The deep venous thrombosis
the significance of deep vein thrombosis(DVT) lies in its potential to cause pulmonary embolism and post-thrombotic calf pump failure .virtually all venous thrombi arise in the deep veins of the legs or pelvis .the incidence of DVT in the general population is approximately .5% where no preventative measures are employed .the incidence of DVT in general surgical patients over 40 years undergoing to major surgery is 30%and 60-80% in patients undergoing hip or knee replacement or surgery for hip fracture in patients recovering from myocardial infarction or cerebro vascular accident the incidence is 20-60% 1- aetiology VIRCHOW,S TRAID hypercoagulability antithrombin 111 deficiency ,protein c deficiency ,protein s deficiency factor v leiden ,antiphospholipid syndrome heparin co factor alpha 11 macroglobulin alpha 1 antitrypsin fibrinolytic impairment oral contraceptive .stasis as in surgery and bed rest. vein wall damage as in surgical injury trauma and radiotherapy risk factor include age sex race operation anaesthetic pregnancy trauma immobilization bed rest malignancy previous thrombosis obesity cardiac failure contraceptive pill congenital venous abnormalities .pathology thrombosis is frequently initiated in the vein valve sinuses of the soleal plexuses platelets adhere to the venous endothelium initially and fibrin and red cells are deposited between the layers of platelets giving rise to laminated thrombus this propagates to extend up th vein being free or loosely attached to the wall initially thrombus then become firmly adherent to the endothelium organizes retracts and recanalizes to varying degrees destroying the endothelium and valves as it resolve clinical features limb swelling pain tenderness erythema and dilated superficial veins are the classic signs but are frequently absent even in a major thrombosis a swollen white leg (phegmasia alba dolens)or blue leg(phlegmasia cerulea dolens
may follow an extensive ileofemoral thrombosis clinical diagnosis is in correct in 50%of patients when compared with venogrphy the differential diagnosis incl
the significance of deep vein thrombosis(DVT) lies in its potential to cause pulmonary embolism and post-thrombotic calf pump failure .virtually all venous thrombi arise in the deep veins of the legs or pelvis .the incidence of DVT in the general population is approximately .5% where no preventative measures are employed .the incidence of DVT in general surgical patients over 40 years undergoing to major surgery is 30%and 60-80% in patients undergoing hip or knee replacement or surgery for hip fracture in patients recovering from myocardial infarction or cerebro vascular accident the incidence is 20-60% 1- aetiology VIRCHOW,S TRAID hypercoagulability antithrombin 111 deficiency ,protein c deficiency ,protein s deficiency factor v leiden ,antiphospholipid syndrome heparin co factor alpha 11 macroglobulin alpha 1 antitrypsin fibrinolytic impairment oral contraceptive .stasis as in surgery and bed rest. vein wall damage as in surgical injury trauma and radiotherapy risk factor include age sex race operation anaesthetic pregnancy trauma immobilization bed rest malignancy previous thrombosis obesity cardiac failure contraceptive pill congenital venous abnormalities .pathology thrombosis is frequently initiated in the vein valve sinuses of the soleal plexuses platelets adhere to the venous endothelium initially and fibrin and red cells are deposited between the layers of platelets giving rise to laminated thrombus this propagates to extend up th vein being free or loosely attached to the wall initially thrombus then become firmly adherent to the endothelium organizes retracts and recanalizes to varying degrees destroying the endothelium and valves as it resolve clinical features limb swelling pain tenderness erythema and dilated superficial veins are the classic signs but are frequently absent even in a major thrombosis a swollen white leg (phegmasia alba dolens)or blue leg(phlegmasia cerulea dolens
may follow an extensive ileofemoral thrombosis clinical diagnosis is in correct in 50%of patients when compared with venogrphy the differential diagnosis incl
the significance of deep vein thrombosis(DVT) lies in its potential to cause pulmonary embolism and post-thrombotic calf pump failure .virtually all venous thrombi arise in the deep veins of the legs or pelvis .the incidence of DVT in the general population is approximately .5% where no preventative measures are employed .the incidence of DVT in general surgical patients over 40 years undergoing to major surgery is 30%and 60-80% in patients undergoing hip or knee replacement or surgery for hip fracture in patients recovering from myocardial infarction or cerebro vascular accident the incidence is 20-60% 1- aetiology VIRCHOW,S TRAID hypercoagulability antithrombin 111 deficiency ,protein c deficiency ,protein s deficiency factor v leiden ,antiphospholipid syndrome heparin co factor alpha 11 macroglobulin alpha 1 antitrypsin fibrinolytic impairment oral contraceptive .stasis as in surgery and bed rest. vein wall damage as in surgical injury trauma and radiotherapy risk factor include age sex race operation anaensthetic pregnancy trauma immobilization bed rest malignancy previous thrombosis obesity cardiac failure contraceptive pill congenital venous abnormalities .pathology thrombosis is frequently initiated in the vein valve sinuses of the soleal plexuses platelets adhere to the venous endothelium initially and fibrin and red cells are deposited between the layers of platelets giving rise to laminated thrombus this propagates to extend up th vein being free or loosely attached to the wall initially thrombus then become firmly adherent to the endothelium organizes retracts and recanalizes to varying degrees destroying the endothelium and valves as it resolve clinical features limb swelling pain tenderness erythema and dilated superficial veins are the classic signs but are frequently absent even in a major thrombosis a swollen white leg (phegmasia alba dolens)or blue leg(phlegmasia cerulea dolens) may follow an extensive ileofemoral thrombosis clinical diagnosis is in correct in 50%of patients when compared with venogrphy the differential diagnosis includes ruptured baker,s cyst ,cellulitis lymphaedema torn calf muscles and calf haematoma investigations ascending venography remains the goal standerd although colour duplex ultra sound is non - invasive and is being used increasingly it is however time consuming and relativaly insensitive in the detection of below -knee thromboses .plethysmography is used to detect reduced venous capacitance after a thrombosis but has low accuracy in non - occlusive thrombi it is used increasingly as screening test
tags: deep,thrombosis,venous
tags: deep,thrombosis,venous
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