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| 1 | Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis显示文摘BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are quite significant.There is a lack of knowledge about the clinical features and risk factors of PVT.Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS:We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution.Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared.Univariate and multivariate analyses of risk factors of PVT were performed.The mortality and rebleeding rate of the patients were also evaluated.RESULTS:Of the 472 patients,52 were excluded from the study.PVT developed in 71(71/420,16.9%) patients.Multivariate analysis revealed that wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio(OR):5.701,2.807,1.850 and 2.090,respectively].The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not.Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant.Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group(P=0.044).CONCLUSIONS:Wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT.PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival. | Mu-Xing Li Xu-Feng Zhang Zheng-Wen Liu Yi Lv | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，5： | 57 |
| 2 | Portal vein thrombosis in cirrhosis: Controversies and latest developments显示文摘Portal vein thrombosis(PVT) is encountered in livercirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus publication.We review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation,and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%.PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions. | Damian J Harding M Thamara PR Perera Frederick Chen Simon Olliff Dhiraj Tripathi | 2015 | World Journal of Gastroenterology2015，21，22： | 42 |
| 3 | Portal vein thrombosis in liver cirrhosis显示文摘Portal vein thrombosis(PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to:(1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis;(2) describe the principal factors most frequently involved in PVT development; and(3) summarize the recent knowledge concerning diagnostic and therapeutic procedures. | Nao Kinjo Hirofumi Kawanaka Tomohiko Akahoshi Yoshi-hiro Matsumoto Masahiro Kamori Yoshihiro Nagao Naotaka Hashimoto Hideo Uehara Morimasa Tomikawa Ken Shirabe Yoshihiko Maehara | 2014 | World Journal of Hepatology2014，6，2： | 38 |
| 4 | Iliac vein compression syndrome: Clinical, imaging and pathologic findings显示文摘May-Thurner syndrome(MTS) is the pathologic compression of the left common iliac vein by the right common iliac artery, resulting in left lower extremity pain, swelling, and deep venous thrombosis. Though this syndrome was first described in 1851, there are currently no standardized criteria to establish the diagnosis of MTS. Since MTS is treated by a wide array of specialties, including interventional radiology, vascular surgery, cardiology, and vascular medicine, the need for an established diagnostic criterion is imperative in order to reduce misdiagnosis and inappropriate treatment. Although MTS has historically been diagnosed by the presence of pathologic features, the use of dynamic imaging techniques has led to a more radiologic based diagnosis. Thus, imaging plays an integral part in screening patients for MTS, and the utility of a wide array of imaging modalities has been evaluated. Here, we summarize the historical aspects of the clinical features of this syndrome. We then provide a comprehensive assessment of the literature on the efficacy of imaging tools available to diagnose MTS. Lastly, we provide clinical pearls and recommendations to aid physicians in diagnosing the syndrome through the use of provocative measures. | Katelyn N Brinegar Rahul A Sheth Ali Khademhosseini Jemianne Bautista Rahmi Oklu | 2015 | World Journal of Radiology2015，7，11： | 36 |
| 5 | Venous thrombosis and prothrombotic factors in inflammatory bowel disease显示文摘Patients with inflammatory bowel disease(IBD)may have an increased risk of venous thrombosis(VTE).PubMed,ISI Web of Knowledge and Scopus were searched to identify studies investigating the risk of VTE and the prevalence of acquired and genetic VTE risk factors and prothrombotic abnormalities in IBD.Overall,IBD patients have a two-to fourfold increased risk of VTE compared with healthy controls,with an overall incidence rate of 1%-8%.The majority of studies did not show significant differences in the risk of VTE between Crohn’s disease and ulcerative colitis.Several acquired factors are responsible for the increased risk of VTEin IBD:inflammatory activity,hospitalisation,surgery,pregnancy,disease phenotype(e.g.,fistulising disease,colonic involvement and extensive involvement)and drug therapy(mainly steroids).There is also convincing evidence from basic science and from clinical and epidemiological studies that IBD is associated with several prothrombotic abnormalities,including initiation of the coagulation system,downregulation of natural anticoagulant mechanisms,impairment of fibrinolysis,increased platelet count and reactivity and dysfunction of the endothelium.Classical genetic alterations are not generally found more often in IBD patients than in nonIBD patients,suggesting that genetics does not explain the greater risk of VTE in these patients.IBD VTE may have clinical specificities,namely an earlier first episode of VTE in life,high recurrence rate,decreased efficacy of some drugs in preventing further episodes and poor prognosis.Clinicians should be aware of these risks,and adequate prophylactic actions should be taken in patients who have disease activity,are hospitalised,are submitted to surgery or are undergoing treatment. | Fernando Magro Jo?o-Bruno Soares Dália Fernandes | 2014 | World Journal of Gastroenterology2014，20，17： | 27 |
