INTRODUCTION: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. CASE REPORT: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patients abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. CONCLUSION: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.
- Klíčová slova
- liver cirrhosis, thrombophlebitis, umbilical vein,
- MeSH
- bolesti břicha * diagnostické zobrazování etiologie MeSH
- krvácení MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- tromboflebitida * komplikace MeSH
- vena portae MeSH
- venae umbilicales * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Acute portal vein thrombosis and septic thrombophlebitis of the portal vein represent serious, although rare cases in the non-cirrhotic population. The authors present a case report, in which nonspecific clinical and CT scan findings led to the difficult diagnosis of pylephlebitis due to perforated rectosigmoid cancer.
- MeSH
- lidé MeSH
- nádory rekta komplikace diagnóza MeSH
- nádory sigmoidea komplikace diagnóza MeSH
- perforace střeva komplikace diagnóza MeSH
- počítačová rentgenová tomografie MeSH
- senioři MeSH
- spontánní ruptura komplikace diagnóza MeSH
- tromboflebitida diagnóza etiologie MeSH
- trombóza diagnóza etiologie MeSH
- vena portae * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: A new consensus on the management of superficial thrombophlebitis (STP) from the Central European Vascular Forum (CEVF) for the diagnosis and treatment of STP recommends anticoagulation treatment either with Fondaparinux 2.5 mg for at least 45 days or with low molecular weight heparin (LMWH) for 4 weeks in patients with thrombosis of GSV/SSV proven by duplex ultrasonography (DUS) and with thrombus length exceeding 5 cm. The dosage and duration of anticoagulation treatment depend on the associated diseases and other risk factors for TVE. Many options for doses an duration of treatment are referred to in the literature. Emergency surgery is not recommended. The aim of this study is to demonstrate the role of DUS examination in acute ascending thrombophlebitis (ASTP) of the GSV, and demonstrate the efficiency of surgical treatment - crossectomy and phlebectomy of thrombosed GSV/SSV. MATERIAL AND METHODS: The authors present their clinical experience with DUS diagnosis and surgical treatment of acute ascending thrombophlebitis in GSV/SSV on 66 patients with 68 operations. In two of them bilateral crossectomy was performed. In the diagnosis it is necessary to perform DUS examination after clinical diagnosis of acute thrombophlebitis. It should be done bilaterally, not only in the affected limb. DUS confirms the measure, progression and eventually ascension of the thrombosis on the trunk of the GSV/SSV and perforating veins. Progress of the thrombotic process from the thigh to the SF/SP junction is usually a matter of a few hours. Daily ultrasound assessment should therefore be performed in acute thrombophlebitis, even during anticoagulation therapy. Thrombus near the SF/SP junction is a reason for urgent surgery - crossectomy and phlebectomy. RESULTS: 66 patients were operated on under general anaesthesia without any complications. A large hematoma in the subinguinal region developed in one patient after surgery. A 50-year-old patient returned with colliquation of the residual varicose vein on the lower leg. Outpatient incision and evacuation had to be performed 3 weeks after surgery. Anticoagulation therapy with warfarin was started in two patients. The other patients were discharged 4 to 6 days following surgery without any problems. Post-operative anti-coagulation in other patients was not longer than 2 weeks. CONCLUSION: Urgent crossectomy and phlebectomy represent a reliable method of treatment in the management of acute ascending thrombophlebitis of GSV/SSV, guaranteeing prophylaxis of complications, especially in pregnant women with PT in the later phase of pregnancy. Surgical treatment destroys the damaged vein with crossectomy as a potential cause of deep vein thrombosis (DVT), pulmonary embolism (PE) and STP recurrence. After anticoagulation therapy the affected vein remains in situ. It can potentially cause the recurrence of STP, and DVT and PE may develop.
- MeSH
- dolní končetina diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tromboflebitida diagnostické zobrazování chirurgie MeSH
- trombóza chirurgie MeSH
- ultrasonografie MeSH
- výkony cévní chirurgie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber (AS SMC) is to address a last european guidelines for the management of thrombophlebitis superficialis, as well as results in evidence based medicine (EBM) in order to assess their contribution to our expanding knowledge on rational management of thrombophlebitis superficialis. DISCUSSION: Superficial thrombophlebitis is a common disease, usually considered to be benign. However, the practice of systemic duplex ultrasonography has revealed a large number of cases of deep vein thrombosis concomitant with superficial thrombophlebitis. Assessment of clinical probability of deep vein thrombosis and venous tromboembolism and systematic duplex ultrasound investigation has been proposed in the initial management of superficial thrombophlebitis, to detect the presence of any underlying deep vein thrombosis. In contrast with extensive information on the management of deep vein thrombosis, there is little knowledge about the most appropriate treatment of the superficial thrombophlebitis. CONCLUSION: The treatment of superficial thrombophlebitis should improve local symptoms while preventing the development of complications such as venous thromboembolism. The most effective therapeutic approach to superficial thrombophlebitis seems to be represented by fondaparinux (a synthetic selective indirect inhibitor of factor Xa) which have been shown to prevent VTE events and the extension and/ or recurrence of superficial thrombophlebitis.
