two cases of VTE after the Janssen vaccine administration. In the first case, a 98-year-old African American female with hypertension developed bilateral lower extremity edema that evolved into unilateral lower extremity edema 20-35 days following the Janssen vaccine administration. She was found to have an extensive unilateral proximal femoral deep vein thrombosis (DVT) 35 days after the vaccination. In the second case, a 64-year-old African American female developed ecchymosis and unilateral edema six days after the Janssen vaccine administration. She was found to have proximal superficial vein thrombosis two days later. In both cases, laboratory data, including platelets and anti-heparin antibodies were within normal limits. Thus, VTE may be an adverse effect of the Janssen vaccine or any adenovirus-based vaccine, but further surveillance and investigation to elucidate this association are necessary. We advise practitioners to have a high index of suspicion for thrombosis after Janssen vaccine administration, regardless of the presence of thrombocytopenia, and avoidance of heparin products until heparin antibody results return.
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Affiliation(s)
- Ana Valle
- Internal Medicine, Albert Einstein College of Medicine, Bronx, USA
| | - Rachel Levy
- Hematology/Oncology, Albert Einstein College of Medicine, Bronx, USA
| | - Abraham Tobias
- Internal Medicine, Albert Einstein College of Medicine, Bronx, USA
| | - Ellen Friedman
- Hematology/Oncology, Albert Einstein College of Medicine, Bronx, USA
| | - Iman Hassan
- Internal Medicine, Albert Einstein College of Medicine, Bronx, USA
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13
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Casian D, Bzovii F, Culiuc V, Gutu E. Urgent surgery versus anticoagulation for treatment of superficial vein thrombosis in patients with varicose veins. VASA 2022; 51:174-181. [DOI: 10.1024/0301-1526/a001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: We performed a prospective observational study to compare the results of surgery and anticoagulation in patients with superficial vein thrombosis (SVT). Patients and methods: A total of 190 patients (195 limbs) with varicose veins and SVT were included and treated by anticoagulation or by surgery. Patients were followed-up during 6 months. The primary outcome for treatment efficacy was the composite rate of SVT extension/recurrence; deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE). The primary outcome for safety was the rate of wound complications and rate of bleedings. Results: Surgery was performed in 85 (44.7%) patients and 105 patients (5 with bilateral SVT) were treated conservatively. In the whole study cohort the primary outcome for treatment efficacy was registered in 15 (7.6%) cases: 9/85 (10.5%) in surgical group and 6/110 (5.4%) in anticoagulation group. Nine patients treated with surgery were diagnosed with postoperative DVT. In anticoagulation group SVT extension occurred in 3 limbs; SVT recurrence in 2 and DVT in one. There were no cases of PE or death during the follow-up. Time-to-event analysis demonstrated no significant difference between groups (HR 0.48; 95% CI 0.17–1.34). The total length of the thrombus was associated with primary efficacy outcome in surgical group (HR 1.07; 95% CI 1.02–1.11); and duration of anticoagulation (HR 0.91 per day; 95% CI 0.83–0.99) and value of Caprini score (HR 1.86; 95% CI 1.1–3.14) in anticoagulation group. Six (7%) wound complications were registered after surgery and 6 (5.71%) bleedings during anticoagulation. Conclusions: Urgent surgery is not associated with reduction of venous thromboembolism compared to anticoagulation in treatment of patients with SVT and varicose veins during 6-months follow-up. However, in patients with isolated thrombosis of varicose tributaries or with limited involvement of the saphenous trunk surgery is relatively safe.
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Affiliation(s)
- Dumitru Casian
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Florin Bzovii
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Vasile Culiuc
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Evghenii Gutu
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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14
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Smith ZT, Bagley AR, Guy D, Preston L, Ali NS. Ultrasound Imaging of Superficial Venous Thrombosis in the Upper and Lower Extremities: Closing the Gap Between Clinical Management Guidelines and Ultrasound Practice Parameters. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:535-542. [PMID: 33929750 DOI: 10.1002/jum.15737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/05/2021] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
Superficial venous thrombosis (SVT) of the upper and lower extremities has long been considered a relatively benign condition. But in recent years, the literature has suggested a benefit to anticoagulation in patients with certain thrombus characteristics (size, location, and distance to deep venous system) resulting in updates to clinical guidelines for the treatment of lower extremity SVT. Despite these now well-established guidelines, there remains a paucity of guidance from national and international societies regarding the imaging of superficial veins when evaluating for venous thrombosis. We recommend potential strategies to close this gap.
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Affiliation(s)
- Zachary T Smith
- The Robert Larner M.D. College of Medicine at the University of Vermont, The University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Dave Guy
- The Robert Larner M.D. College of Medicine at the University of Vermont, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Lindsey Preston
- The Robert Larner M.D. College of Medicine at the University of Vermont, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Naiim S Ali
- The Robert Larner M.D. College of Medicine at the University of Vermont, The University of Vermont Medical Center, Burlington, Vermont, USA
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15
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Antic D, Lefkou E, Otasevic V, Banfic L, Dimakakos E, Olinic D, Milić D, Miljić P, Xhepa S, Stojkovski I, Kozak M, Dimulescu DR, Preradović TK, Nancheva J, Pazvanska EE, Tratar G, Gerotziafas GT. Position Paper on the Management of Pregnancy-Associated Superficial Venous Thrombosis. Balkan Working Group for Prevention and Treatment of Venous Thromboembolism. Clin Appl Thromb Hemost 2022; 28:1076029620939181. [PMID: 35187959 PMCID: PMC8864277 DOI: 10.1177/1076029620939181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Venous thromboembolism (VTE) is a multifactorial disease that can possibly affect
any part of venous circulation. The risk of VTE increases by about 2 fold in
pregnant women and VTE is one of the major causes of maternal morbidity and
mortality. For decades superficial vein thrombosis (SVT) has been considered as
benign, self-limiting condition, primarily local event consequently being out of
scope of well conducted epidemiological and clinical studies. Recently, the
approach on SVT has significantly changed considering that prevalence of lower
limb SVT is twice higher than both deep vein thrombosis (DVT) and pulmonary
embolism (PE). The clinical severity of SVT largely depends on the localization
of thrombosis, when it concerns the major superficial vein vessels of the lower
limb and particularly the great saphenous vein. If untreated or inadequately
treated, SVT can potentially cause DVT or PE. The purpose of this review is to
discuss the complex interconnection between SVT and risk factors in pregnancy
and to provide evidence-based considerations, suggestions, and recommendations
for the diagnosis and treatment of this precarious and delicate clinical
entity.
