Value of Doppler ultrasound in diagnosis of clinically suspected deep vein thrombosis.

Doppler ultrasound was used to study 120 legs of 106 patients with suspected deep vein thrombosis (DVT) or pulmonary embolism. Venography was subsequently performed in all. DVT was confirmed by venography in 44 legs and was confined to the calf in 10 of these. Ultrasound detected three calf thromboses and 29 out of 34 more extensive thromboses. Of five undetected thrombi that were proximal to the calf one was associated with partial occlusion and four with extensive collateral circulation. Of the 76 limbs without venographic evidence of thrombosis 21 were thought to have DVT by ultrasound; 18 of these false-positive results could be attributed to external compression of veins, two to excessive tenderness precluding adequate examination; and in one no explanation was found. This test gives more accurate results than judging by clinical signs alone, but users must be aware of its limitations and, particularly, the causes of false-positive and false-negative results.     

Ultrasound diagnosis in endoprosthesis of lower extremity arterial aneurysms with "Hemobahn"- and "Viabahn"-eluted stents

The paper presents the results of color duplex scanning (CDS) in 7 patients treated at the Unit of Vascular Surgery, Clinical Hospital No. 83, from 2002 to 2006, in whom 5 Hemobahn grafting stents and 2 Viabahm ones were implanted into the lower limb arterial aneurysms and the proximal anastomoses of the iliofemoral alloshunts "Gore-tex". A grafting stent was individually selected for each specific case. All the examinees were males. The patients' age was 60 to 70 years. The results of endovascular interventions were assessed, by analyzing color duplex scanning (CDS) of a grafting stent implantation area in early postoperative periods (days 1-3), further by the scheme following 1, 3, 6, and 12 months and then twice a year. Endovascular intervention areas were studied by the standard procedure on Logic-500 and Vivid-700 ultrasound apparatuses (USA) with a 7.5-MHz linear transducer and a 3.5-MHz convection transducer. In the postoperative period, multiprojection scanning was used to detect stent configuration impairments. According to the data of examination using the CDS technique, a surgical success was noted in 100% of cases. In all cases, stage, adequate aneurysmal stenting along with the restoration of the geometry of proximal anastomoses of iliofemoral alloshunts, iliac and superficial femoral arteries with exclusion of aneurysms from blood flow was diagnosed at a hospital stage. Follow-up ultrasonography revealed no changes in the area of endovascular intervention. Thus, as a highly informative, noninvasive technique, CDS can assess the results of implantation of grafting stents into the arteries and shunts of the lower extremities in both early and late postoperative periods.     

Prophylaxis of postoperative leg vine thrombosis by low dose subcutaneous heparin or peroperative calf muscle stimulation: a controlled clinical trial.

In a randomized, controlled clinical trial of two methods of preventing postoperative leg vein thrombosis patients undergoing major surgery were divided into three groups. One received intermittent electrical calf muscle stimulation during surgery, the second subcutaneous heparin calcium 5000 IU every eight hours for six days, and the third no specific prophylaxis. Leg vein thrombosis was detected by the 125-I-fibrinogen uptake test. Neither method was effective in patients undergoing open bladder or prostatic surgery. Stimulation did not reduce the incidence of leg vein thrombosis in patients with malignant disease undergoing laparotomy, but heparin calcium was highly successful in this group (P smaller than 0-001). When the laparotomy was for a benign condition, however, both heparin calcium (P smaller than 0-001) and stimulation (P smaller than 0-01) were effective.     

Dextran and intermittent pneumatic compression in prevention of postoperative deep vein thrombosis: multiunit trial.

Seven general surgical units co-operated in a clinical trial of dextran 70 and pneumatic calf compression alone and in combination in the preventing of 125I-fibrinogen-detectable deep vein thrombosis in 305 patients. Both dextran regimens were significantly more effective than pneumatic compression alone. Pulmonary embolism was diagnosed in 14 patients, but there was no significant difference in incidence among the three treatment groups. In patients receiving dextran there was no greater median operative blood loss but there was a significantly greater incidence of postoperative bleeding complications.     

Prevention of Postoperative Deep Vein Thrombosis in Patients with Malignant Disease

We have used the ¹²⁵I-fibrinogen test to asses the value of an improved method of peroperative intermittent calf compression as a prophylactic measure against postoperative thrombosis. In a group of 99 patients over the age of 40 undergoing operations lasting more than 30 minutes the technique reduced the incidence of postoperative thrombosis by over 75%. In patients suffering from malignant disease, who are generally considered to be in the very high risk category, the reduction achieved was almost 90%.     

