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DEEP VEIN THROMBOSIS Edited by Gregory Cheng Deep Vein Thrombosis Edited by Gregory Cheng Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Masa Vidovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Deep Vein Thrombosis, Edited by Gregory Cheng p. cm. 978-953-51-0225-0 Contents Preface IX Chapter 1 Risk Factors of Deep Vein Thrombosis 1 Mustafa Sirlak, Mustafa Bahadir Inan, Demir Cetintas and Evren Ozcinar Chapter 2 Venous Stasis and Deep Vein Thrombosis Prevention in Laparoscopic Surgery 31 Mindaugas Kiudelis, Dalia Adukauskienė and Rolandas Gerbutavičius Chapter 3 Vena Cava Malformations as an Emerging Etiologic Factor for Deep Vein Thrombosis in Young Patients 43 Massimiliano Bianchi, Lorenzo Faggioni, Virna Zampa, Gina D'Errico, Paolo Marraccini and Carlo Bartolozzi Chapter 4 Endovascular Therapies in Acute DVT 59 Jeff Tam and Jim Koukounaras Chapter 5 Radiological Imaging and Intervention in Venous Thrombosis 79 Andrew Christie, Giles Roditi, Ananthakrishnan Ganapathy and Chris Cadman Chapter 6 Emerging Issues in Deep Vein Thrombosis; (DVT) in Liver Disease and in Developing Countries 99 Farjah H. AlGahtani and Abdel Galil Abdel Gader Chapter 7 Venous Thromboembolism Prophylaxis in Cancer Patients 111 Hikmat Abdel-Razeq Chapter 8 Deep Vein Thrombosis of the Arms 129 Peter Marschang VI Contents Chapter 9 The Post Thrombotic Syndrome 143 Paolo Prandoni and Susan R Kahn Chapter 10 Venous Thromboembolism in Orthopaedic Surgery 159 Justin R. Knight and Michael H. Huo Chapter 11 Deep Venous Thrombosis After Radical Pelvic Surgery 173 Bedeir Ali-El-Dein Preface Venous thromboembolism (VTE) is a common disease with an incidence of over 1 in 1000 in Western countries. It is associated with significant morbidities and costs. Post- thrombotic syndrome may develop in one third of patients with deep vein thrombosis (DVT) with considerable socio-economic consequences. DVT is usually seen in patients with underlying risk factors and patients undergoing major pelvic and orthopaedic surgeries. Numerous guidelines suggest use of DVT thromboprophylaxis in these patients, but despite encouraging results of thromboprophylaxis, many studies showed low compliance rates with such guidelines. Also in regions with low DVT prevalence, the benefit of pharmacological prophylaxis is not clear. Patients undergoing laporoscopic operations are also at risks of VTE because of increased venous stasis caused by abdominal insufflation and prolonged reverse Trendelenburg position. Most DVT occur in the lower limbs, but DVT the arms may account for 5% of VTE cases. Cancer and its treatment are recognized risk factors for VTE and extended prophylaxis in ambulatory cancer patients may be required. Recent radiological advances have facilitated the diagnosis and management of DVT and have also identified vena cava malformations as a new etiologic factor in young DVT patients. Endovascular therapy is a potential treatment option in acute DVT. Chronic liver disease is recently recognised as a hypercoagulable state. All this issues will be addressed by various experts in this book. Dr. Gregory Cheng Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong [...]