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Affiliation(s)
- Darko Antic
- University Clinical Center of Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Eleftheria Lefkou
- Sorbonne University, INSERM, UMR_S 938, Research Group “Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis” Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Paris, France
| | | | - Ljiljana Banfic
- Department of Cardiovascular Diseases, Zagreb University Hospital
Centre, School of Medicine, Croatia
| | - Evangelos Dimakakos
- Vascular Unit of 3rd Internal Medicine Department of the University
of Athens-Sotiria General Hospital, Athens, Greece
| | - Dan Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy,
Cluj-Napoca, Romania
| | | | - Predrag Miljić
- University Clinical Center of Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Sokol Xhepa
- Service of Vascular Surgery, University Hospital Center “Mother
Theresa” of Tirana, Albania
| | - Igor Stojkovski
- University Clinic for Oncology and Radiotherapy, Faculty of
Medicine, Ss Cyril and Methodius University of Skopje, Republic of North
Macedonia
| | - Matija Kozak
- University Medical Centre Ljubljana, Department for Vascular
Diseases, Ljubljana, Slovenia
| | - Doina Ruxandra Dimulescu
- University of Medicine and Pharmacy “Carol Davila” Bucharest,
Ponderas Academic Hospital Bucharest, Cardiology Department, Romania
| | | | - Jasminka Nancheva
- University Clinic for Orthopedic Diseases, Medical Faculty,
University “Ss. Cyril and Methodius” Skopje, Republic of North Macedonia
| | | | - Gregor Tratar
- Department of Angiology, University Medical Centre, Ljubljana,
Slovenia
| | - Grigoris T. Gerotziafas
- Sorbonne University, INSERM, UMR_S 938, Research Group “Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis” Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Paris, France
- Sorbonne University, INSERM, UMR_S 938, Research Group "Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis" Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancõrologie, Paris, France
- Grigoris T. Gerotziafas, MD, PhD, INSERM
U938 Bâtiment Kourilsky, 34 rue Crozatier, Hôpital Saint Antoine, Paris, Cedex
75012, France.
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16
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Kalinin R, Suchkov I, Mzhavanadze N, Uporov M. Surgical Prevention of Venous Thromboembolism in Patients with Superficial Vein Thrombosis and Phlebitis on the Thigh in Routine Clinical Practice. FLEBOLOGIIA 2022; 16:139. [DOI: 10.17116/flebo202216021139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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17
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Rass K, Gerontopoulou SA, Wienert V. Oberflächliche Venenthrombose der Beinvenen – Eine systematische Übersicht – Teil 1: Definition, Ätiologie, Diagnostik. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1238-6613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Einleitung Die oberflächliche Venenthrombose (OVT) der Beinvenen ist mit einer Inzidenz von 0,5–1/1000 Einwohner/Jahr ein häufiges und mit einer Frequenz assoziierter thromboembolischer Ereignisse in bis zu 25 % der Fälle ein ernst zu nehmendes Krankheitsbild. In der vorliegenden Übersichtsarbeit sollen alle relevanten Aspekte der OVT basierend auf der aktuellen wissenschaftlichen Literatur behandelt werden.
Methoden Die systematische Übersicht umfasst das Wissen über die OVT basierend auf dem gesamten, systemisch recherchierten Erkenntnismaterial in den Datenbanken PubMed und Google Scholar. Eine Literaturrecherche in PubMed von Publikationen (1968–2018) mit den Suchbegriffen „Superficial vein thrombosis; thrombophlebitis“ ergab 102 aussagekräftige Arbeiten, die nach Vorlage der Originalarbeit ausgewertet wurden. Teil 1 der Arbeit behandelt Aspekte zur Definition, Klassifikation, Ätiologie und Diagnostik.
Ergebnisse Die OVT manifestiert sich klinisch neben den typischen Entzündungszeichen als strangförmige Induration, die Ausdruck eines thrombotischen Verschlusses epifaszialer Venen ist. Ätiologisch bedeutsam ist das Vorhandensein von Varikose (68 % der Fälle), Adipositas (23 %), Gerinnungsstörungen (18 %) und Tumorleiden (8 %). Das Durchschnittsalter der Betroffenen beträgt 62 Jahre, in 60 % der Fälle sind Frauen betroffen. Zunehmendes Lebensalter ist ein relevanter Risikofaktor. Diagnostisch ist es wichtig, das genaue Ausmaß der OVT zu beschreiben, insbesondere die Thrombuslänge und die Entfernung zum tiefen Venensystem. Dies, einschließlich der Beurteilung des tiefen Beinvenensystems, sollte bei jedem Patienten mit möglicher OVT zeitnah mittels Ultraschalldiagnostik erfolgen. Eine hier vorgeschlagene Klassifikation von 4 Ausprägungsgraden der OVT kann die Zuordnung zur aktuell empfohlenen Therapie erleichtern.
Schlussfolgerung Aufgrund der Häufigkeit und des Risikos potenziell lebensbedrohender Komplikationen sollte der OVT der Beinvenen eine größere Beachtung zukommen, insbesondere mit Blick auf eine spezialisierte Diagnostik durch Phlebologen.
