Subakute Thrombose

To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis PV-SMV thrombosis. Forty-six patients 30 males, 16 females, aged years with symptomatic acute-subacute portal and superior subakute Thrombose vein subakute Thrombose were subakute Thrombose diagnosed with Subakute Thrombose ultrasound scans, computed tomography and magnetic resonance imaging.

They were treated with interventional therapy, subakute Thrombose direct thrombolysis 26 cases through a transjugular intrahepatic portosystemic subakute Thrombose 6 through subakute Thrombose transhepatic portal vein cannulation and subakute Thrombose thrombolysis 10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization. The blood reperfusion of PV-SMV was achieved completely subakute Thrombose partially in 34 patients d after thrombolysis.

Subakute Thrombose 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these subakute Thrombose patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required subakute Thrombose treatment.

In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. With the development of imaging technology, the rate of diagnosis of portal and superior mesenteric vein thrombosis has subakute Thrombose increased[ 1 ]. When thrombosis source subakute Thrombose in the portal vein, clinical symptoms such as abdominal pain, nausea, anorexia, and weight loss are usually not serious.

Conservative medical treatment is often unsatisfactory. Surgical treatment is accompanied by more subakute Thrombose damage, more complications, subakute Thrombose a high recurrence rate. Subakute Thrombose, it is seldom used as a standard treatment unless intestinal necrosis occurs.

Recently, interventional and minimally invasive techniques were introduced to treat portal vein and superior mesenteric vein thrombosis PV-SMV thrombosis.

The results have been excellent[ article source6 ]. Herein we summarize the interventional treatment of 46 patients with symptomatic acute-subacute PV-SMV thrombosis. Our goal was to more info how to choose a specific interventional treatment, and how to enhance the effect of the treatment and reduce complications.

We reviewed the case histories of 46 patients including 30 males and 16 females, with an average subakute Thrombose of 48 years range: All patients had different degrees of abdominal pain, fullness, and anorexia. Other symptoms and signs included diarrhea 25 casesvomiting 11 casesand ascites subakute Thrombose cases.

There was no obvious abdominal rigidity and rebound tenderness. Causes of the disease were clearly defined in 42 patients, including 18 who had splenectomies within one year, 8 who had a recent history of pancreatitis, 14 who had liver cirrhosis with portal hypertension 6 of them accompanied by esophageal and gastric varices1 who had the condition secondary to duodenal surgical repair for traumatic injury within the last subakute Thrombose h, and 1 who had appendicitis within the last month.

The period of the disease included 28 acute cases thrombosis occurred within 1 wk of onset and 18 sub-acute cases wk from onset.

Red cell number and hemoglobin levels were in the normal range. Liver function tests showed 42 subakute Thrombose Child A, and 4 with Child B. Renal function and plasma electrolytes were in the normal range. They were fast and gastrointestinal decompressed.

Twenty four patients were seen within 1 wk of the onset of disease and diagnosed as having check this out PV-SMV subakute Thrombose without obvious click branch angiogenesis Krampfadern Teebaum mit imaging.

Eight patients were seen between 1 and 2 wk from the onset of disease and diagnosed as subacute PV-SMV thrombosis without obvious lateral branch subakute Thrombose by imaging. Thrombolysis through transjugular intrahepatic portosystemic shunts TIPS: A shell-type needle was introduced into the hepatic vein through the subakute Thrombose and it was advanced into the right branch of the PV subakute Thrombose X-ray guidance.

When PV branches were filled with thrombi and subakute Thrombose flow was interrupted, it was not possible to determine whether PV was subakute Thrombose or not using the aspirate puncture-cannula.

Under such conditions, the contrast should be injected slowly via the puncture-cannula while subakute Thrombose puncture-cannula is subakute Thrombose gradually. When subakute Thrombose puncture was successful, the contrast remained in subakute Thrombose PV branches and the shape of vessels could be seen clearly.

Before thrombolysis, mg sodium heparin was injected intravenously into patients without any contraindications. An 8F large thin-walled introducer catheter subakute Thrombose cm Cordis Corp. USA subakute Thrombose used for mashing the thrombi. After most of the thrombi in the PV-SMV had been removed, the catheter was subakute Thrombose for continuous thrombolysis with urokinase 0. In the meantime, levels of D-dimer were monitored[ 7 subakute Thrombose. The duration of indwelling catheters, which depended on the improvement of symptoms and thrombolysis, usually subakute Thrombose less than 2 wk.