| 6 | Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate显示文摘Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic decompensation.Portal flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development.However,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still elusive.In particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet.Moreover,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression.Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still unknown.Nevertheless,their impact on mortality rates should be addressed more extensively.In this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials. | Mariella Faccia Maria Elena Ainora Francesca Romana Ponziani Laura Riccardi Matteo Garcovich Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco | 2019 | World Journal of Gastroenterology2019，25，31： | 23 |
| 7 | NETosis,complement,and coagulation:a triangular relationship显示文摘NETosis is a regulated form of neutrophil cell death that contributes to the host defense against pathogens and was linked to various diseases soon after its first description in 2004.During NETosis,neutrophils release neutrophil extracellular traps(NETs),which can capture and kill bacteria and other pathogens to prevent them from spreading.Although substantial progress has been made in our understanding of NETosis,the precise mechanism underlying NETosis is still a matter of debate.Research continues to elucidate the molecular pathways involved in NETosis.In recent years,interactions with the complement and coagulation systems have become increasingly apparent.Activated complement proteins can stimulate NET formation,and NETs,in turn,can serve as a platform for complement activation.In addition,NETs can act as a scaffold for thrombus formation during coagulation.While crosstalk between the coagulation and complement systems has been previously described,NETosis appears to be a third important player in this consortium to protect the host against pathogens.This review summarizes our current knowledge on the mutual interactions between NETosis,the complement system and the coagulation system,with an emerging description of their complex triangular relationship. | Cynthia M.de Bont Wilbert C.Boelens Ger J.M.Pruijn | 2019 | Cellular & Molecular Immunology2019，16，1： | 22 |
| 8 | Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers显示文摘Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide:Portal vein tumor thrombosis(PVTT)occurs in about 35%-50%of patients and represents a strong negative prognostic factor,due to the increased risk of tumor spread into the bloodstream,leading to a high recurrence risk.For this reason,it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care,due to its antiangiogenetic action,although it can grant only a poor prolongation of life expectancy.Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition,including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement,tumor biological aggressiveness,complications caused by portal hypertension,patient’s clinical features and tolerance to antineoplastic treatments.The median survival has been reported to range between 2.7 and 4 mo in absence of therapy,but it can vary from 5 mo to 5 years,thus depicting an extremely variable scenario.For this reason,it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients. | Lucia Cerrito Brigida Eleonora Annicchiarico Roberto Iezzi Antonio Gasbarrini Maurizio Pompili Francesca Romana Ponziani | 2019 | World Journal of Gastroenterology2019，25，31： | 21 |
| 9 | Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis显示文摘AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis(PSMVT) in the early stage of severe acute pancreatitis(SAP).METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography(CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic(ROC) curve was generated for the qualifying independent risk factors.RESULTS Twenty-five of the one hundred and forty(17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis(AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index(CTSI) scores [odds ratio(OR): 2.742; 95% confidence interval(CI): 1.664-4.519; P = 0.000], hypoalbuminemia(serum albumin level < 25 g/L)(OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening(OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777(P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSION High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP. | Ling Ding Feng Deng Chen Yu Wen-Hua He Liang Xia Mi Zhou Xin Huang Yu-Peng Lei Xiao-Jiang Zhou Yin Zhu Nong-Hua Lu | 2018 | World Journal of Gastroenterology2018，24，35： | 20 |
| 10 | Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis显示文摘Although the current standard treatment for hepatocellular carcinoma(HCC) with portal vein tumor thrombosis(PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy(RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT. | Jeong Il Yu Hee Chul Park | 2016 | World Journal of Gastroenterology2016，22，30： | 20 |