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Affiliation(s)
- Knuth Rass
- Eifelklinik St. Brigida, Zentrum für Venen und periphere Arterien, Simmerath
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg
| | | | - Volker Wienert
- Klinik für Dermatologie und Allergologie, Universitätsklinikum RWTH Aachen, Aachen
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18
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Li K, Yu G, Xu Y, Chu H, Zhong Y, Zhan H. Phenotypic and Functional Transformation in Smooth Muscle Cells Derived from a Superficial Thrombophlebitis-affected Vein Wall. Ann Vasc Surg 2021; 79:335-347. [PMID: 34648856 DOI: 10.1016/j.avsg.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Superficial thrombophlebitis (ST) is a frequent pathology, but its exact incidence remains to be determined. This study tested the hypothesis whether relationships exist among smooth muscle cells (SMCs) derived from ST, varicose great saphenous veins (VGSVs), and normal great saphenous veins (GSVs). METHODS Forty-one samples of ST, VGSVs, and GSVs were collected. SMCs were isolated and cultured. Proliferation, migration, adhesion, and senescence in SMCs from the three vein walls were compared by various methods. Bax, Bcl-2, caspase-3, matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and TIMP-2 messenger RNA (mRNA) and protein expressions were detected by fluorescence quantitative PCR and Western blot. RESULTS An obvious decrease in cytoskeletal filaments was observed in thrombophlebitic vascular smooth muscle cells (TVSMCs). The quantity of proliferation, migration, adhesion, and senescence in TVSMCs was significantly higher than in varicose vascular smooth muscle cells and normal vascular smooth muscle cells (NVSMCs) (all P < 0.05). Bax and caspase-3 mRNA and protein expression were decreased, while Bcl-2 mRNA and protein expression were increased in the TVSMCs compared with the varicose vascular smooth muscle cells and the NVSMCs (all P < 0.05). MMP-2, MMP-9, TIMP-1, and TIMP-2 mRNA and protein expression were significantly increased in the TVSMCs compared with the VVGSVs and the NVSMCs (all P < 0.05). CONCLUSION SMCs derived from ST are more dedifferentiated and demonstrate increased cell proliferation, migration, adhesion, and senescence, as well as obviously decreased cytoskeletal filaments. These results suggest that the phenotypic and functional differences could be related to the presence of atrophic and hypertrophic vein segments during the disease course among SMCs derived from ST, VGSVs, and GSVs.
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Affiliation(s)
- Kun Li
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China.; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Guoting Yu
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China.; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yongbo Xu
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China
| | - Haibo Chu
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China
| | - Yuxu Zhong
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China..
| | - Hanxiang Zhan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China..
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19
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van Royen FS, van Smeden M, Moons KGM, Rutten FH, Geersing GJ. Management of superficial venous thrombosis based on individual risk profiles: protocol for the development and validation of three prognostic prediction models in large primary care cohorts. Diagn Progn Res 2021; 5:15. [PMID: 34404480 PMCID: PMC8371853 DOI: 10.1186/s41512-021-00104-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Superficial venous thrombosis (SVT) is considered a benign thrombotic condition in most patients. However, it also can cause serious complications, such as clot progression to deep venous thrombosis (DVT) and pulmonary embolism (PE). Although most SVT patients are encountered in primary healthcare, studies on SVT nearly all were focused on patients seen in the hospital setting. This paper describes the protocol of the development and external validation of three prognostic prediction models for relevant clinical outcomes in SVT patients seen in primary care: (i) prolonged (painful) symptoms within 14 days since SVT diagnosis, (ii) for clot progression to DVT or PE within 45 days and (iii) for clot recurrence within 12 months. METHODS Data will be used from four primary care routine healthcare registries from both the Netherlands and the UK; one UK registry will be used for the development of the prediction models and the remaining three will be used as external validation cohorts. The study population will consist of patients ≥18 years with a diagnosis of SVT. Selection of SVT cases will be based on a combination of ICPC/READ/Snowmed coding and free text clinical symptoms. Predictors considered are sex, age, body mass index, clinical SVT characteristics, and co-morbidities including (history of any) cardiovascular disease, diabetes, autoimmune disease, malignancy, thrombophilia, pregnancy or puerperium and presence of varicose veins. The prediction models will be developed using multivariable logistic regression analysis techniques for models i and ii, and for model iii, a Cox proportional hazards model will be used. They will be validated by internal-external cross-validation as well as external validation. DISCUSSION There are currently no prediction models available for predicting the risk of serious complications for SVT patients presenting in primary care settings. We aim to develop and validate new prediction models that should help identify patients at highest risk for complications and to support clinical decision making for this understudied thrombo-embolic disorder. Challenges that we anticipate to encounter are mostly related to performing research in large, routine healthcare databases, such as patient selection, endpoint classification, data harmonisation, missing data and avoiding (predictor) measurement heterogeneity.
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Affiliation(s)
- F S van Royen
- Dept. General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
| | - M van Smeden
- Dept. Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - K G M Moons
- Dept. Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - F H Rutten
- Dept. General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - G J Geersing
- Dept. General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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20
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Zosel KL, Dummar MK, Adams BG, Henderson NC, Westrick RB. Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report. Int J Sports Phys Ther 2021; 16:854-861. [PMID: 34123537 PMCID: PMC8169024 DOI: 10.26603/001c.23429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Neck pain in the United States is pervasive and contributes to disability. While the majority of neck pain in young and healthy individuals is neuromusculoskeletal in nature, screening for red flags is necessary for ruling-out serious medical pathologies. The purpose of this case report is to describe a young and healthy male subject with a primary complaint of acute neck pain with multiple underlying upper extremity superficial vein thromboses (UESVTs). CASE DESCRIPTION The subject was a 27-year-old male active-duty Soldier referred to physical therapy by his primary care provider (PCP) for acute left-sided neck pain. Prior to physical therapy, the subject had been treated with cyclobenzaprine, oxycodone-acetaminophen, trigger point injection and had undergone a D-dimer to rule out a potential thrombus due to air travel and lower extremity immobilization. OUTCOMES The subject underwent a D-dimer, Doppler ultrasound, pharmacological treatment of Rivaroxaban, and was referred to hematology/oncology to rule out systemic causes of SVTs. Evidence of subtle increases in blood pressure over the course of three months, a positive D-dimer, and symptoms incongruent with clinical presentation contributed to referral to a hematology/oncology specialist and a diagnosis of multiple UESVTs. The subject was able to return to his previous level of activity by six months and remained free of SVTs at two-year follow-up. DISCUSSION UESVT events are rare and can be challenging to identify. This case report describes a unique presentation of acute neck pain caused by underlying UESVTs in an otherwise healthy and active young male. LEVEL OF EVIDENCE Level 4.