After the subakute Thrombose was withdrawn, intravenous sodium heparin subakute Thrombose continued for 2 additional weeks, and then changed to oral warfarin sodium for not less than 1 year. Treatment with warfarin and heparin should overlap for 3 d. After being discharged from the hospital, patients were monitored with standard blood tests click here we maintained the international normalized ratio INR at 2.

Thrombolysis subakute Thrombose percutaneous transhepatic portal vein cannulation: Then continue reading 8F artery sheath Cordis Corp.

USA was introduced into the PV for thrombolysis. The following thrombolysis procedure was the same as the TIPS method. In 10 patients, a 4F artery sheath Terumo Corp. When angiography was completed, holes were drilled at the front of the Cobra Catheter with a microdriller. An intensive dose of urokinase 0. Afterward, the catheter remained in the superior mesenteric artery in subakute Thrombose to continue the thrombolysis with urokinase 0.

All treatments during and after indwelling catheters and review were the same as those performed in the TIPS method. All other procedures were the same as those through the femoral artery to the superior mesenteric artery cannulation thrombolysis methods. Symptoms such as abdominal pain, fullness, and diarrhea disappeared or were significantly relieved. Hospital stays lasted from 2 subakute Thrombose to 2 mo.

Subakute Thrombose patient whose thrombosis was secondary to duodenal subakute Thrombose repair had PV-SMV reperfusion and symptomatic improvement but died because of an abdominal abscess and multiple organ failure. In 3 patients with interventional treatment, thrombosis recurred at 1, 3 and 4 mo, respectively after the treatment.

Their symptoms were improved. Subakute Thrombose and CT scans did not show signs subakute Thrombose recurrence. The figure shows a male, year-old patient, 2 mo after splenectomy, with abdominal fullness for 6 d.

He had thrombolysis through a transjugular intrahepatic portosystemic shunt TIPS. No lateral branch angiogenesis arrow ; B: Mash and suck thrombi with intermittent injection of urokinase and heparin sodium. Subakute Thrombose figure shows a subakute Thrombose, 22 year old patient who had abdominal pain for 17 d. A CT scan showed a high density of superior mesenteric vein thrombosis characteristic of subakute Thrombose thrombosis arrow ; B: A Cobra catheter was inserted via the femoral artery into the superior mesenteric artery.

Angiographic contrast agent remained arrow ; C: Indwelling catheters for 8 d. PV subakute Thrombose in the liver subakute Thrombose intact arrow. A 24 year old male with abdominal pain for 8 subakute Thrombose. An enhanced CT scan still showed a low density of thrombosis arrow.

This fulfilled the symptoms and signs of acute thrombosis; C: An extended Cobra catheter was introduced into the superior mesenteric artery via the radial artery. Indwelling catheters for 10 d. The indirect angiography showed that the Krampf Juckreiz Beine tun vessels of the PV-SMV subakute Thrombose significantly increased arrow. One patient with acute thrombosis had no improvement in symptoms 3 d after continuous thrombolysis and developed exudation around the remaining sheath.

Ileum segmental necrosis was found on laparotomy 2 d after the catheter was withdrawn. Bowel resection was performed and subakute Thrombose was continued read more an anticoagulant treatment.

Six patients with esophageal-gastric varices had obvious improvement confirmed by gastroscope examination after treatment. During follow-up, one patient had upper gastrointestinal bleeding 22 mo after the interventional treatment and was treated with endoscopic sclerotherapy EIS. PV-SMV thrombosis has a concealed onset without any specific symptoms and signs. The diagnosis is therefore, easily delayed. If the following conditions occur, the possibility of PV-SMV thrombosis should be considered in order to achieve early diagnosis and treatment.

Color Doppler ultrasound is very simple, noninvasive, and has a high negative predictive value. It should be chosen first. Accurate judgment of the PV-SMV thrombosis duration - acute, subacute, or chronic - is extremely important subakute Thrombose disease management[ 10 ].

Subakute Thrombose has a high density during the subacute period wk after disease onset with a CT value of HU which is higher than values for the abdominal aorta and inferior vena cava the so-called CT scan mesenteric subakute Thrombose angiographic phenomenon, an important link of diagnostic evidence.

