Definition.
A group of conditions in which blood clots abnormally in the veins, resulting in obstruction of distal blood return.
Hazards.
1, pulmonary embolism, which is the third leading cause of death in hospitalized patients, after cardiovascular accidents.
2.Femoral cyanosis.
3.White swelling of the femur.
4.Venous thrombosis sequelae.
The prognosis of lower extremity deep vein thrombosis depends on: early diagnosis and standardized treatment.
Early diagnosis.
The early stage of lower extremity deep vein thrombosis can have no symptoms such as swelling, and only when the thrombus spreads and blocks the opening of the lateral branch vein, or spreads rapidly, does it show symptoms such as swelling and pain in the lower extremity. Therefore, most of the clinically diagnosed DVTs are often more than a few days old. Squeezing the calf muscle, or dorsiflexion of the foot to stretch the muscle can induce calf muscle pain, which can indicate early gastrocnemius thrombosis. This test should be a mandatory procedure for physician visits in thrombosis-related departments.
Once deep vein thrombosis is suspected, aim to have lower extremity deep vein ultrasound and blood D-dimer testing at the first opportunity. The value of early diagnosis is that early treatment can be initiated. The earlier the treatment, the better the outcome.
Examination.
1.Ultrasound examination.
2.Contrast examination: For venous thrombosis that cannot be clearly confirmed by ultrasound, contrast examination is required.
Treatment: Once the diagnosis is clear, first emergency check blood routine and coagulation complete set, liver and kidney function.
1.Anticoagulation therapy.
If there is no contraindication to anticoagulation, use anticoagulant drugs as soon as possible. Warfarin can be used orally at the same time. After the effect of Warfarin and stabilization, stop using heparin. Warfarin should be continued orally for 3-6 months. For very early iliofemoral vein thrombosis, cannulation thrombolysis is recommended, provided that the risk of bleeding is assessed.
2. Thrombolytic therapy.
The word “thrombolysis” refers more to the mechanism of the drug than to the inevitable outcome of the treatment. It is often more than 48 hours from the formation of venous thrombosis to the appearance of clinical manifestations such as obvious swelling of the lower limbs. Therefore, some of the thrombi that begin to mechanize are not sensitive to thrombolytic drugs. The risk of bleeding with thrombolytic drugs is high, especially in elderly patients with potentially fatal cerebral hemorrhage; placement of thrombolysis reduces the risk of bleeding.
Thrombolytic therapy is not superior to anticoagulation. Local placement of thrombolysis is preferred for thrombolytic therapy; systemic application increases the risk of bleeding. Further experience is still underway to determine whether the development of cannulated thrombolysis can reduce complications and improve treatment outcomes. From the current clinical results, it is still optimistic, but the indications should be strictly controlled. For acute iliac vein thrombosis or inferior vena cava thrombosis, active interventional thrombolysis can be considered if the onset time is within one week and no risk factors for bleeding exist.
If survival is expected to be more than one year and there is a risk of anticoagulation, implantation of a vena cava filter is recommended to prevent pulmonary embolism. Permanent filters are preferred.
Inferior vena cava filter: A vena cava filter must be implanted in the following cases
1, in cases where anticoagulation is contraindicated.
2, Those who experience embolic events despite standardized anticoagulation.
3. Those who terminate anticoagulation due to hemorrhage in the course of standardized anticoagulation.
Implantation of a vena cava filter may be considered, as appropriate, in the following cases.
1, used in conjunction with acute deep vein thrombectomy or thrombolysis.
2, Patients with malignancy who are expected to survive for more than 1 year or more
3, those with floating thrombus in the iliac vein.
4, the thrombus continues to spread under anticoagulation.
5.Patients at high risk of falls or collisions.
6, the patient lacks nursing care or monitoring of INR conditions.
If the risk of thrombosis is not persistent, an optional filter is recommended. If there is thrombus spread, or if there is significant thrombus under the filter, and the safety of removal is difficult to ensure, consider leaving the filter in the body without removing it. If the risk of recurrence of thrombosis is high, and if the patient is older or in poor general condition, a permanent filter should be considered first. The indications for temporary filter implantation include, in addition to the above, severe polytrauma.
Possible complications of filter implantation, including.
1, complications arising from puncture of the femoral vein on the healthy side, such as hematoma, thrombosis, etc.
2, accidental injury to arteries, nerves, etc.
3, complications brought about by contrast agents, such as allergy, phlebitis, etc.
4, complications when releasing the filter incorrectly, such as filter inversion, filter displacement, filter misalignment, etc.
5.Other rare complications are vena cava perforation, filter blockage of pulmonary artery, etc.
In critically ill patients, those with contrast allergy, and those with renal insufficiency, the conventional filter implantation procedure should be avoided and ultrasound-guided trans-saphenous vena cava filter implantation should be chosen.