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21
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Hesam-Shariati N, Fatehi P, Fathi F, Abouzaripour M, Hesam Shariati MB. A case report of greater saphenous vein thrombosis in a patient with coronavirus (COVID-19) infection. Trop Dis Travel Med Vaccines 2021; 7:6. [PMID: 33658082 PMCID: PMC7928195 DOI: 10.1186/s40794-021-00131-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/21/2021] [Indexed: 01/30/2023] Open
Abstract
In December 2019, the World Health Organization (WHO) announced a series of pneumonia cases caused by an unknown origin, discovered in Wuhan, China. A dangerous virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a disease named acute respiratory syndrome, which was later popularly called coronavirus infection (COVID-19). Patients with acute COVID-19 are at high risk of thrombosis in various blood vessels due to hypercoagulability, blood stasis, and endothelial damage. In this study, we present a case report of a patient with COVID-19, who was hospitalized in one of the hospitals in Sanandaj, Iran. There were symptoms of fever, chills, muscle aches, cough, and tachycardia. Laboratory tests showed high levels of CRP, ESR, Ferritin CLIA, LDH and D-Dimer in this patient. Doppler ultrasound of the patient also revealed an abnormal finding, thrombosis in the right greater saphenous vein. This suggests that COVID-19 may lead to other negative effects through damage to blood vessels.
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Affiliation(s)
- Negin Hesam-Shariati
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Poya Fatehi
- Department of Radiology, Tohid Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fardin Fathi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Morteza Abouzaripour
- Department of Anatomical Sciences, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Karathanos C, Chatzis D, Latzios P, Papakostas I, Goumas K, Giannoukas AD. Treatment of superficial vein thrombosis with intermediate dose of tinzaparin: A real word cohort study - The SeVEN EXTension study. Phlebology 2021; 36:423-431. [PMID: 33407054 DOI: 10.1177/0268355520947300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess the treatment of superficial vein thrombosis (SVT) with intermediate dose of tinzaparin in a setting of real world practice. METHODS Prospective observational study of consecutive patients treated by vascular physicians in the private sector with tinzaparin (131 IU/Kg) once daily. Treatment duration was at the treating physician's discretion. The outcomes of the study were symptomatic venous thromboembolism, extension of thrombus and bleeding complications. RESULTS 660 patients were included and followed up for at least 3 months. Median duration of treatment was 30 days (14-120). History of prior deep vein thrombosis (HR 2.77; 95% CI= 1.18-6.49; p = 0.018) and current SVT above the knee (HR1.84; 95% CI = 1.33-3.53; p = 0.0002) were associated with prolonged treatment duration. Primary efficacy outcomes occurred in 20 (3%) patients. The median time to the event was 24 (6-92) days and was not related to treatment duration. CONCLUSIONS Tinzaparin at intermediate dose is an effective and safe treatment for SVT.
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Affiliation(s)
- Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Chatzis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Panagiotis Latzios
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Papakostas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Goumas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Anemone study: prevalence of risk factors for superficial vein thrombosis in a large Italian population of blood donors. J Thromb Thrombolysis 2020; 50:689-696. [DOI: 10.1007/s11239-020-02140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Eleanor Atkins
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Nadeem A Mughal
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Patrick A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Rezziki A, Hussam A, Oussama A, Taha A, Adnane B, Omar EM. Superficial-vein thrombosis of the lower limb: A pathology that is not always benign. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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de Almeida MJ, Guillaumon AT, Miquelin D, Joviliano EE, Hafner L, Sobreira ML, Geiger MA, Moura R, Raymundo S, Yoshida WB. Guidelines for superficial venous thrombosis. J Vasc Bras 2019; 18:e20180105. [PMID: 31807127 PMCID: PMC6880617 DOI: 10.1590/1677-5449.180105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
Superficial venous thrombosis (SVT) or superficial thrombophlebitis is characterized by thrombi within superficial veins, with partial involvement or occlusion of the lumen and inflammatory reaction along the course of the vein. Clinical diagnosis tends to be straightforward, but supplementary tests and examinations are needed to confirm thrombosis extension and possible thromboembolic complications. SVT can be associated with deep venous thrombosis in 6 to 40% of cases, with asymptomatic pulmonary embolism (PE) in 20 to 33%, and with symptomatic PE in 2 to 13%. Despite the morbidity and complications, there are currently no Brazilian guidelines for SVT. These guidelines cover the most important issues related to SVT definition, terminology, and etiology, and set out recommendations for diagnosis and treatment.
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Affiliation(s)
| | | | - Daniel Miquelin
- Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Ludvig Hafner
- Faculdade de Medicina de Marília – FAMEMA, Marília, SP, Brasil.
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | | | - Regina Moura
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | - Selma Raymundo
- Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.
| | - Winston Bonnetti Yoshida
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
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Abstract
Venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) is one of the leading causes of preventable cardiovascular disease in the United States (US) and is the number one preventable cause of death following a surgical procedure. Post-operative VTE is associated with multiple short and long-term complications. We will focus on reviewing the many faces of VTE in detail as they represent common challenging scenarios in clinical practice.
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Stoyko YM, Kirienko AI, Ilyukhin EA, Lobastov KV, Chabbarov RG, Parikov MA, Khorev NG, Zolotukhin IA, Andriyashkin VV, Karpenko AA, Fokin AA, Sushkov SA, Sapelkin SV, Suchkov IA, Krylov AY, Ignatiev IM. Diagnostics and Treatment of Superficial Trombophlebitis. Guidelines of the Russian PhlebologicalAssociation. FLEBOLOGIIA 2019; 13:78. [DOI: 10.17116/flebo20191302178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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Bauersachs R, Gerlach HE, Heinken A, Hoffmann U, Langer F, Noppeney T, Pittrow D, Klotsche J, Rabe E. Rationale, design, and methodology of the observational INSIGHTS-SVT study on the current state of care and outcomes of patients with superficial vein thrombosis. J Vasc Surg Venous Lymphat Disord 2018. [PMID: 28623995 DOI: 10.1016/j.jvsv.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Superficial vein thrombosis (SVT) is a common disease in clinical practice. In terms of pathophysiology and outcomes, the condition is related to venous thromboembolism, bearing a potential for severe thromboembolic complications if it is not treated adequately. A wide range of treatment approaches (including oral and injectable anticoagulants, pain medication, nondrug therapy including compression therapy, and no treatment at all) are applied in clinical practice, but there is sparse information about selection of patients for therapies, current treatment pathways, and drug use as well as outcomes. The INvestigating SIGnificant Health TrendS in the management of Superficial Vein Thrombosis (INSIGHTS-SVT) study aims to close this gap by collecting representative data on the current treatment of SVT. METHODS The observational prospective study of about 1200 patients is carried out by up to 120 clinical and office-based physicians who regularly treat patients with SVT and are capable of conducting appropriate compression ultrasound diagnostics, such as vascular physicians, phlebologists, internists, vascular surgeons, and general practitioners. Patients are eligible for inclusion if they have ultrasound-confirmed acute, isolated SVT of the lower extremities. Documentation about the characteristics of the patients, diagnostics, comorbidities, and medical and nonmedical treatment is collected at baseline, at 10 ± 3 days or at approximately 45 days (depending on treatment), at approximately 3 months, and at approximately 12 months. Patients are requested to fill in quality of life questionnaires (on pain, Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms [VEINES-QOL/Sym], EuroQol-5 Dimension 5-Level [EQ-5D-5L]) at baseline and at approximately 3 months. Interventions are not stipulated by the trial protocol. RESULTS The primary efficacy outcome is the incidence of venous thromboembolism at 3 months; the primary safety outcome is the combined incidence of major and clinically relevant bleeding events at 3 months. As quality measures, plausibility checks at data entry, queries based on statistical analyses that focus on outliers and distribution of values, monitoring visits, and adjudication procedures will be applied. CONCLUSIONS This large study is expected to provide a comprehensive picture of patients with SVT under clinical practice conditions in Germany.
