femoral thrombosis literature search

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

femoral thrombosis literature search

Postby Cece » Thu Mar 10, 2011 8:28 am

http://jama.ama-assn.org/content/140/5/476.short

The early diagnosis of thrombosis of the deep veins of the legs is one of the most difficult, as well as most important diagnoses doctors have to make. The condition, frequently, is unsuspected until embolism occurs. This missed diagnosis may cause a serious or a fatal complication. While surgical or anticoagulant therapy, or a combination of the two, can reduce effectively these complications, the diagnosis must be made first.

In a previous report on the diagnosis and treatment of thrombosis of the deep veins of the leg, I briefly mentioned the presence of three dilated veins over the tibia as an early sign.1 Since then, this phenomenon has been observed so consistently that the term "sentinal" veins has been coined for it. I believe that these veins are the earliest objective sign of deep vein thrombosis and that attention should be directed to their presence so that effective therapy ...

The tibia is one of the leg bones below the knee. If you've had CCSVI venoplasty with entry through the femoral vein and you exhibit any of the symptoms of deep vein thrombois (swelling? dilated veins over the tibia?), consider seeing a doctor to get this checked out. It's a newly reported complication, I've only heard of one patient having had this but there may be more that have gone unreported.
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Postby Cece » Thu Mar 10, 2011 8:29 am

Incidence of Deep Venous Thrombosis Associated with Femoral Venous Catheterization
Nabeela Z. Mian MD1, Robert Bayly MD1,2, David M. Schreck MD1,3,*, Eva B. Besserman DO1, David Richmond MD1,4

ABSTRACT
Objective: To determine in adult medical patients the incidence of deep venous thrombosis (DVT) resulting from femora] venous catheterization (FVC).

Methods: A prospective, observational study was performed at a 420-bed community teaching hospital. Hep-arin-coated 7-Fr 20-cm femoral venous catheters were inserted unilaterally into a femoral vein. Each contra-lateral leg served as a control site. Age, gender, number of FVC days. DVT risk factors, administration of DVT prophylaxis, and DVT formation and site were tabulated for each patient. Venous duplex sonography was performed bilaterally on each patient within 7 days of femoral venous catheter removal.

Results: Catheters were placed in 29 men and 13 women. Femoral DVT was identified by venous duplex sonography in 11 (26.2%) of the FVC legs and none (0%) in the control legs. Posterior tibial and popliteal DVT was identified in both the FVC and control legs of 1 patient. DVT formation at the site of FVC insertion was highly significant (p = 0.005). There were no statistically significant associations with age (p = 0.42), gender (p = 0.73), number of DVT risk factors (p = 0.17), number of FVC days (p = 0.89), or DVT prophylaxis (p — 099).

Conclusion: Placement of femoral catheters for central venous access is associated with a significant incidence of femoral DVT as detected by venous duplex sonography criteria at the site of femoral venous catheter placement. Physicians must be aware of this risk when choosing this vascular access route for adult medical patients. Further studies to assess the relative risk for DVT and its clinical sequelae when using the femoral vs other central venous catheter routes are indicated.

http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract
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Postby Cece » Thu Mar 10, 2011 8:32 am

Femoral Catheters and Deep Venous Thrombosis: A Prospective Evaluation With Venous Duplex Sonography

Journal of Trauma-Injury Infection & Critical Care:


Abstract
Femoral vein cannulation (FVC) with 8.5F Swan-Ganz catheter introducers allows expeditious intravenous access and rapid volume infusion; however, the incidence of associated iliofemoral deep venous thrombosis (DVT) is unknown. Trauma patients (n = 76) requiring unilateral FVC were prospectively entered into a study where they were resuscitated via FVC and serially evaluated with bilateral venous duplex sonography (VDS). The incidence of DVT in catheterized femoral veins was compared with that in uncatheterized femoral veins. Catheters were removed promptly and VDS was performed within 24 hours and weekly for 1 month. Iliofemoral DVTs were identified in 11 of the 76 patients (14%). Iliofemoral DVTs occurred on the cannulated side in 9 (81.8%) compared with 2 (18.2%) on the uncannulated side (p < 0.05). We conclude that the use of the 8.5F FVC is associated with an increased incidence of DVT and that despite its convenience, this technique should not be routine.

http://journals.lww.com/jtrauma/Abstrac ... __A.3.aspx
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Postby Cece » Thu Mar 10, 2011 8:35 am

http://journals.lww.com/ccmjournal/Abst ... _A.13.aspx

Critical Care Medicine:
December 1997 - Volume 25 - Issue 12 - pp 1982-1985
Clinical Investigations
Lower extremity deep vein thrombosis: A prospective, randomized, controlled trial in comatose or sedated patients undergoing femoral vein catheterization
Durbec, Oliver MD; Viviand, Xavier MD; Potie, Frederic MD; Vialet, Renaud MD; Martin, Claude MD

...

