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Abstract: The patient complained of swelling and pain in the left lower limb with no obvious cause 2 days before admission, which was obvious after activity and could be relieved after bed rest. After physical examination combined with ultrasound examination, a comprehensive diagnosis of lower limb venous thrombosis was made. After physical examination and ultrasound, the patient was diagnosed with lower limb venous thrombosis. The patient was recommended to undergo surgery and medication, and the swelling and pain of the lower limb improved significantly after surgery.
Basic information】Female, 58 years old
Disease Type】Venous thrombosis of lower extremity
Hospital】Xing’an League People’s Hospital of Inner Mongolia
Date of Consultation】February 2022
Treatment plan】Medication (rivaroxaban tablets) + surgery (inferior vena cava filter implantation, lower limb vein mechanical aspiration, iliac vein balloon dilatation stent implantation)
Treatment period】3 days of hospitalization and review after 1 month
Effectiveness】Significant improvement of lower limb swelling and pain
I. Initial consultation
Aunt Huang, a middle-aged woman with a slightly fat body type, suddenly developed swelling and pain in her left lower limb 2 days ago without any obvious cause, which was obvious after activity and could be relieved after bed rest. This morning, the swelling of the lower extremity increased significantly, so she came to the emergency department of the hospital. Through the patient’s self-report and physical examination, the patient was initially judged to have lower extremity venous thrombosis, and the initial diagnosis was verified by the completion of lower extremity venous ultrasound examination.
II. Treatment process
After admission, the relevant auxiliary examinations were completed, which indicated that D-2 aggregates were significantly elevated, but other blood tests were not significantly abnormal. The cardiac ultrasound showed no abnormality in the pulmonary artery, and the possibility of pulmonary artery embolism was initially excluded. Because of the severe swelling of the lower limbs, we explained the patient’s condition to the patient and his family and suggested surgery to solve the swelling problem as soon as possible. At the same time, the patient was given rivaroxaban tablets and told to elevate the affected limb by 30° to speed up the venous return of the lower limb and to stay in bed as much as possible to avoid thrombus dislodgement leading to pulmonary artery embolism. The inferior vena cava filter was implanted in the femoral vein, and the popliteal vein was punctured and a vascular sheath was placed in the affected limb. After mechanical aspiration of the lower extremity veins, the femoral vein was patent and the iliac vein was occluded, and balloon dilatation stent implantation of the iliac vein was performed.
III. Treatment effect
The patient felt that the swelling of the lower limb was significantly relieved during the operation, and the circumference of the lower leg was reduced by 3 cm after the operation compared with that before the operation. The patient was advised to rest in bed with the affected limb elevated, and continued to be given rivaroxaban tablets for anticoagulation and decongestion. Postoperatively, the puncture site was changed, and the puncture site was seen to be healing well with relief of swelling and pain. The patient was advised to come to the hospital one month later for removal of the inferior vena cava filter and to continue to take oral rivaroxaban tablets.
IV. Notes
We are glad that the patient’s swelling and painful symptoms of the lower limbs were relieved after treatment. Lower extremity venous thrombosis is a common venous disease in vascular surgery, and the dislodged thrombus can lead to pulmonary artery embolism. Patients usually pay attention to elevate the affected limb 30° when lying in bed, which can promote the venous blood return to the lower limb, while avoiding forceful activities of the lower limb to reduce the risk of thrombus dislodgement. After the venous thrombosis of lower limbs enters the chronic stage, patients can wear medical elastic stockings to improve the symptoms of swelling of lower limbs.
V. Personal insight
Lower limb venous thrombosis is one of the main causes of pulmonary artery embolism and sudden death, and about 50% of lower limb venous thrombosis has no obvious cause. With the progress of medical treatment, venous thrombosis is getting more and more attention, and once it is diagnosed, timely treatment should be carried out, and reasonable treatment plan should be determined according to the location and scope of thrombosis. For the lower extremity venous thrombosis in this patient, surgical treatment is a good choice to quickly reduce the thrombotic load, reduce the swelling of the lower extremity, and prevent the thrombus from dislodging and leading to pulmonary embolism.