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Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Langer
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum, Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany
| | - Jens Klotsche
- Epidemiology, German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
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Kim SH, Patel N, Thapar K, Pandurangadu AV, Bahl A. Isolated proximal greater saphenous vein thrombosis and the risk of propagation to deep vein thrombosis and pulmonary embolism. Vasc Health Risk Manag 2018; 14:129-135. [PMID: 29928127 PMCID: PMC6003293 DOI: 10.2147/vhrm.s164190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Greater saphenous vein (GSV) thrombosis is concerning due to its close proximity to the deep femoral vein. This study sought to identify the risk of propagation to deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with isolated proximal GSV superficial thrombosis and describe provider practice patterns related to treatment. Materials and methods This is an Institutional Review Board-approved retrospective multi-center study. Patients presented to one of three possible emergency departments in a large health system. About 21,716 patients were queried through the electronic medical record. Ninety-five patients or 0.4% of study subjects met inclusion criteria of isolated proximal GSV thrombosis. Forty-five patients were excluded, leaving a final data set of 40 patients. Investigators recorded radiology impressions, patient demographics, past medical history, DVT/PE risk factors, and treatment plans. Propagation of GSV thrombosis to DVT/PE was also noted. Follow-up methods included chart review, primary care physician follow-up, and direct, scripted patient follow-up phone calls. Descriptive statistics were applied to study subjects using SAS for Windows, version 9.3. Results Three patients (7.5%) had progression of GSV thrombosis to DVT/PE. Twenty percent of patients without malignancy were treated with anticoagulation compared to 14% of those with preexisting malignancy upon initial diagnosis of isolated GSV thrombosis. Forty-five percent of patients were prescribed some type of supportive therapy to aid in the treatment of GSV thrombosis. Conclusion Isolated proximal GSV thrombosis, while uncommon, may frequently progress to DVT or PE. Our work suggests clinicians should consider anticoagulation for isolated GSV thrombosis.
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Affiliation(s)
- Samuel H Kim
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Nimesh Patel
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kanika Thapar
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Amit Bahl
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA
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Geersing GJ, Cazemier S, Rutten F, Fitzmaurice DA, Hoes AW. Incidence of superficial venous thrombosis in primary care and risk of subsequent venous thromboembolic sequelae: a retrospective cohort study performed with routine healthcare data from the Netherlands. BMJ Open 2018; 8:e019967. [PMID: 29678975 PMCID: PMC5914716 DOI: 10.1136/bmjopen-2017-019967] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/18/2018] [Accepted: 04/03/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Recent studies in referred populations of patients with superficial venous thrombosis (SVT) report risks of venous thromboembolic (VTE) sequelae (deep vein thrombosis or pulmonary embolism) as high as 25%. Likely, these estimates are lower in non-referred patients, but large-scale population-based studies are lacking. We aimed to estimate the incidence rate of SVT in primary care and quantify its risk of VTE sequelae. DESIGN A retrospective cohort study, using International Classification of Primary Care coding (K94.02) combined with free text searching (synonyms for SVT) to capture all SVT events. All patients were followed up for 3 months using manual free text searching. SETTING Primary care. PARTICIPANTS All patients enlisted with general practitioners within the Utrecht General Practitioner Network between 2010 and 2016 (1 534 845 person-years follow-up). MAIN OUTCOME MEASURES The incidence rate of SVT was expressed as the number of SVT events per 1000 person-years of follow-up and the 3-month cumulative incidence of VTE events was calculated. Logistic regression analysis was used to compare patients with SVT with and without VTE sequelae. RESULTS A total of 2008 SVT cases were identified, that is, an SVT incidence rate of 1.31 (95% CI 1.25 to 1.37) per 1000 person-years follow-up, with higher rates notably with increasing age. VTE sequelae occurred in 83 patients; 51 at the time of SVT diagnosis and 32 patients during follow-up (total cumulative incidence of 4.1%; 95% CI 3.3% to 5.1%), and were more frequent in those with an active malignancy (OR 2.19; 95% 0.97 to 4.95) and less frequent in those with varicose veins at baseline (OR 0.57, 95% CI 0.34 to 0.94). CONCLUSION We found an incidence rate of SVT in primary care of 1.31 per 1000 person-years. The risks of VTE sequelae was relatively low at 4.1%, with the highest risk in patients with cancer and in those who experience an SVT in the absence of varicose veins.
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Affiliation(s)
- Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Selma Cazemier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bauersachs RM. Diagnosis and treatment of superficial vein thrombosis. Hamostaseologie 2017; 33:232-40. [DOI: 10.5482/hamo-13-04-0027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 05/24/2013] [Indexed: 11/05/2022] Open
Abstract
SummarySuperficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory- thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebocontrolled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.
