May-Thurner syndrome and deep vein thrombosis: A series of 8 patients
Alejandra García-GarcíaCrhistian‐Mario OblitasFrancisco Galeano‐ValleAndrea Olmos-NietoAna Ortega-SoudantPablo Demelo‐Rodríguez
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May–Thurner syndrome
肺動脈血栓塞栓症(pulmonary thromboembolism; PTE)による突然死の剖検例40例について,深部静脈血栓症(deep vein thrombosis; DVT)を病理形態学的に検討した結果を報告するとともに,PTEによる突然死の疫学的調査を行った.東京都監察医務院の過去10年間のfatal PTEは215例(男性97例,女性118例 年齢60±39歳)で,年間患者数は10年前と比較し約1.2倍に増加していた.
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Twenty-two patients who had an acute episode of thrombosis in the deep veins of the legs were studied by a new technique of ascending functional cinephlebography 6 to 12 months after the episode of thrombosis.If the condition was diagnosed within 36 hours and the thrombus was dissolved rapidly valve function was preserved. When diagnosis was delayed there was a very great risk of permanent damage to the valves.
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May–Thurner syndrome
Post-thrombotic syndrome
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The upper extremity deep vein thrombosis rate is increasing at the same time that the rate for insertions of peripherally inserted central catheters is on the rise. There is little information on whether the established risk factors for lower extremity deep vein thromboses are effective to predict the occurrence of upper extremity deep vein thrombosis. The purpose of this study was to identify patients at highest risk for upper extremity deep vein thrombosis in order to initiate effective prophylaxis. A retrospective review was undertaken of medical records of all patients with peripherally inserted central catheters inserted in a 6-month period at a Midwestern US hospital. Of the 233 charts reviewed, 17 (7.3%) recorded an upper extremity deep vein thrombosis during the patient's hospital stay. Of the multiple factors identified with deep vein thrombosis in the literature, a weighted risk factor measure, the upper extremity deep vein thrombosis prediction tool, was developed. Sensitivity of the instrument for upper extremity deep vein thrombosis is high (88%), as are its specificity (82%) and negative predictive value (99%), whereas the positive predictive value is low (28%). The total percentage of cases correctly classified is 82%. Further testing is indicated on a larger sample to extend the validity of this instrument.
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Case reportA 90-year-old woman was admitted to the emergency department because of severe left leg edema in the past 4 days.Her symptoms were progressive, and she faced difficulty in moving her leg.She had a history of chronic respiratory failure following tracheostomy with ventilator support as well as Parkinsonism.Moreover, she presented with deep vein thrombosis.Heparinization was performed, which was ineffective, and phlegmasia cerulea dolens was noted ( Fig. 1 ).Computed tomography revealed May-Thurner syndrome, with left com-
May–Thurner syndrome
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Isolated calf vein thrombosis in the population of patients with deep vein thrombosis is found approximately in 10 to 25 % of cases. We present 3 cases of calf vein thrombosis which occurred due to unusual causes. Specific characteristics of this form of thromboembolic disease are discussed and compared to proximal deep vein thrombosis with emphasis to symptoms, risk of complications, prognosis and therapeutic approach.
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In general medical patients presenting with suspected deep vein thrombosis routine use of x ray venography was associated with a large fall in the proportion of patients with a final diagnosis of deep vein thrombosis, from 83% to 25% (p less than 0.001), and with an appreciable shortening of hospital stay, from 13.6 to 7.2 days. The diagnosis of deep vein thrombosis was rejected in only 4% of patients when a venogram was not performed, and it is estimated that two patients were treated with anticoagulants unnecessarily for every patient treated correctly. The risk, expense, and inconvenience of unnecessary anticoagulant treatment far exceeds the risk, expense, and inconvenience of performing venograms routinely. The common practice of misdiagnosing deep vein thrombosis clinically should be abandoned.
Venography
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