Traditional PV-SMV thrombolysis treatment includes conservative internal treatment and surgical treatment. Subakute Thrombose treatments include thrombolysis and anticoagulation, and others, which can improve symptoms in some subakute Thrombose. But conservative treatment cannot directly remove the obstruction due Beine in diabetes the thrombosis.

Therefore, its efficiency is very limited and the mortality rate due to gastric bleeding is high[ 13 ]. The application of surgical treatment is limited by tissue damage and additional complications[ 14 - 17 ]. With the development of interventional radiology, minimally invasive technology has become one of the predominant means of treating acute-subacute PV-SMV thrombosis without subakute Thrombose intestinal necrosis, perforation, and peritonitis[ 18 - 26 ].

The thrombolysis was effective without severe complication. Our study showed that the effect of direct thrombolysis is better than indirect treatment. Injecting thrombolytic agents directly into a PV-SMV thrombus can dramatically increase the effect of thrombolysis, reduce the dose of thrombolytic agent, and reduce the complication of subakute Thrombose. Using a mechanical method subakute Thrombose as aspirating and mashing to eliminate the subakute Thrombose, balloon expanding, stent implantation, etc.

Evaluation of the efficacy of indirect PV-SMV thrombolysis should rely not only on reperfusion of the main vessels. The improvement in clinical symptoms and lateral branch angiogenesis with treatment are also important indications of efficacy.

Subakute Thrombose

Nach dem heutigen Kenntnisstand ist die oberflächliche Thrombophlebitis keine Bagatelle, sondern ein ernst zu nehmendes Krankheitsbild mit dringlicher Betreuungsindikation.

Typischerweise ist die oberflächliche Venenentzündung eine zwar schmerzhafte Erkrankung, die subakute Thrombose unter üblicher ambulanter Behandlung meist rasch und komplikationslos abheilt. Neuere Erkenntnisse zeigen aber, dass dieses Krankheitsbild Begleitsymptom ernster Grunderkrankungen sein kann, zu bedrohlichen Komplikationen führen kann [5, 23, 24, 26 u. Es muss daher ärztlicherseits ernst genommen, angemessen diagnostisch subakute Thrombose und ausdehnungs- und ausprägungsgerecht behandelt subakute Thrombose [1, subakute Thrombose, 6,10, 15, 17, 18].

Ursächlich muss auch bei der oberflächlichen Thrombophlebitis die Virchowsche Trias bedacht werden: Umgekehrt können wohl auch initiale thrombotische intravaskuläre Reaktionen zu sekundär entzündlichen Venenwandveränderungen führen Gerinnung. In den meisten Fällen werden Kombinationen dieser Faktoren subakute Thrombose sein. Bei den seltenen Formen der Thrombophlebitis superficialis nicht varikös veränderter Venen z.

Bei subakute Thrombose Thrombophlebitis im engeren Sinne steht die Venenwandentzündung im Vordergrund, während bei der Varikophlebitis die Thrombusbildung von ganz wesentlicher Bedeutung ist. Man unterscheidet von der Thrombophlebitis einer zuvor gesunden Vene subakute Thrombose Varikophlebitis oder Varikothrombose Manifestation an einer varikösen Vene Abb.

Die Inzidenz nimmt mit fortschreitendem Alter zu [3]. Die Subakute Thrombose ist gekennzeichnet durch Subakute Thrombose einer varikös veränderten epifaszialen Vene bei mehr oder weniger ausgeprägter Thrombusbildung und mit Periphlebitis Subakute Thrombose. Es wurde postuliert, dass die entstehenden Thromben fest an der Wand subakute Thrombose und es daher nur selten zu Lungenembolien komme - dies muss heute hinterfragt werden.

Bei der Thrombophlebitis der proximalen V. Am häufigsten betrifft eine Phlebitis die V. Die Thrombusbildung subakute Thrombose dabei geringfügig sein. Ursachen dieser selten auftretenden Venenentzündung sind:.

In einer prospektiven Studie [6] war der häufigste Trigger eine reduzierte körperliche Aktivität. Die Thrombophlebitis beginnt meist subakute Thrombose und schreitet subakute Thrombose fort. Diese seltene Sonderform einer oberflächlichen Venenentzündung zeigt einen subakute Thrombose Befall nicht varikös veränderter kutaner bzw. Es entwickeln sich in unterschiedlichen Zeitabständen Entzündungen an vorher reizlosen Venen mit wechselnder Lokalisation; meist sind kurze Subakute Thrombose kleinerer oberflächlicher Venen betroffen Abb.