... and is associated with both arterial and venous thrombosis Clinically, patients may present with deep venous thrombosis of the lower extremity, cerebral venous thrombosis, as well as arterial thrombosis The risk of thrombosis increases in the presence of other genetic coagulation defects and with acquired risk factors.88,84 Risk Factors of Deep Vein Thrombosis 9 8.5 Hyperhomocysteinemia Homocysteine... stasis and vein lumen changes during surgery Br J Surg 1990;77:1055–9 [13] Coleridge Smith PD, Hasty JH, Scurr JH Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf Br J Surg 1991;78:724–6 [14] Comerota AJ, Stewart GJ, Alburger PD, et al Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis. .. rates of deep vein thrombosis and pulmonary embolism The Worcester DVT Study Arch Intern Med 1991;151:933– 8 [26] Borow M, Goldson H Postoperative venous thrombosis Evaluation of five methods of treatment Am J Surg 1981;141:245–51 [27] Borow M, Goldson HJ Prevention of postoperative deep venous thrombosis and pulmonary emboli with combined modalities Am Surg 1983;49:599–605 20 Deep Vein Thrombosis. .. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans Am J Cardiol 2000; 85: 1334–37 [9] Anderson FA, Wheeler HB, Goldberg RJ, et al A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study Arch Intern Med 1991; 151: 933–38 Risk Factors of Deep Vein Thrombosis 19 [10] Kyrle PA, Minar... Factors of Deep Vein Thrombosis Mustafa Sirlak, Mustafa Bahadir Inan, Demir Cetintas and Evren Ozcinar Ankara University School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey 1 Introduction Deep vein thrombosis is a clinical challenge for doctors of all disciplines It can complicate the course of a disease but might also be encountered in the absence of precipitating disorders Thrombosis. .. epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly Arch Intern Med 1994; 154: 861–66 [5] Heit JA, O’Fallon WM, Petterson TM, et al Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study Arch Intern Med 2002; 162: 1245–48 [6] Cushman M, Tsai AW, White RH, et al Deep vein thrombosis and pulmonary embolism in two cohorts:... [113] Gunduz S, Ogur E, Mohur H, et al: Deep vein thrombosis in spinal cord injured patients Paraplegia 31:606410, 1993 [114] Hull R Venous thromboembolism in spinal cord injury patients Chest 102:658-662, 1992 [115] Merli GJ: Management of deep vein thrombosis in spinal cord injury Chest 102652657, 1992 [116] Myllynen P, Kammonen M, Rokkanen P, et al: Deep venous thrombosis and pulmonary embolism in... whereas heterozygotes typically have an antithrombin level that is 40 to 70% of normal 8 Deep Vein Thrombosis Antithrombin deficiency is associated with lower extremity venous thrombosis as well as mesenteric venous thrombosis The most common presentation in those with antithrombin deficiency is deep venous thrombosis with or without pulmonary embolism.82 8.2 Protein C and protein S deficiency Protein... dihydroergotamine and heparin prophylaxis of postoperative deep vein thrombosis: proposed mechanism of action Am J Surg 1985;150:39–44 [16] Stamatakis JD, Kakkar VV, Sagar S, et al Femoral vein thrombosis and total hip replacement BMJ 1977;2:223–5 [17] Mammen EF Pathogenesis of venous thrombosis Chest 1992;102:640S–4S [18] Mackman N Role of tissue factor in hemostasis, thrombosis, and vascular development Arterioscler... incidence per 1000 person-years of 1·8 at age 65–69 years and 3·1 at age 85–89 years.4 Two-thirds of first-time episodes of deep vein thrombosis are caused by risk factors, including surgery, cancer, immobilisation, or admission for other reasons.5,6 Risk for first deep vein thrombosis seems to be slightly higher in men than in women.6,9 In a populationbased cohort study, the age-adjusted incidence . DEEP VEIN THROMBOSIS Edited by Gregory Cheng Deep Vein Thrombosis Edited by Gregory Cheng Published by InTech. orders@intechweb.org Deep Vein Thrombosis, Edited by Gregory Cheng p. cm. 978-953-51-0225-0 Contents Preface IX Chapter 1 Risk Factors of Deep Vein Thrombosis 1 Mustafa. first-time episodes of deep vein thrombosis are caused by risk factors, including surgery, cancer, immobilisation, or admission for other reasons. 5,6 Risk for first deep vein thrombosis seems to