Prevention of Deep Vein Thrombosis by Intermittent Pneumatic Compression of Calf

A consecutive, randomly allocated, controlled clinical trial of the prophylactic effect of intermittent pneumatic compression of the calf on the incidence of postoperative deep vein thrombosis showed that in patients without malignant disease there was a highly significant reduction in the incidence of thrombosis. In patients with malignant disease the incidence of thrombosis was higher than in those without, and there was no reduction in incidence by the application of intermittent compression. In the absence of malignant disease, severity of operation and the age of the patient were the most significant aetiological factors. We found no relation between the incidence of deep venous thrombosis and obesity, length of preoperative stay, location of hospital, or duration of anaesthesia. We suggest that intermittent pneumatic compression as used in this trial is a safe, effective, and extremely practical method of preventing postoperative deep vein thrombosis in patients not suffering from malignant disease.     

Continuous measurement of aortic blood velocity,after cardiac surgery,by means of an extractable doppler ultrasound probe

A new method has been developed for the continuous measurement of aortic blood velocity in patients following cardiac surgery. Using an extractable Doppler ultrasound probe placed on the ascending aorta, the changes in aortic velocity were recorded up to 24 h postoperatively, in 14 patients undergoing coronary bypass surgery. Volume flow rate is calculated from the mean velocity, the diameter of the aorta and the angle between the ultrasound beam and the direction of the blood flow, by means of an analogue flow calculator. Estimation of aortic flow showed a correlation of r = 0.79 with cardiac output measured by a thermodilution technique. The main advantage of the system is that it allows continuous monitoring of cardiac output, as well as short and long-term trend analyses, during the early postoperative period.     

Position of patient and respiratory function in immediate postoperative period.

Respiratory function was studied in 19 patients placed in both the supine and sitting positions in the early postoperative period. Although the sitting position was expected to improve respiratory function, no such advantage was found; instead, a small but statistically significant deterioration in arterial oxygenation was found in most patients when sitting up. It is concluded that no respiratory benefit should be expected from sitting patients up in the early postoperative period.     

Puerperal Thromboembolic Disease in “High Risk” Cases

One hundred obstetric patients were studied for evidence of puerperal thromboembolic disease. Only one case of deep vein thrombosis was detected in patients thought to be in a “high risk” category because of age or operative intervention. Clinical findings were unreliable compared with measurements of ¹²⁵I-labelled fibrinogen uptake. Doppler ultrasound flow detection proved a simple screening technique but produced no abnormal findings in this series.     

Heparin in the Prevention of Deep Vein Thrombosis after Myocardial Infarction

A trial of continuous intravenous heparin in the prevention of deep vein thrombosis was undertaken in 48 patients who had suffered a myocardial infarction. Of the 24 control patients who did not receive heparin seven (29%) developed calf vein thrombosis as detected by the radioactive fibrinogen technique. None of the 24 heparinized patients had any evidence of venous thrombosis. This difference is significant at the 1% level.     

Early neurological complications of coronary artery bypass surgery.

A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports.     

Prevention of Early Postoperative Deep Vein Thrombosis by Passive Exercise of Leg during Surgery

A clinical trial assessed the effect of passive exercise of the lower limb during surgery on the incidence of early postoperative deep vein thrombosis. Thrombosis was diagnosed by means of the ¹²⁵I-fibrinogen uptake test. Passive exercise of the lower limb during the operation was achieved by using a motorized foot mover designed for use on supine subjects, and by pedalling only one leg each patient acted as his own control.In a sequential statistical analysis, 47 patients were required to reach the 5% level of significance. Thrombosis was detected in 11 control (unpedalled) legs alone, and in only one pedalled leg alone. Two patients developed thrombosis bilaterally. The investigation shows that the incidence of early thrombosis in legs which were exercised during surgery was reduced by 77%.     

Safety of withholding anticoagulation in pregnant women with suspected deep vein thrombosis following negative serial compression ultrasound and iliac vein imaging

Background:

Compression ultrasonography performed serially over a 7-day period is recommended for the diagnosis of deep vein thrombosis in symptomatic pregnant women, but whether this approach is safe is unknown. We evaluated the safety of withholding anticoagulation from pregnant women with suspected deep vein thrombosis following negative serial compression ultrasonography and iliac vein imaging.

Methods:

Consecutive pregnant women who presented with suspected deep vein thrombosis underwent compression ultrasonography and Doppler imaging of the iliac vein of the symptomatic leg(s). Women whose initial test results were negative underwent serial testing on 2 occasions over the next 7 days. Women not diagnosed with deep vein thrombosis were followed for a minimum of 3 months for the development of symptomatic deep vein thrombosis or pulmonary embolism.

