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Patients with Upper Extremity Deep Vein Thrombosis in a Clinical Material of Warsaw Medical University

100%
Jeleńska M., Romanowski Ł.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
603-609
EN
The aim of the study was to analyze causes, location and signs and symptoms of the upper extremity deep vein thrombosis (UEDVP) in twelve patients who were referred for tests for trombophilia; these patients were treated from 2002 to 2009 in various Clinics of Warsaw Medical University.Material and methods. Retrospective analysis involved collection of clinical data of hospitalized patients related to signs and symptoms and location of the thrombosis, antithrombotic treatment and results of tests for thrombophilia. Patients with thrombosis caused by dialysis catheter, chemotherapy or paranteral nutrition and cardiac pacemaker electrode were excluded from the study.Results. Eight of the study subjects had a primary thrombosis: in as many as five of them this was an exercise-induced thrombosis. Secondary thrombosis was diagnosed in four patients, two of whom had a malignancy, the third one used oral contraceptives while the fourth, pregnant patient, had UEDVP associated with ovarian hyperstimulation syndrome.Conclusions. Pulmonary embolism (PE) without lower extremity thrombosis should prompt the search for UEDVT that can be asymptomatic. One of the study subjects underwent imaging studies that confirmed presence of thrombosis of the left brachiocephalic vein only after PE was detected.The study group contained many relatively young patients (five patients) with exercise-induced UEDVT, indicating possible thrombotic complications following too vigorous physical exercise.UEDVT that occurred in a pregnant patient was a complication of hormonal stimulation of ovaries used in the treatment of infertility. Pain and edema of the neck in such patients should prompt their attending physician to perform imaging studies. Should UEDVT be detected, antithrombotic heparin therapy should be started.
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Blood Platelet Accumulation in a Dacron Graft Implanted in a Patient with Abdominal Aorta Aneurysm: Quantitative Scintigraphic Assessment Using Indium-111 Labeled Platelets - Case Report*

71%
Jeleńska M., Bojakowski K., Mączewska J., Królicki L., Szmidt J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 9
610-613
EN
During routine screening after abdominal aorta aneurysm repair, thrombocytopenia accompanied by chronic activation of coagulation was detected in an 80-year old patient. Coagulation activity was assessed by the increased concentration of coagulation and fibrinolysis activation markers (prothrombin fragment F1+2 and D-dimer). After the most common causes of such activation were excluded using imaging and laboratory studies, Indium-111 labeled autologous blood platelet accumulation on a dacron graft was demonstrated using the scintigraphic technique. Thus, the implanted dacron graft was the cause of chronic thrombocytopenia and coagulation activation during the two years of follow up.
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Assessment of Early Results of Fibrinolytic Treatment of Acute Ischemia of the Lower Limbs

71%
Łukawski K., Jeleńska M., Solonynko B., Kulisiewicz P., Szmidt J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
337-340
EN
Acute ischemia of lower limbs due to thrombosis of large arteries is associated with high mortality and high rate of dangerous complications. Isolated intraarterial thrombolysis may improve prognosis of patients at high operative risk.The aim of the study was to assess early results of local thrombolytic therapy (recombinant tissue plasminogen activator r-tPA) of acute ischemia of lower limbs (duration of ischemia up to 15 days) in patients with poor general condition and with a history of vascular operations.Material and methods. Local intraarterial thrombolysis was performed in 35 patients who had developed acute ischemia of lower limbs due to thrombosis, in Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University in the period of time between 2003 and 2006. Twenty six of these patients previously underwent implantation of grafts made of artificial material. Signs and symptoms of ischemia persisted from several hours to 15 days. Nine patients were classified as ASA-IV, 26 patients as ASA-III on the risk scale.Thrombolytic therapy involved local infusion of recombinant tissue plasminogen activator r-tPA (Actylise) through a catheter inserted into the common femoral artery (contralateral to the ischemic limb). When thrombolysis was completed, heparin (given at a prophylactic dose) was started and continued until discharge.Results. Thrombolytic therapy resulted in vessel patency in 18 out of 35 treated patients (51%). Treatment effectiveness increased with shortening of duration of the limb ischemia. During thrombolytic therapy, one patient developed gastrointestinal bleeding that despite treatment resulted in death. In ten treated patients local bleeding from the puncture site was found, treated with compression in 9 patients while one patient required surgical intervention (evacuation of hematoma). Neither death nor limb amputation occurred during the hospitalization of 18 patients after the successful thrombolysis. Three patients required angioplasty due to vascular stenoses found in angiography as the cause of thrombosis. After unsuccessful thrombolysis, necrosis of peripheral parts of the limbs occurred and due to lack of possibility of further vascular reconstruction, amputation was required. Surgical restoration of vessel patency performed in the remaining 12 patients was successful in eight patients, while unsuccessful in the other 4 patients who also required limb amputation. Three deaths occurred in this group, caused by heart failure after the procedure of restoration of vessel patency.Conclusions. Our results indicate that local thrombolytic therapy can be effective in rescuing a limb at risk in patients with contraindications to surgical treatment.
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