- MeSH
- antikoagulancia terapeutické užití MeSH
- duplexní dopplerovská ultrasonografie MeSH
- fondaparinux MeSH
- inhibitory faktoru Xa terapeutické užití MeSH
- kontrastní látky MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- polysacharidy terapeutické užití MeSH
- recidiva MeSH
- tromboflebitida klasifikace diagnostické zobrazování farmakoterapie MeSH
- žilní trombóza diagnostické zobrazování farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- antikoagulancia MeSH
- fondaparinux MeSH
- inhibitory faktoru Xa MeSH
- kontrastní látky MeSH
- polysacharidy MeSH
Superficial thrombophlebites represent a very heterogeneous group of diseases which is caused by the difference between two basic forms of ST - varicophlebitis and thrombophlebitis of a "healthy" vein, as well as by other factors - the ratio of thrombotic and inflammatory process, the location and extent of thrombosis in superficial venous system, the distance from deep venous system, the stage of venous insufficiency and the general thrombotic risk of a patient. ST shares many common features with deep vein thrombosis (clinical risk factors, thrombophilic disorders), both diseases often coincide or follow one another. Some authors suggest considering ST as a part of venous thromboembolism in a broader sense. There are ensuing unresolved questions regarding ST management. So far, no evidence-based treatment has been clearly defined. Anticoagulation is recommended in more serious cases but no consensus about dosing and duration has been reached. The CALISTO trial confirmed a benefit of fondaparinux in prophylactic dose in the therapy of isolated ST and the results have been reflected in recent guidelines of expert groups. Further studies to improve our knowledge of ST and to earn more evidence about its management are definitely needed.
- MeSH
- lidé MeSH
- tromboflebitida komplikace diagnóza terapie MeSH
- žilní trombóza diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
We present a 55-year-old man with acute migrating thrombophlebitis and deep vein thrombosis of muscle veins in both calves indicating occurrence of acute myelomonocytic leukemia. Thrombosis of superficial and deep veins of the lower limbs arose in spite of the adequate anticoagulation therapy with warfarin.
- MeSH
- akutní myelomonocytární leukemie komplikace MeSH
- antikoagulancia terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- svaly krevní zásobení MeSH
- tromboflebitida komplikace MeSH
- ultrasonografie MeSH
- vény diagnostické zobrazování MeSH
- warfarin terapeutické užití MeSH
- žilní trombóza komplikace diagnostické zobrazování farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antikoagulancia MeSH
- warfarin MeSH
Superficial thrombophlebitis (ST) is a common disease, usually considered benign. However, the practice of systemic duplex ultrasonography has revealed a large number of deep-vein thromboses concomitant with ST. In contrast with extensive information on the management of deep vein thrombosis, little is known about the most appropriate treatment of the ST. Systematic duplex ultrasonography investigation has been proposed in the initial management of ST, to detect the presence of any underlying deep vein thrombosis. Because ST may extend into the deep venous system and potentially engender pulmonary embolism, treatment with low-molecular-weight-heparins might be the best choice. In our work diagnostic and therapeutic procedures for ST, proposed by Slovak angiological society, Slovak society for vascular surgeons, Slovak dermatological society, Slovak society for haemostasis and thrombosis, Slovak surgical society and Slovak internistic society are discussed.
- MeSH
- lidé MeSH
- tromboflebitida diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
BACKGROUND: The question whether the primary increase of vasa vasorum (VV) of venous wall (i) plays an initial role in varicogenesis or (ii) is an expression of impairment of the nutritional conditions in superficial veins of lower extremities is not unambiguously solved yet. The aim of the study was to describe the arrangement of the VV within the wall of the human great saphenous vein (GSV) qualitatively, and of its tributaries at different stages of varicosis and in other pathological states like thrombophlebitis or phlebosclerosis. MATERIAL AND METHODS: 22 patients deserving an aorto-coronary bypass surgery or GSV surgery were subdivided into three groups according to the staging of their varices and other pathology. The harvested GSV were prepared for light and scanning electron microscopy. One cadaverous specimen of GSV was injected with India ink. RESULTS: In specimens from reticular and primary large varices local intimal hyperplasia was regularly found, partially accompanied with a mild increase of VV. Tortuosities and irregular dilations of adventitial veins were also found. In patients with recurrent primary varices or thrombophlebitis severe intimal and medial hyperplasia, thrombosis and a striking increase of VV were found. The intima remained avascular in all cases. CONCLUSIONS: Remarkable increase of VV accompanies the most severe forms of varices as well as all cases of the extreme grades of phlebosclerosis, medial hyperplasia and thrombosis. We hypothesize that this increase in VV is rather a secondary vascular reaction to the impaired metabolic conditions within the venous wall than a primary varicogenic factor.
- MeSH
- anatomické modely * MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- tromboflebitida patologie MeSH
- varixy patologie MeSH
- vasa vasorum patologie MeSH
- vaskulární nádory patologie MeSH
- vena saphena patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Thrombosis represents one of the most frequent and severe complication of central venous catheterization. The incidence of catheter-related venous thrombosis is not well established. This complication was found in 3.3% patients in the analysis of 23 studies with central venous access devices-ports. We have found it in 3% of our patients with implanted port. The types of catheter related thrombosis are following: mural thrombosis, fibrin sheath, thrombosis on the catheter tip. Venography has been shown to be highly reliable in identification of upper-extremity deep venous thrombosis. The up-to-date possibility of treatment and prophylaxis of venous thrombosis associated with central venous catheters are reviewed in this paper.
- MeSH
- katetrizace centrálních vén škodlivé účinky MeSH
- lidé MeSH
- tromboflebitida diagnóza etiologie prevence a kontrola terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
