1/28. An alternative approach: antegrade catheter-directed thrombolysis in a case of phlegmasia cerulea dolens.Phlegmasia cerulea dolens is an uncommon sequela of severe deep venous thrombosis of the lower extremities. Characterized by massive edema, arterial and venous compromise, and threats to limb and life, this clinical entity is a clear indication for thrombolytic therapy. We report an innovative approach to conventional thrombolysis via a lesser saphenous vein cut-down. This simple technique is a safe, reliable alternative to present methods of achieving deep venous access. Hence, it should be considered as an addition to the treatment armamentarium for massive deep venous thrombosis of the lower extremity.- - - - - - - - - - ranking = 1keywords = phlegmasia, dolens (Clic here for more details about this article) |
2/28. A case of idiopathic deep vein thrombosis improved with glucocorticoid therapy.A healthy, middle-aged Japanese man with no family history of thrombotic disorders presented with acute abdominal pain due to ischemic colitis. Two months later, he developed left leg pain and swelling. A venogram of the lower limbs, computed tomography, and a scintigram of pulmonary blood flow revealed deep vein thrombosis of the left lower limb extending to the inferior vena cava and emboli of both pulmonary arteries with bilateral pleural effusions. The responsible coagulation disorder was not detected in this case. Since these thrombi were refractory to the thrombolytic therapy with urokinase and anticoagulant therapy with warfarin, prednisolone was chosen for the suppression of accompanying thrombophlebitis. Two months following the initiation of prednisolone (20 mg/day), the venous thrombosis, abnormal pulmonary shadows, and pleural effusions had completely resolved. This case demonstrates the successful treatment of idiopathic venous and pulmonary thrombosis with glucocorticoids.- - - - - - - - - - ranking = 0.0041874341795627keywords = thrombophlebitis (Clic here for more details about this article) |
3/28. Homozygous prothrombin gene mutation and ischemic cerebrovascular disease: a case report.We report the case of a 31-year-old woman who, at the age of 26 suffered from an episode of superficial thrombophlebitis in the left leg, experienced two episodes of transient ischemic attacks at the age of 30 and had an ischemic stroke with left-sided hemiparesis at the age of 31 years. A cerebral CT scan showed an ischemic lesion in the right sylvian area involving the opercular and nucleocapsular regions. Her father had had an ischemic stroke at the age of 54 years and died at the age of 58; her mother had had a myocardial infarction at the age of 48 years and died at 51 years from breast cancer. Laboratory investigation of the patient demonstrated high levels of fibrinogen, F II, F VII, F 1 2, FPA and ACA-IgG with low levels of HDL cholesterol associated with homozygosity for the 20210 A genotype. There were no other genetic or acquired prothrombotic defects. In conclusion, this case strongly suggests a clinically significant role ot the prothrombin gene mutation in both arterial and venous thrombosis.- - - - - - - - - - ranking = 0.0041874341795627keywords = thrombophlebitis (Clic here for more details about this article) |
4/28. Cavographic study of an early stage of obstruction of the hepatic portion of the inferior vena cava.BACKGROUND: liver disease caused by a chronic lesion of the hepatic portion of the inferior vena cava (IVC) is clinically characterized by dilated superficial veins in the body trunk with cephalad flow, hepatomegaly and splenomegaly. Cavography shows stenosis or complete obstruction near the cava-atrial junction. methods: Early (acute and subacute) forms of the disease were recognized. The early stage of the disease manifested as jaundice, hepatomegaly or ascites and fever. patients with acute and subacute onset of the illness with no past history of liver disease were studied with inferior vena cavography. Some of the patients had repeat cavography at 6 months and at 1 year after the initial investigations. RESULTS: Three types of cavographic lesions were observed in the early stages of the disease: type 1, linear lucent area in the IVC close to cava-atrial junction; type 2, a smooth or irregular narrowing of almost the whole segment of the hepatic portion of the IVC; and type 3, a constriction or narrowing of a segment of the IVC near the cava-atrial junction. The first two types were associated with the acute stage of the disease and type 3 with the subacute stage. Type 2 and 3 lesions were associated with post-stenotic dilatation (PSD) close to the atrium. Lucent areas resulting from thrombosis are common in PSD. The acute and subacute hepatic IVC diseases in nepal are commonly associated with bacterial infection. CONCLUSIONS: It is postulated that the early cavographic lesions are consistent with thrombosis and thrombophlebitis of the hepatic portion of the IVC, and that resolution of the lesions leads to the development of stenosis and to complete obstruction.- - - - - - - - - - ranking = 0.0041874341795627keywords = thrombophlebitis (Clic here for more details about this article) |