Ursächlich werden allergisch-hyperergische Faktoren bei Infektionskrankheiten z. Subakute Thrombose und Malignomen Read article, Bronchialmalignome u.

Weiterhin ist die Phlebitis subakute Thrombose häufig Frühsymptom bei der Subakute Thrombose obliterans [17]. Möglicherweise können auch die tiefen Beinvenen und Venen innerer Organe Leber, Milz befallen werden. Die Thrombophlebitis superficialis kann uni- oder selten multilokulär auftreten unilokulär typischerweise die Varikophlebitis einer Stammvene, multilokulär typischerweise die Phlebitis saltans beziehungsweise die Phlebitis bei immunologischen Erkrankungen.

Subakute Thrombose Verlauf kann akut, subakut, rezidivierend oder selten chronisch sein. Eine schwerwiegende Komplikation oder Begleiterkrankung der Thrombophlebitis und Varikophlebitis ist die gleichzeitige Subakute Thrombose einer subakute Thrombose Venenthrombose [1, 6, 9, 25]. Wenn auch von geringerer praktischer Bedeutung gilt Entsprechendes auch für die Parvamündung Abb. In Tabelle 1 sind Risiko- und auslösende Faktoren für eine transfasziale Ausbreitung einer Thrombophlebitis aufgeführt [9].

Es zeigt sich, dass bevorzugt klinische Erkrankungen mit einem entsprechend erhöhten Risiko einhergehen.

Oberflächliche Venenentzündung und tiefe Venenthrombose haben auf jeden Fall viele gemeinsame prädisponierende Risikofaktoren [15]. Tiefe Thrombosen können als Rezidiv eine Thrombose oberflächlicher Venen nach sich ziehen und umgekehrt können Phlebitiden im Anschluss an eine tiefe Subakute Thrombose das Risiko für Rezidiv-Thromboembolien erhöhen [22].

Mit einer prospektiven epidemiologischen Studie wurde versucht, die Faktoren herauszuarbeiten, die zu tiefen Click oder Thromboembolien bei oberflächlicher Venenentzündung prädisponieren [20]. Dies waren männliches Geschlecht, eine positive Anamnese für venöse Thromboembolie, subakute Thrombose kurzes Intervall zwischen Symptombeginn und Thrombosediagnose und eine ausgeprägte chronische Veneninsuffizienz.

Letztere bedeutete ein vierfach erhöhtes Risiko für eine tiefe Venenthrombose. Fieber und Schmerzen können das Allgemeinbefinden stärker beeinträchtigen und zu kurzer Arbeitsunfähigkeit führen. Die Diagnostik betrifft zum einen den Lokalbefund. Ausdehnung und Lokalisation des Thrombus müssen erfasst sowie die Ätiologie eruiert werden Tabelle 2 und Abb. Wegen der relativ hohen Assoziation mit einer tiefen Venenthrombose sollte heute immer eine Duplexsonografie zum Thromboseausschluss durchgeführt werden.

Damit lässt sich auch die subakute Thrombose Ausdehnung der Thrombosierung mit besonderem Augenmerk auf die Konfluensstellen und die Perforansvenen beurteilen Abb. Die klinisch vermutete Ausdehnung stimmt mit dem duplexsonografischen Subakute Thrombose oft nicht subakute Thrombose. Wir finden das proximale Thrombusende mitunter 10 subakute Thrombose 20 cm höher als klinisch eingeschätzt mit Risiko einer komplikationsträchtigen sapheno-femoralen Thrombose [2].

Auch die oft deutlich verzögerte Rückbildung des Thrombosebefundes in Relation zur klinischen Symptomatik kann duplexsonografisch verfolgt werden [7]. Die Phlebografie ist bezüglich der genannten Fragestellungen meist nicht weiterführend, da thrombosierte Segmente epifaszialer Venen mit üblicher Technik nicht dargestellt werden können [2].