| 11 | challenges of advanced hepatocellular carcinoma显示文摘Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials. | Stefano Colagrande Andrea L Inghilesi Sami Aburas Gian G Taliani Cosimo Nardi Fabio Marra | 2016 | World Journal of Gastroenterology2016，22，34： | 19 |
| 12 | Prevention and treatment of hepatic artery thrombosis after liver transplantation显示文摘BACKGROUND: Hepatic artery thrombosis (HAT) which is a serious complication after orthotopic liver transplanta- tion (OLT) remains a significant cause of graft loss. The purpose of this study was to sum up our experiences in the prevention, diagnosis and management of HAT after liver transplantation. METHODS: From April 1993 to September 2003, a total of 198 patients underwent OLT at our hospital. The hepatic artery was anastomosed using 7/0 prolane with running continuous suture in 96 patients (group 1) and with inter- rupted suture in 102 (group 2). Ultrasonography was per- formed every day in two weeks after operation and selec- tively afterwards. RESULTS: HAT occurred in 6 patients (6.3%, 6/96) of group 1, and in 1 (1%, 1/102) of group 2 (x2=4.027, P= 0.045). Six patients received emergency thrombectomy, and 1 conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 patients af- ter thrombectomy of whom 2 died of liver failure and one waited for retransplantation. In the other 3 patients after thrombectomy, 1 died of renal failure, and 2 survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSIONS: The technique of hepatic arterial anasto- mosis is the key factor for the prevention of HAT. Routine ultrasonography is very important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT. | Shu-Sen Zheng, Zhi-Yong Yu, Ting-Bo Liang, Wei-Lin Wang, Yan Shen, Min Zhang, Xiao Xu and Jian Wu Hangzhou, China Centre of Organ Transplantation and Department o Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medica College, Zhcjiang University, Hangzhou 310003, China | 2004 | Hepatobiliary & Pancreatic Diseases International2004，3，1： | 18 |
| 13 | The fate of medications evaluated for ischemic stroke pharmacotherapy over the period 1995–2015显示文摘Stroke is a brain damage caused by a loss of blood supply to a portion of the brain, which requires prompt and effective treatment. The current pharmacotherapy for ischemic stroke primarily relies on thrombolysis using recombinant tissue plasminogen activators(rt-PAs) to breakdown blood clots. Neuroprotective agents that inhibit excitatory neurotransmitters are also used to treat ischemic stroke but have failed to translate into clinical benefits. This poses a major challenge in biomedical research to understand what causes the progressive brain cell death after stroke and how to develop an effective pharmacotherapy for stroke. This brief review analyzes the fate of about 430 potentially useful stroke medications over the period 1995–2015and describes in detail those that successfully reached the market. Hopefully, the information from this analysis will shed light on how future stroke research can improve stroke drug discovery. | Xiaoling Chen Kewei Wang | 2016 | Acta Pharmaceutica Sinica B2016，6，6： | 18 |
| 14 | Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma显示文摘BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult. | Li Zhou Jing-An Rui Shao-Bin Wang Shu-Guang Chen Qiang Qu | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，1： | 17 |
| 15 | Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity(second edition)显示文摘This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome. | Jianping Gu Ke Xu Gaojun Teng | 2018 | Journal of Interventional Medicine2018，1，3： | 16 |
| 16 | Asymptomatic process of hepatic artery thrombosis in a patient after orthotopic liver transplantation显示文摘BACKGROUND: Hepatic artery thrombosis is one of the serious complications after liver transplantation. It wil mostly cause a failure of the transplantation. This case o hepatic artery thrombosis showed a stable clinical course and minimal histological change, and now has been survi ving for 4 years with normal liver function. We investigated the possible causes for asymptomatic hepatic artery throm bosis in one patient after orthotopic liver transplantation ( OLT) and discussed the diagnosis of ischemia of OLT pathologically and clinically. METHODS: Liver function test, color Doppler ultrasono graphy, and hepatic arteriography were performed during the development of hepatic arteriothrombosis. Possible fac- tors for the asymptomatic process of the thrombosis were analyzed. RESULTS: On the 4th postoperative day, thrombosis form ed at the anastomotic stoma of the hepatic artery, and on the 11th postoperative day, the artery was completely oc- cluded. Serial liver biopsies revealed intrahepatic cholesta- sis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium, and fibrosis in the portal area. Monitor- ing of liver function showed nothing abnormal except ele- vation of γ-GT and ALP levels. On the 71st day after OLT, arteriography demonstrated that the hepatic artery re- mained completely occluded in addition to the establish- ment of collateral circulation and compensation of the por- tal vein. The patient didn’ t show any symptoms of arterial thrombosis. CONCLUSION: Collateral circulation and compensation o the portal vein are beneficial to allograft survival and avoidence of retransplantation after thrombosis of the he- patic artery. Color Doppler ultrasonography within 2 weeks after OLT is helpful to the early diagnosis of hepatic arterio- thrombosis. | Jia-Wei Chen, Da-Zhi Chen and Guang-Zhong Lu Shanghai, China Department of Pathology, Shanghai First People’ s Hospital, Shanghai 200080 , China Department of Surgery, Beijing Chaoyang Hospital, Beijing 100020, China | 2004 | Hepatobiliary & Pancreatic Diseases International2004，3，1： | 15 |