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Giannoukas A, Karathanos C, Nikolakopoulos K, Georgiadis GS, Maltezos C, Ioannou C, Vasdekis S, Trelopoulos G. Tinzaparin in intermediate dose for the treatment of superficial vein thrombosis: Results from an observational multicenter study—SeVEN study. Phlebology 2017; 33:636-645. [DOI: 10.1177/0268355517748540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives Low-molecular-weight heparins are recommended in the treatment of superficial vein thrombosis but with low grade of evidence. This study was conducted to assess the treatment outcomes of acute superficial vein thrombosis with intermediate dose of Tinzaparin. Methods Retrospective analysis of records from outpatients over a period of 16 months treated in seven centers with Tinzaparin 0.5 ml (10,000 anti-Xa IU) once daily for a period that was at the treating physician’s discretion. All the patients were followed up for at least 12 weeks. Results A total of 296 patients (189 females, mean age 57.4 years) were included. Two thirds of the patients (191/296, 64.5%) received treatment for approximately five weeks (mean 36.9 days) and the remaining (105/296, 35.5%) for a shorter period (mean 16.2 days). There was no difference in patients’ characteristics between the two treatment duration groups. The presence of thrombus above the knee and restricted daily activity were associated with longer period of treatment. Only one case with minor bleeding was observed. Recurrence of thrombosis over a 12-week follow-up period occurred in 6% (superficial vein thrombosis in 14 (4.7%), deep vein thrombosis in 3 (1%) and thrombus extension in the superficial veins in 1 (0.3%)). Recurrence was not related to the duration of treatment. Conclusions Intermediate dose of Tinzaparin was an effective and safe treatment for superficial vein thrombosis in the setting of real world practice. Location of thrombus and status of patients’ mobilization were associated with longer duration of treatment. Future prospective randomized studies are needed to corroborate these findings.
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Affiliation(s)
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Christos Ioannou
- Department of Vascular Surgery, University Hospital of Heraklion, Crete, Greece
| | - Spyros Vasdekis
- Department of Vascular Surgery, “ATTIKON” University Hospital, Athens, Greece
| | - Georgios Trelopoulos
- Vascular Surgery Unit, Department of Cardio-Thoracic Surgery, “Papanikolaou” Hospital, Thessaloniki, Greece
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Beyer-Westendorf J. Controversies in venous thromboembolism: to treat or not to treat superficial vein thrombosis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:223-230. [PMID: 29222259 PMCID: PMC6142594 DOI: 10.1182/asheducation-2017.1.223] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions. However, several recent observational and interventional studies provide better insight into the optimal treatment of patients with SVT who are at different risks for thromboembolic complications. This educational review summarizes the available evidence and aims to provide practical guidance based on a clinical decision pathway.
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Affiliation(s)
- Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology, Department of Medicine I, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany; and King's Thrombosis Service, Department of Hematology, King's College London, London, United Kingdom
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Bertanha M, Pimenta REF, Brandão GMS, Sobreira ML, Moura R, Jaldin RG, de Camargo PAB, Yoshida WB. Trombo flutuante em veia femoral. J Vasc Bras 2017; 16:314-319. [PMID: 29930666 PMCID: PMC5944309 DOI: 10.1590/1677-5449.005817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos.
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Affiliation(s)
- Matheus Bertanha
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Rafael Elias Farres Pimenta
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Gustavo Muçouçah Sampaio Brandão
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Regina Moura
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Rodrigo Gibin Jaldin
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Paula Angeleli Bueno de Camargo
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
| | - Winston Bonetti Yoshida
- Universidade Estadual Paulista Júlio de Mesquita Filho – UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil.
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Abstract
Venous thromboembolism (VTE) has a wide range of clinical presentations. Deep venous thrombosis may occur in upper or lower extremities or in visceral veins. Extremity deep venous thrombosis usually manifests with unilateral painful swelling in the limb, while visceral deep venous thrombosis manifestations vary on the basis of the involved organ. Pulmonary embolism classically manifests with sudden pleuritic chest pain and unexplained dyspnea. Superficial thrombophlebitis usually presents with acute inflammation around a palpable thrombosed superficial vein. Risk factors of VTE are either inherited or acquired. The inherited causes of VTE tend to be familial and more common in younger patients. The common acquired risk factors of VTE include previous history of venous thrombosis, immobilization, recent surgery or trauma, malignancy, and pregnancy. Identifying high-risk patients for VTE based on these risk factors is the cornerstone to provide the prophylactic treatment to prevent thrombotic events.
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Risk of Pulmonary Embolism in Patients With Isolated Great Saphenous Vein Thrombus. Ultrasound Q 2017; 34:167-169. [PMID: 28877099 DOI: 10.1097/ruq.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Risks associated with isolated great saphenous vein (GSV) thrombosis remain controversial. The purpose of this study is to identify the risk of pulmonary embolism (PE) in patients with isolated GSV thrombosis, particularly those with thrombus within 3 cm of the sapheno-femoral junction. A retrospective chart review of color flow Doppler lower extremity venous ultrasound examinations from an academic hospital from 2011 to 2016 was conducted. Seventy-eight patients were identified as having acute thrombus in their GSV and were then further stratified based on the presence or absence of concomitant deep venous thrombosis (DVT). A control group of 49 patients who presented with leg swelling and were found to have a normal color flow Doppler examination was also identified. Patients without thrombus (n = 49), patients with isolated GSV thrombus (n = 29), and patients with GSV thrombus with concomitant DVT (n = 49) underwent full chart review to determine whether any patients developed PE. This was diagnosed specifically by computed tomography angiogram or ventilation/perfusion scan, within 60 days of initial diagnosis of lower extremity thrombus. In our analysis, there was no significant difference in the risk of PE in patients with isolated GSV thrombus compared with a control group of normal patients (3.5% vs 2.0%, P = 0.38). However, patients with GSV thrombus and concomitant DVT had a significantly increased risk of PE compared with patients with isolated GSV thrombus (26.5% vs 3.5%, P = 0.01). We found that the risk of PE in patients with isolated GSV thrombus is not significantly increased compared with a normal cohort.