Conclusions: Femoral vein catheterization with a polyurethane catheter is associated with a lower rate of extremity deep vein thrombosis which is similar to the rate observed after superior vena cannulation in comatose or sedated patients. Femoral vein thrombosis was observed at a rate of 6.6% after femoral vein cannulation and a rate of 3% after superior vena cava cannulation. Given the acceptable rate of this clinically important complication, femoral vein cannulation offers an attractive alternative to insertion via the vena cava in the critically ill. (Crit Care Med 1997; 25:1982-1985)
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Postby Cece » Thu Mar 10, 2011 8:36 am

Prevention of Venous Thrombosis With Small, Subcutaneous Doses of HeparinAlexander S. Gallus, MB, BS; Jack Hirsh, MD; Stephen E. O'Brien, MD; John A. McBride, MB, ChB; Robert J. Tuttle, MD; Michael Gent, MSc
[+] Author Affiliations

From the departments of hematology (Dr Gallus), surgery (Dr O'Brien), and radiology (Dr Tuttle), St Joseph's Hospital; the departments of pathology (Drs Gallus, Hirsh, and McBride), medicine (Drs Gallus and Hirsh), clinical epidemiology and biostatistics (Mr Gent), McMaster University; and the Department of Hematology, Henderson General Hospital, Hamilton, Ontario.

Abstract

The effect of low-dose heparin prophylaxis on venous thrombosis and bleeding after major elective surgery was studied in a prospective controlled study of 820 patients. The total incidence of venous thrombosis detected with leg-scanning using fibrinogen labeled with radioactive iodine (125I) was reduced from 16.0% in the control group to 4.2% in treated patients. More important, the incidence of popliteal or femoral vein thrombosis was reduced from 2.9% to 1.0%. Prophylaxis resulted in a slight increase in bleeding—minor wound hematoma, mean volume of blood transfused, and a postoperative hematocrit fall in treated patients. However, increased bleeding was clinically minor, and prophylaxis was well tolerated.


http://jama.ama-assn.org/content/235/18/1980.abstract
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Postby Cece » Thu Mar 10, 2011 8:40 am

Deep Venous Thrombosis Caused by Femoral Venous Catheters in Critically Ill Adult Patients*
Gavin M. Joynt, MBBCh, Jacqueline Kew, MBBCh, Charles D. Gomersall, MBBS † , Vivian Y. F. Leung, PDDR, MPhil and Eric K. H. Liu, PDDR, MPhil

Abstract
Study objectives: To determine the frequency of and potential risk factors for catheter-related deep venous thrombosis (DVT) in critically ill adult patients.

Design: Prospective, controlled, observational cohort study.

Setting: A mixed medical and surgical ICU in a university hospital.

Patients: All adult patients undergoing femoral vein catheterization.

Interventions: None.

Measurements: ICU diagnosis, underlying disease, demographic data, type of catheter, complications during cannulation, use of anticoagulants, coagulation status, medications infused, and duration of catheterization were recorded. Compression and duplex Doppler ultrasound studies of both femoral veins were performed prior to insertion, at 12 h after insertion, and daily until catheter removal. Follow-up investigation was performed at 24 h and 1 week after removal.

Results: Of 140 cases entered into the study, 124 were evaluated. Fourteen patients developed iliofemoral vein DVTs. Two were clinically obvious. Twelve (9.6%) were line related (uncannulated leg normal) and two (1.6%) occurred only in the uncannulated leg (p = 0.011; relative risk, 6.0; confidence interval, 1.5 to 23.5). Line-related DVT can occur any time from the day after insertion to 1 week after removal. The incidence of catheter-related DVT was unrelated to number of insertion attempts, arterial puncture or hematoma, duration of catheterization, coagulation status, or type of infused medications. No other predisposing or protective factors were identified. Three of the 12 patients with catheter-related DVT died. In no patient was clinical pulmonary embolus suspected.

Conclusion: Although the femoral route is convenient and has potential advantages, the use of femoral lines increases the risk of iliofemoral DVT. Catheter-related DVT may occur as soon as 1 day after cannulation and is usually asymptomatic. This increased risk should be carefully considered when the femoral route of cannulation is chosen.

http://chestjournal.chestpubs.org/conte ... 8.abstract
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Postby Cece » Thu Mar 10, 2011 8:51 am

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Postby Cece » Thu Mar 10, 2011 8:52 am

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Postby Cece » Thu Mar 10, 2011 8:57 am

Consequences
The formation of blood clots can have two serious consequences:

1. If the thrombus partially or completely blocks the flow of blood through the vein, blood begins to pool and build-up below the site. Chronic swelling and pain may develop. The valves in the blood vessels may be damaged, leading to venous hypertension. A person's ability to live a full, active life may be impaired.