Results:

In total, 221 pregnant women presented with suspected deep vein thrombosis. Deep vein thrombosis was diagnosed in 16 (7.2%) women by initial compression ultrasonography and Doppler studies; none were identified as having deep vein thrombosis on serial testing. One patient with normal serial testing had a pulmonary embolism diagnosed 7 weeks later. The overall prevalence of deep vein thrombosis was 7.7% (17/221); of these, 65% (11/17) of cases were isolated to the iliofemoral veins and 12% (2/17) were isolated iliac deep vein thromboses. The incidence of venous thromboembolism during follow-up was 0.49% (95% confidence interval [CI] 0.09%–2.71%). The sensitivity of serial compression ultrasonography with Doppler imaging was 94.1% (95% CI 69.2%–99.7%), the negative predictive value was 99.5% (95% CI 96.9%–100%), and the negative likelihood ratio was 0.068 (95% CI 0.01–0.39).

Interpretation:

Serial compression ultrasonography with Doppler imaging of the iliac vein performed over a 7-day period excludes deep-vein thrombosis in symptomatic pregnant women.Over the last 2 decades, venous compression ultrasonography has become the imaging test of choice for diagnosing deep vein thrombosis in the lower extremities of men and nonpregnant women.^1–4 Although this test is highly sensitive (about 97%) for deep vein thrombosis involving the femoral and popliteal veins, compression ultrasonography is less sensitive for the detection of isolated deep vein thrombosis in the calf.⁵ Because proximal propagation of isolated calf deep vein thrombosis occurs in about 20% of cases, serial compression ultrasonography performed over a 7-day period is recommended to definitely exclude such thromboses if the results of the initial compression ultrasound are negative.⁶The use of serial compression ultrasonography in symptomatic men and nonpregnant women has been validated in prospective studies,^1,7 suggesting that withholding anticoagulation from symptomatic patients whose serial compression ultrasound results are negative is safe, with less than 2% of patients subsequently being diagnosed with deep vein thrombosis.^1,7,8 Although the use of serial compression ultrasonography has not been validated in pregnant women, this strategy is also advocated for symptomatic pregnant women.⁹The appeal of using compression ultrasonography for diagnosing deep vein thrombosis in pregnant women is obvious: it is noninvasive, widely available and does not expose the fetus to ionizing radiation. However, generalizing results from studies involving men and nonpregnant women to pregnant women is problematic because of differences in clinical presentation and anatomic distribution of deep vein thromboses.¹⁰ Compared with men and nonpregnant women, pregnant women more often present with very proximal deep vein thrombosis (including isolated iliac vein deep vein thrombosis); isolated distal calf deep vein thromboses are infrequent.¹⁰ In a recent review of the literature, we found that 62% of all deep vein thromboses in symptomatic pregnant women were in the iliofemoral veins, 17% were in the iliac vein alone, and 6% were in the calf veins.¹⁰ In contrast, in the general population, more than 80% of deep vein thromboses involved calf veins, and iliofemoral deep vein thromboses or isolated iliac veins are uncommon (< 5%).^1–4Physiologic changes associated with pregnancy might affect blood flow patterns and normal compressibility of the proximal veins, thereby affecting the diagnostic accuracy of compression ultrasonograpy. This technique cannot be used to detect isolated deep vein thromboses in the iliac vein; these veins are not compressible because of their intrapelvic location. Whether Doppler studies are sensitive for detecting deep vein thromboses in these high proximal veins (i.e., iliac veins) has not been well studied, but data suggest that this method of detection compares favourably to compression ultrasonography in men and nonpregnant women for proximal deep vein thromboses.¹¹ The use of Doppler imaging in pregnant women for the purpose of detecting iliac vein deep vein thromboses has been reported in the literature,^12,13 but it has not been adequately evaluated.Currently, the standard practice of diagnosing deep vein thrombosis in symptomatic pregnant women is by compression ultrasonography. If the results of the compression ultrasound are negative, Doppler imaging of the iliac vein (with or without vagal manoeuvres) is recommended, particularly for women with a high clinical probability of deep vein thrombosis in the iliac vein.^9,12,13 This diagnostic approach is advocated despite the absence of any prospective studies validating its use. In this study, we evaluated the diagnostic accuracy of serial compression ultrasonography and Doppler imaging of the iliac veins over a 7-day period among symptomatic pregnant women.     

Capacities of ultrasound study in a follow-up of patients with lower extremity varicose veins after phlebectomy

The study was undertaken to estimate the capacities of triplex ultrasound angioscanning in patients with lower extremity varicose veins in the late period after phlebectomy. Seventy patients operated on for the underlying disease were examined. According to the duration of the underlying disease, all the patients were divided into 4 groups: 1) 4 (5.7%) patients had a 5-year history of lower limb varicose veins; 2) 16 (22.9%) had a 5-to-15-year history; 3) 42 (60%) had a 15-to-25-year history; 4) 8 (11.4%) had a more than 25-year history. The ultrasonic marker of recurrent lower limb varicose veins was the re-emergence of dilated saphenous and perforating veins, as well as valve apparatus failure in the operated leg. In groups 1, 2, and 3, a recurrence of the underlying disease was detected just 2 years after surgical treatment. Good results could be obtained with multimodality treatment: phlebosclerotherapy at early stages of the disease, followed by phlebectomy, or multiple phlebosclerotherapy from the earliest stages. Ultrasound study (USS) is the most rational method for screening diagnosis in case of abnormal veins of the lower extremities in the postoperative period. USS carried out at early disease stages and in the postoperative period permits prevention of recurrent lower limb varicose veins.     