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Cesarone MR, Belcaro G, Agus G, Georgiev M, Errichi BM, Marinucci R, Errichi S, Filippini A, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Cipollone G, Lania M, Gizzi G, Ippolito E, Bavera P, Fano F, Dugall M, Adovasio R, Gallione L, Del Boccio G, Cornelli U, Steigerwalt R, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi M, Di Ciano L, Simeone E, Collevecchio G, Grossi MG, Di Giambattista F, Carestia F, Zukowski A. Management of Superficial Vein Thrombosis and Thrombophlebitis: Status and Expert Opinion Document. Angiology 2016; 58 Suppl 1:7S-14S; discussion 14S-15S. [PMID: 17478877 DOI: 10.1177/0003319706297643] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb®, Lipohep ®, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.
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Affiliation(s)
- M R Cesarone
- Vascular Lab, Department of Biomedical Science, G D'Annunzio University, Pescara; San Valentino Vascular Screening Project, Italy
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Tepper NK, Marchbanks PA, Curtis KM. Superficial venous disease and combined hormonal contraceptives: a systematic review. Contraception 2016; 94:275-9. [DOI: 10.1016/j.contraception.2015.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
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Karathanos C, Spanos K, Lachanas V, Athanasoulas A, Giannoukas AD. Patterns in the management of superficial vein thrombosis. Phlebology 2016; 32:207-213. [PMID: 27052040 DOI: 10.1177/0268355516641003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To highlight current practice patterns in management of superficial vein thrombosis. Methods An electronic survey was conducted using the mailing lists of the Mediterranean League of Angiology and Vascular Surgery and European Venous Forum regarding superficial vein thrombosis diagnosis, investigation, and treatment. Results The response rate was 41% (175/430) and the majority of the participants were vascular surgeons practicing in a hospital. More experienced physicians considered superficial vein thrombosis as a medical issue of moderate seriousness and performed duplex ultrasound for confirmation of diagnosis. Elastic stockings were recommended by 87% of the physicians, while 57% prescribed nonsteroidal anti-inflammatory drugs. Eighty six percent advised anticoagulation, although a large disparity was shown regarding regime, dose, and duration. Thrombophilia test was regularly suggested by 19% of the physicians. Ligation of the saphenofemoral junction was the treatment of choice by those who suggested intervention in the acute phase of superficial vein thrombosis. Conclusions A great disparity exists in the management of superficial vein thrombosis. Current guidelines have not been adopted by physicians; more focused training is needed for those involved in the management of venous diseases.
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Affiliation(s)
- Christos Karathanos
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vasileios Lachanas
- 2 Department of Otorhinolaryngology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Athanasios Athanasoulas
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Abstract
Objective To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Materials and methods Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical–etiology–anatomy–pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Results Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Conclusions Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term.
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Rikimaru H. Clinical Features and Developing Risks of Saphenous Vein Thrombophlebitis. Ann Vasc Dis 2016; 9:85-90. [PMID: 27375800 DOI: 10.3400/avd.oa.16-00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
We evaluated the clinical features and the risks of 14 patients with 14 limbs affected by saphenous vein thrombophlebitis from April 2007 to May 2013 and compared the results with patients undergoing operative repair of varicose veins (127 patients, 193 limbs) during the study period. The frequency of patients with a body mass index over 25 (78.6% vs. 35.3%, p = 0.0018), varicose change in the saphenous vein (78.6% vs. 6.2%, p <0.0001), and concurrent thrombosis in another vein (50.0% vs. 7.1%, p <0.0001) were all significantly higher than those of the patients under operative repair for varicose veins. These patients with clinical features above may be at an elevated risk of thrombophlebitis of the saphenous trunk. (This article is a translation of J Jpn Coll Angiol 2014; 54: 151-157).
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Affiliation(s)
- Hiroto Rikimaru
- Department of Vascular Surgery, Tome City Hospital, Tome, Miyagi, Japan
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Marker BA, Barber LG, Clifford CA, Correa SS, Thalhofer PL, LaDue TA, Mullin CM, Sauerbrey ML, Wood CC. Extravasation reactions associated with the administration of pamidronate: 11 cases (2008-2013). Vet Comp Oncol 2016; 15:470-480. [PMID: 27174040 DOI: 10.1111/vco.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022]
Abstract
Pamidronate is a bisphosphonate drug widely utilized in veterinary oncologic practice for the palliation of malignant osteolysis. Pamidronate has not been previously reported to cause tissue injury upon extravasation in dogs. The medical records of 11 client-owned dogs undergoing palliative treatment for primary bone tumors with known or suspected pamidronate extravasation reactions were reviewed. The majority of adverse events were low grade in nature, however in some cases, the reactions were severe and led to euthanasia in one instance. Time to complete resolution of lesions ranged from within several days to greater than one and a half months. Aside from the dog that was euthanized, no long-term sequelae of extravasation were identified. Treatments employed to address the reactions varied widely. Pamidronate extravasation reaction appears to be an uncommon, but potentially serious complication of intravenous administration.
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Affiliation(s)
- B A Marker
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - L G Barber
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - C A Clifford
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - S S Correa
- Animal Cancer Care Clinic, Ft. Lauderdale, FL, 33304, USA
| | - P L Thalhofer
- Metropolitan Veterinary Hospital, Akron, OH, 44321, USA
| | - T A LaDue
- Southeast Veterinary Oncology, Orange Park, FL, 32073, USA
| | - C M Mullin
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - M L Sauerbrey
- Oakland Veterinary Referral Services, Bloomfield Hills, MI, 48302, USA
| | - C C Wood
- Veterinary Referral and Emergency Center of Westbury, Westbury, NY, USA
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Di Minno MND, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost 2016; 14:964-72. [PMID: 26845754 DOI: 10.1111/jth.13279] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials The association of superficial vein thrombosis (SVT) with venous thromboembolism (VTE) is variable. We performed a meta-analysis to assess the prevalence of concomitant VTE in patients with SVT. Deep vein thrombosis was found in 18.1%, and pulmonary embolism in 6.9%, of SVT patients. Screening for VTE may be worthy in some SVT patients to plan adequate anticoagulant treatment. SUMMARY Background Some studies have suggested that patients with superficial vein thrombosis (SVT) have a non-negligible risk of concomitant deep vein thrombosis (DVT) or pulmonary embolism (PE) at the time of SVT diagnosis. Unfortunately, the available data on this association are widely variable. Objectives To perform a systematic review and meta-analysis of the literature in order to evaluate the prevalence of concomitant DVT/PE in patients with SVT of the lower limbs. Methods Studies reporting on the presence of DVT/PE in SVT patients were systematically searched for in the PubMed, Web of Science, Scopus and EMBASE databases. The weighted mean prevalence (WMP) of DVT and PE was calculated by use of the random effect model. Results Twenty-one studies (4358 patients) evaluated the prevalence of DVT and 11 studies (2484 patients) evaluated the prevalence of PE in patients with SVT. The WMP of DVT at SVT diagnosis was 18.1% (95%CI: 13.9%, 23.3%) and the WMP of PE was 6.9% (95%CI: 3.9%, 11.8%). Heterogeneity among the studies was substantial. Selection of studies including outpatients only gave similar results (WMP of DVT, 18.2%, 95% CI 12.2-26.3%; and WMP of PE, 8.2%, 95% CI 3.3-18.9%). Younger age, female gender, recent trauma and pregnancy were inversely associated with the presence of DVT/PE in SVT patients. Conclusions The results of our large meta-analysis suggest that the prevalence of DVT and PE in patients presenting with SVT is not negligible. Screening for a major thromboembolic event may be worthwhile in some SVT patients, in order to allow adequate anticoagulant treatment to be planned. Other high-quality studies are warranted to confirm our findings.