2. If the thrombus breaks free and travels through the veins, it can reach the lungs, where it is called a pulmonary embolism (PE). A pulmonary embolism is a potentially fatal condition that can kill within hours.

...
Diagnosis
Diagnosing DVT is difficult. Current diagnostic techniques have both advantages and disadvantages. The most commonly used diagnostic tests include venography, duplex or Doppler ultrasonography, and magnetic resonance imaging (MRI).

http://orthoinfo.aaos.org/topic.cfm?topic=a00219
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Postby Cece » Thu Mar 10, 2011 9:05 am

Post-thrombotic syndrome
Without treatment, up to 6 in 10 people who have a DVT develop long-term symptoms in the calf. This is called 'post-thrombotic syndrome'. Symptoms occur because the increased flow and pressure of the diverted blood in other veins can affect the tissues of the calf. Symptoms can range from mild to severe and include: calf pain, discomfort, swelling, and rashes. An ulcer on the skin of the calf may develop in severe cases. Post-thrombotic syndrome is more likely to occur if the DVT occurs in a thigh vein, or extends up into a thigh vein from a calf vein.

Compression and raising the leg - to prevent post-thrombotic syndrome
If the DVT was in a thigh vein, you may be advised to wear a compression stocking. With this treatment the risk of developing post-thrombotic syndrome is much reduced. You should wear the stocking each day, for at least 2 years. (Symptoms of post-thrombotic syndrome may develop even several months after a DVT, which is why you should wear the stocking long-term.)

The slight pressure from the stocking helps to prevent fluid seeping into the calf tissues from the outer veins which carry the extra diverted blood following a DVT. The stocking also reduces, and may prevent, calf swelling. This in turn reduces discomfort and the risk of skin ulcers forming.

If you are advised to wear a compression stocking, you should put it on each day whilst lying in bed before getting up. Wear it for the whole day until you go to bed, or until you rest in the evening with the leg raised. Take the stocking off before going to bed.

In addition, the following are also commonly advised.

Raise your leg when you are resting. This too reduces the pressure in the calf veins, and helps to prevent blood and fluid from 'pooling' in the calves. 'Raised' means that your foot is higher than your hip so gravity helps with blood flow returning from the calf. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion.
Raise the foot of the bed a few inches if it is comfortable to sleep like this. This is so your foot and calf are slightly higher than your hip when you are asleep.

http://www.e-radiography.net/radpath/d/dvt.htm
I bolded that last one but would not do it myself, it is the opposite of inclined bed theory!!

Compression stockings sounds like a very good idea for anyone who has had this complication.
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Postby HappyPoet » Thu Mar 10, 2011 9:42 am

Cece,

You've done it again! Terrific work!

I want to personally thank you for all this research...lots to read while I continue to rest after my procedure. Thank goodness for our brilliant Dr. Sclafani who discovered the problem. The "asymptomatic" article grabbed my attention the most!
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Postby Cece » Thu Mar 10, 2011 8:31 pm

HappyPoet wrote:Cece,

You've done it again! Terrific work!

I want to personally thank you for all this research...lots to read while I continue to rest after my procedure. Thank goodness for our brilliant Dr. Sclafani who discovered the problem. The "asymptomatic" article grabbed my attention the most!

Rest up, HappyPoet!! I hope you are still doing just as well as in your post in the American Access Care thread.

Asymptomatic is good if it stays that way (thus no problems) but not good if it hides the condition when there might be treatment alternatives. Just like jugular thrombosis, I would assume the vein has a chance at recanalization?

If anticoagulants are prescribed post-procedure, those should reduce the risk of clotting in the femoral vein as well.
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ccsvi

Postby blossom » Mon Mar 21, 2011 9:35 pm

i got them to doppler my femoral vein when i had my follow up. nobody told me to but i just thought it made sence. i would think that any vein that was disrupted stood a chance of intimal hyperplasia or clotting.

my concern is that where i am from i'm being tolerated lets say by my doctors and getting these dopplers requires me to explain over again why. they are doctors they should already understand that angioplasty can bring on all these possible problems and should be monitored regulary. but they are against ccsvi but did say they would look after me but i'm afraid as time passes it will be harder to get my dopplers ordered.
and then they listen to me about the femoral vein too.

another concern is when would i be able to relax a little and feel-ok i don't need checked anymore. i'm safe. this intimal hyperplasia and clots is not to be taken lightly as we are learning.

i hope the future follow ups recommended include the femoral vein or whatever vein disrupted. then i pray for those of us that are getting reg. ultrasounds that the technician is good at it.
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Postby Cece » Mon Mar 21, 2011 9:58 pm

Blossom, I trust that the femoral vein results will come back ok, but let us know, ok?

Intimal hyperplasia is a concern from 3 months to 12 months, iirc. Clotting is more of a concern right away or if good flow was not established or if restenosis happens, maybe.
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