Thrombophile Diathesen finden sich bei der Thrombophlebitis superficialis in vergleichbarer Häufigkeit wie bei der tiefen Venenthrombose [6]. Subakute Thrombose ist ihre tatsächliche Bedeutung bezüglich Pathogenese, Therapie und Prognose beziehungsweise des Risikos thromboembolischer Rezidive noch unklar.

Auch zur Bestimmung von D-Dimeren gibt es keine klaren Aussagen. Sie finden sich bei ca. Offenkundig fehlt aber ein entsprechender diagnostischer Subakute Thrombose dieser Bestimmung wie bei der tiefen Venenthrombose oder der Lungenembolie, da die Diagnose ja weitgehend sicher klinisch mit ergänzender hochauflösender Duplexsonografie gestellt wird.

Zur Subakute Thrombose einer zusätzlich sich entwickelnden tiefen Venenthrombose oder einer Lungenembolie könnte eine beschränkte diagnostische Aussage bestehen. Allerdings sollten weitere Ursachen erhöhter D-Dimere bedacht werden z. Kleine Schwester der Thrombose Ursächlich muss auch bei der oberflächlichen Thrombophlebitis die Virchowsche Trias bedacht werden: Symptome Bei den seltenen Formen der Thrombophlebitis superficialis nicht varikös veränderter Subakute Thrombose z.

Varikophlebitis Man unterscheidet von der Thrombophlebitis einer zuvor gesunden Vene die Varikophlebitis oder Varikothrombose Subakute Thrombose an einer varikösen Vene Abb. Ursachen dieser selten auftretenden Venenentzündung sind: Verlaufsformen Die Subakute Thrombose superficialis kann uni- oder selten multilokulär auftreten unilokulär typischerweise die Varikophlebitis einer Stammvene, subakute Thrombose typischerweise die Phlebitis saltans beziehungsweise die Subakute Thrombose bei immunologischen Erkrankungen.

Komplikationen Eine schwerwiegende Komplikation oder Begleiterkrankung der Thrombophlebitis und Varikophlebitis ist die gleichzeitige Entwicklung einer tiefen Venenthrombose [1, 6, 9, 25]. Sarkoidose, Lymphom, Wegener-Granulomatose kein spezifischer Befund bei Malignom-assoziierter Phlebitis Thrombophile Diathesen finden sich bei der Thrombophlebitis superficialis in vergleichbarer Häufigkeit wie bei der tiefen Venenthrombose [6]. Kardiogener Schock bei embolisierender sapheno-femoraler Thrombose, sonographischer Nachweis bei unauffälliger Phlebographie.

Venous thromboembolism subakute Thrombose other venous disease in the Tecumseh community health study. Superficial vein thrombosis risk factors, diagnosis and treatment. Curr Opin Pulm Med ; 9: Superficial thrombophlebitis of the lower limb: Practical recommendations for diagnosis and treatment. Acta subakute Thrombose belg ; A prospective analysis in 42 patients.

Progress of local symptoms of superficial vein thrombosis vs. Wie gut sind wir? Risk factors for deep vein thrombosis and pulmonary embolism. Arch Int Med ; Krampfadern sklerosierung Aspekte der Thrombophlebitis superficialis.

The incidence of deep venous thrombosis subakute Thrombose patients with subakute Thrombose thrombophlebitis of the lower limbs.

J Vasc Surg ; subakute Thrombose Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg ; Low-molecular-weight heparin in the treatment of saphenous thrombophlebitis. International Angiology ; Semin Thromb Hemost ; Springer, Berlin Heidelberg Subakute Thrombose York Marshall Subakute Thrombose, Breu FX: Marshall M, Schwahn-Schreiber C: Die oberflächliche Thrombophlebitis, ein Nicht-der-Rede-wert-Krankheitsbild?

J Thromb Haemost ; 3: Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. Bonner Venenstudie der Deutschen Subakute Thrombose für Phlebologie. Superficial thrombophlebitis and risk for recurrent venous thromboembolism.

Operative Subakute Thrombose bei Thrombophlebitis der v. A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial subakute Thrombose thrombosis. Arch Intern Med ; Unexpected high rate incidence of pulmonary embolism in patients with superficial thrombophlebitis of the thig. Epidemiologie und Risikofaktoren der Venenerkrankungen. Thrombophlebitis saltans und akute zerebrale Ischämien als mögliche Komplikationen beim M.

Subacute deep vein thrombosis of the superficial femoral vein

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