5/28. Indications for surgical treatment of iliofemoral vein thrombosis.The goals of treatment of acute iliofemoral DVT should be prevention of fatal PE, reduction of pain and swelling of the involved leg, trying to stop the development of phlegmasia cerulea dolens and venous gangrene, prevention of disabling PTS by early removal of the blood clot, avoiding proximal venous obstruction, preserving normal, functioning valves in the leg veins, and preventing reflux. The authors recommend an aggressive approach with rapid removal of the occluding thrombus in the leg veins extending up into the iliac veins in active patients with a short history of symptomatic DVT, usually less than 7 days. This approach is not justified in chronically ill, bedridden, high-risk, or aged patients, or those with serious intercurrent disease or limited life expectancy. In these patients, such interventions can only be indicated for limb salvage in phlegmasia cerulea dolens when conservative treatment does not prevent the development of an acute compartment syndrome with venous gangrene. The preferred means of accomplishing early and quick removal of the thrombus is CDITT. Most of the authors' positive experience with thrombolysis is based on the use of urokinase. The food and Drug Administration (FDA) has put this drug on temporary hold for almost 1 year. The alternative drugs (e.g., tissue plasminogen activator [tPA]) have not been tested for CDITT of DVT, and tPA is not FDA-approved for this indication. When there are contraindications or failure of thrombolysis, TE with a temporary AVF is a valid alternative.- - - - - - - - - - ranking = 0.46975592176789keywords = phlegmasia, dolens (Clic here for more details about this article) |
6/28. Venous gangrene of lower extremities and staphylococcus aureus sepsis.This is a study of the venous gangrene of lower extremities and staphylococcus aureus sepsis. We report on a premature infant who developed phlegmasia cerulea dolens (PCD) in both lower extremities in association with S. aureus sepsis, resulting in gangrene of the right foot. Non-pitting edema and cyanosis of the digits of the right lower extremity were noted 48 hours after hypotension and severe shock due to S. aureus sepsis. Intravenous antibiotics, isotonic fluids, and heparin were administered. Twenty-four hours later, edema and ischemic changes of the first and fifth left toes were also noted. Doppler flow study showed flow signals in both right and left popliteal arteries. However, there were no Doppler signals in neither right nor left popliteal vein. Emergency fasciotomies were performed on both lower limbs. The progression of the gangrene was limited to the right foot. There was complete resolution of PCD in both lower extremities. To the best of our knowledge, the association of S. aureus sepsis with PCD and venous gangrene in an infant has not been reported previously. This case illustrates the need for early recognition of PCD and aggressive intervention.- - - - - - - - - - ranking = 0.23487796088394keywords = phlegmasia, dolens (Clic here for more details about this article) |
7/28. Upper extremity venous gangrene following coronary artery bypass. A case report and review of the literature.Acute symptomatic upper extremity deep vein thrombosis (DVT) are estimated to account for only 2-4% of all deep vein thrombosis. Upper extremity DVT leading to phlegmasia cerulea dolens (PCD) occurs in an estimated 2-5% of these cases. Progression of PCD to venous gangrene is extremely rare with only 16 previously reported cases in the literature. Only 7 of the cited cases document significant tissue loss. This report describes a 61-year-old male who developed upper extremity DVT complicated by PCD which led to venous gangrene and limb loss.- - - - - - - - - - ranking = 0.23487796088394keywords = phlegmasia, dolens (Clic here for more details about this article) |
8/28. Medical treatment of a central vein suppurative thrombosis with cerebral metastatic abscesses in a burned child.A 2-year-old girl admitted with third degree burns (35% TBSA) received 7 weeks poly-antibiotic therapy combined with heparin for a severe methicillin-resistant staphylococcus aureus sepsis with multiple metastatic abscesses (lung, skin, brain), from a suppurative thrombophlebitis of the right jugularis interna, extended to the axillary and cava superior veins. Surgical treatment was contraindicated by the local extension. The child was discharged without major neurological sequelae 3 months after admission.- - - - - - - - - - ranking = 0.0041874341795627keywords = thrombophlebitis (Clic here for more details about this article) |
9/28. Behcet's disease complicated by pylephlebitis and hepatic abscesses.A 22 year old man presented with fever, abdominal pain, weight loss and diarrhea. Past medical history revealed recurrent aseptic meningitis, uveitis, and erythema nodosum. Further inquiry unveiled a prominent history of oral aphthous ulcers; all features of Behcet's disease. Imaging revealed mesenteric arteritis and pylephlebitis, septic thrombophlebitis of the portal vein, a previously unrecognized complication of Behcet's disease, with multiple intrahepatic abscesses. Portal venography demonstrated an extensively diseased, expanded, and obstructed portal venous system. blood cultures and portal vein aspirate yielded polymicrobial flora. Percutaneous intraportal thrombolytic therapy and mechanical thrombectomy were attempted to restore flow to the portal venous system. This distinctly rare manifestation of Behcet's disease, pylephlebitis, may result from ischemic injury and structural compromise of the bowel mucosa, resulting from underlying vasculitis.- - - - - - - - - - ranking = 0.0041874341795627keywords = thrombophlebitis (Clic here for more details about this article) |
10/28. Deep venous thrombosis and venous thrombophlebitis associated with alprostadil treatment for erectile dysfunction.We report a patient who developed deep vein thrombosis of the calf and thrombophlebitis after treatment with intracorporeal alprostadil (Viridal). The reaction recurred on rechallenge with Viridal. This adverse effect has not been reported in the literature but six patients have been reported to the Medicines Control Agency in great britain. The history of deep venous thrombosis or thrombophlebitis may not be a formal contraindication to treatment with alprostadil, but the patient should be made aware of this possible complication before embarking on this form of treatment.- - - - - - - - - - ranking = 0.025124605077376keywords = thrombophlebitis (Clic here for more details about this article) |
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