彩超检查在肾脏恶性肿瘤诊断及治疗中的应用

目的:探讨应用彩超在肾脏恶性肿瘤诊断及治疗中的应用效果。方法:回顾分析2006年1月~2010年12月在我院采用彩超确诊的肾脏恶性肿瘤138例,所有患者均采用LOGIQ-7彩色多普勒超声诊断仪进行检测并行手术治疗,术后均行病理检查。结果:138例患者彩超影像显示瘤体内具有丰富的动静脉血流信号,诊断为肾脏恶性肿瘤,与病理诊断完全相符。结论:彩超检查可以明确肾脏肿瘤的性质和范围,以供临床决定手术方式,也可用于术后复查。     

股神经阻滞和收肌管阻滞对全膝关节置换术后下肢静脉血栓形成的影响

目的:探究股神经阻滞(femoral nerve block,FNB)和收肌管阻滞(adductor canal block,ACB)对全膝关节置换术(total knee arthroplasty,TKA)后下肢静脉血栓形成的影响。方法:将2019年3月-2019年4月拟在全身麻醉下行全膝关节置换术的40例患者随机分为FNB组和ACB组,所有患者均给予超声引导下单次注射,术后均给予标准化抗凝治疗。术后评估两组患者不同时间节点的疼痛评分、股四头肌肌力及术后下肢静脉血栓形成情况。结果:两组患者术后2、6、12、24、48、72 h患肢术区局部疼痛的VAS评分差异无统计学意义(P0.05)。ACB组患者术后2、6、12、24、48 h股四头肌肌力均明显高于FNB组(P0.05),术后72 h两组患者股四头肌肌力无明显差异(P0.05)。ACB组在术后患者首次直腿抬高时间(4.5±4.6)h,显著低于FNB组在术后患者首次直腿抬高时间(25.6±12.6)h,两组对比差异有统计学意义(P0.05)。术后72 h给予两组患者复查双下肢血管超声,复查结果显示,FNB组19例患者中共有2例出现下肢静脉血栓,均为肌间隙静脉血栓形成;ACB组20例患者中无患者出现下肢静脉血栓形成,差异无有统计学意义(P0.05)。结论:FNB与ACB在全膝关节置换术后镇痛方面无明显差异,但ACB组较好的保留患者术后早期股四头肌肌力,对于术后功能锻炼和快速康复有较积极的作用,两种神经阻滞方式对患者VTE风险的影响相同。     

Prevention of Postoperative Leg Vein Thrombosis by Electrical Muscle Stimulation. An Evaluation with 125I-Labelled Fibrinogen

In a prospective trial of preventing deep vein thrombosis electrical stimulation of the calf muscles of one leg was used in 110 patients undergoing major surgery. Deep vein thrombosis was detected by means of the ¹²⁵I-fibrinogen uptake test in nine of the stimulated legs and in 23 of the unstimulated legs. It is suggested that this technique, which is both simple and effective, should be used on all patients undergoing major surgery.     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。     

Prevention of Early Postoperative Deep Vein Thrombosis by Intermittent Compression of the Leg during Surgery

A clinical trial is described in which the effect of intermittent compression of the lower limb during surgery on the incidence of early postoperative deep vein thrombosis was assessed. Deep vein thromboses were diagnosed by the ¹²⁵I-fibrinogen uptake test. Peroperative intermittent compression was achieved by means of an inflatable plastic splint coupled to a pneumatic controller. By compressing only one leg of each patient, each patient acted as his own control.With a sequential statistical analysis, 39 patients were required to pass the 5% level of significance. Eleven thrombi were detected in the control (uncompressed) legs and two occurred in the compressed legs; one of the latter was bilateral. The investigation shows that increasing the pulsatility of the venous flow in the leg is a potent prophylactic against postoperative deep vein thrombosis.     

Deep venous thrombosis and occult malignancy: an epidemiological study.

OBJECTIVE--To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. DESIGN--Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. SUBJECTS--4399 patients who had phlebography in one hospital. SETTING--General hospital in Malmö, Sweden, serving a population of 230,000. MAIN OUTCOME MEASURE--Number of cancers recorded. RESULTS--4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. CONCLUSION--Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.