| 17 | Anticoagulation and delayed bowel resection in the management of mesenteric venous thrombosis显示文摘Acute mesenteric venous thrombosis is potentially lethal because it can result in mesenteric ischemia and,ultimately,bowel infarction requiring surgical intervention.Systemic anticoagulation for the prevention of thrombus propagation is a well-recognized treatment modality and the current mainstay therapy for patients with acute mesenteric venous thrombosis.However,the decision between prompt surgical exploration vs conservative treatment with anticoagulation is somewhat difficult in patients with suspected bowel ischemia.Here we describe a patient with acute mesenteric venous thrombosis who presented with bowel ischemia and was treated with anticoagulation and delayed short-segment bowel resection. | Hyung-Kee Kim Jae Min Chun Seung Huh | 2013 | World Journal of Gastroenterology2013，19，30： | 15 |
| 18 | Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014显示文摘The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT) should be based on an overall objective post incidence of venous thromboembolism(VTE) of less than 1% during 3 mo fol low-up. Compression ultrasonography(CUS) of the leg veins has a negative predictive value(NPV) of 97%-98% indicating the need of repeated CUS testing within one week. A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99% and 100% at a low clinical score of zero. The combination of low clinical score and a less sensitive D-dimer test(Simplify) is not sensitive enough to exclude DVT and VTE in routine daily practice. From prospective clinical research studies it may be concluded that complete recanalization within 3-6 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT. Partial and complete recanalization after 6 to more than 12 mo is usually complicated by reflux due to valve destruction and symptomatic PTS. Reflux seems to be a main determinant for PTS and DVT recurrence, the latter as a main contributing factor in worsening PTS. This hypothesis is supported by the relation between the persistent residual vein thrombosis(RVT = partial recanalization) and the risk of VTE recurrence in prospective studies. Absence of RVT at 3 mo postDVT and no reflux is predicted to be associated with no recurrence of DVT(1.2%) during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT. The presence or absence of RVT but with reflux at or after 6 mo postDVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment. To test this hypothesis we designed a prospective DVT and postthrombotic syndrome(PTS) Bridging the Gap Study by addressing at least four unanswered questions in the treatment ofDVT and PTS.Which DVT patient has a clear indication for long-term compression stocking therapy to prevent PTS after the initial anticoagulant treatment in the acute phase of DVT?Is 6 mo the appropriate point in time to determine candidates at risk to develop DVT recurrence and PTS?Which high risk symptomatic PTS patients need extended anticoagulant treatment? | Jan Jacques Michiels Janneke Maria Michiels Wim Moossdorff Mildred Lao Hanny Maasland Gualtiero Palareti | 2015 | World Journal of Critical Care Medicine2015，4，1： | 14 |
| 19 | Venous thromboembolism in inflammatory bowel disease显示文摘Patients with inflammatory bowel disease(IBD)are at an increased risk for venous thromboembolism(VTE).VTE events carry significant morbidity and mortality,and have been associated with worse outcomes in patients with IBD.Studies have suggested that the hypercoagulable nature of the disease stems from a complex interplay of systems that include the coagulation cascade,natural coagulation inhibitors,fibrinolytic system,endothelium,immune system,and platelets.Additionally,clinical factors that increase the likelihood of a VTE event among IBD patients include older age(though some studies suggest younger patients have a higher relative risk of VTE,the incidence in this population is much lower as compared to the older IBD patient population),pregnancy,active disease,more extensive disease,hospitalization,the use of certain medications such as corticosteroids or tofacitinb,and IBD-related surgeries.Despite the increased risk of VTE among IBD patients and the safety of pharmacologic prophylaxis,adherence rates among hospitalized IBD patients appear to be low.Furthermore,recent data suggests that there is a population of high risk IBD patients who may benefit from post-discharge prophylaxis.This review will provide an overview of patient specific factors that affect VTE risk,elucidate reasons for lack of VTE prophylaxis among hospitalized IBD patients,and focus on recent data describing those at highest risk for recurrent VTE post-hospital discharge. | Kimberly Cheng Adam S Faye | 2020 | World Journal of Gastroenterology2020，26，12： | 14 |
| 20 | Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis显示文摘Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens. | Janesya Sutedjo Yan Li Jianping Gu | 2018 | Journal of Interventional Medicine2018，1，4： | 14 |
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