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Affiliation(s)
- M N D Di Minno
- Division of Cardiology - Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - F Ambrosini
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Tremoli
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - F Dentali
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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Yazdani M, Lau CT, Lempel JK, Yadav R, El-Sherief AH, Azok JT, Renapurkar RD. Historical Evolution of Imaging Techniques for the Evaluation of Pulmonary Embolism. Radiographics 2016; 35:1245-62. [PMID: 26172362 DOI: 10.1148/rg.2015140280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As we celebrate the 100th anniversary of the founding of the Radiological Society of North America (RSNA), it seems fitting to look back at the major accomplishments of the radiology community in the diagnosis of pulmonary embolism. Few diseases have so consistently captured the attention of the medical community. Since the first description of pulmonary embolism by Virchow in the 1850s, clinicians have struggled to reach a timely diagnosis of this common condition because of its nonspecific and often confusing clinical picture. As imaging tests started to gain importance in the 1900s, the approach to diagnosing pulmonary embolism also began to change. Rapid improvements in angiography, ventilation-perfusion imaging, and cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging have constantly forced health care professionals to rethink how they diagnose pulmonary embolism. Needless to say, the way pulmonary embolism is diagnosed today is distinctly different from how it was diagnosed in Virchow's era; and imaging, particularly CT, now forms the cornerstone of diagnostic evaluation. Currently, radiology offers a variety of tests that are fast and accurate and can provide anatomic and functional information, thus allowing early diagnosis and triage of cases. This review provides a historical journey into the evolution of these imaging tests and highlights some of the major breakthroughs achieved by the radiology community and RSNA in this process. Also highlighted are areas of ongoing research and development in this field of imaging as radiologists seek to combat some of the newer challenges faced by modern medicine, such as rising health care costs and radiation dose hazards.
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Affiliation(s)
- Milad Yazdani
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruchi Yadav
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ahmed H El-Sherief
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Rahul D Renapurkar
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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Cascella M, Viscardi D, Bifulco F, Cuomo A. Postoperative Massive Pulmonary Embolism Due to Superficial Vein Thrombosis of the Upper Limb. J Clin Med Res 2016; 8:338-41. [PMID: 26985256 PMCID: PMC4780499 DOI: 10.14740/jocmr2362w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/02/2022] Open
Abstract
It is well known that deep vein thrombosis of the upper extremities is linked to high morbidity/mortality, resulting in 12-20% of all documented pulmonary embolism; however, there are few data about thromboembolism originating from a vein and/or a branch of a superficial vein of the upper extremities. Pulmonary embolism secondary to upper limb superficial vein thrombosis (not combined with upper extremities deep vein thrombosis) is a very rare clinical manifestation with few cases reported in the literature. We report a rare case of thrombophlebitis in departure from a superficial branch of the cephalic vein of the right arm, complicated by cardiac arrest secondary to a massive pulmonary embolism in a patient who underwent major surgery for ovarian cancer. We discuss on the numerous thrombotic risk factors, triggering a cascade of reactions and resulting in a potential fatal clinical manifestation.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesiology, Department of Anesthesiology, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - Daniela Viscardi
- Division of Anesthesiology, Department of Anesthesiology, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - Francesca Bifulco
- Division of Anesthesiology, Department of Anesthesiology, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesiology, Department of Anesthesiology, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
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Saghazadeh A, Rezaei N. Inflammation as a cause of venous thromboembolism. Crit Rev Oncol Hematol 2016; 99:272-85. [DOI: 10.1016/j.critrevonc.2016.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 11/27/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022] Open
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Baha A, Mehmet Baha R, Eroglu V, Logoglu A, Kemal Icen Y. Massive Pulmonary Embolism Following Varicose Vein Surgery That Was Successfully Treated with Thrombolytic Therapy. Intern Med 2016; 55:1907-10. [PMID: 27432101 DOI: 10.2169/internalmedicine.55.5068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk of massive pulmonary thromboembolism (PTE) secondary to varicose vein surgery is very low. There are only two cases which have been reported regarding massive PTE occurring after varicose vein surgery. We herein present the case of a woman who had suffered from chest pain. A short period following her admission to the emergency department, she had cardiac arrest and was subsequently diagnosed with massive PTE. Thrombolytic therapy was administered and her clinical status dramatically improved thereafter. Massive PTE may occur after minor surgical procedures, and thrombolytic therapy can safely be administered after cardiopulmonary resuscitation.
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Affiliation(s)
- Ayse Baha
- Department of Pulmonary Medicine, Osmaniye National Hospital, Turkey
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Zavala-Hernández C, Hernández-Zamora E, Martínez-Murillo C, Majluf-Cruz A, Vela-Ojeda J, García-Chávez J, Reyes-Maldonado E. Risk Factors for Thrombosis Development in Mexican Patients. Ann Vasc Surg 2015; 29:1625-32. [DOI: 10.1016/j.avsg.2015.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 05/01/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
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