VENOUS THROMBOSIS – PRINCIPLES AND PRACTICE Edited by Ertugrul Okuyan Venous Thrombosis – Principles and Practice Edited by Ertugrul Okuyan Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 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 Image Copyright julos, 2011. DepositPhotos First published December, 2011 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 Venous Thrombosis – Principles and Practice, Edited by Ertugrul Okuyan p. cm. ISBN 978-953-307-885-4 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Etiology 1 Chapter 1 Aetiology of Venous Thrombosis 3 Mehrez M. Jadaon Chapter 2 Venous Thrombosis in Behcet’s Disease 43 Selda Pelin Kartal Durmazlar Chapter 3 Antiphospholipıd Syndrome and Venous Thrombosis 55 Ertugrul Okuyan Chapter 4 Deep Venous Thrombosis in Children with Musculoskeletal Infection 69 Lawson A. B. Copley and Ngozi Okoro Part 2 Management and Complications 77 Chapter 5 Current Endovascular Treatments for Venous Thrombosis 79 Glenn W. Stambo Chapter 6 Late Complications of Deep Venous Thrombosis: Painful Swollen Extremities and Non Healing Ulcers 91 Daniel Link Part 3 Cerebral Venous Thrombosis and Venous Thrombosis of the Eye 111 Chapter 7 Cerebral Venous Thrombosis in Patients Using Oral Contraceptives 113 Procházka Václav, Procházka Martin, Ľubušký Marek, Procházková Jana and Hrbáč Tomáš VI Contents Chapter 8 Cerebral Venous Sinus Thrombosis - Diagnostic Strategies and Prognostic Models: A Review 129 Penka A. Atanassova, Radka I. Massaldjieva, Nedka T. Chalakova and Borislav D. Dimitrov Chapter 9 Venous Thrombosis and the Eye 159 Bob Z. Wang and Celia S. Chen Part 4 Venous Thrombosis in Special Patient Populations 179 Chapter 10 Approaching Venous Thrombosis in General Surgery Patients 181 Gulcin Hepgul, Fatih Yanar and Meltem Küçükyılmaz Part 5 Special Issues 197 Chapter 11 Heparin-Induced Thrombocytopenia 199 Kelly L. Cervellione and Craig A. Thurm Chapter 12 Cavitary Pulmonary Infarct: The Differential Diagnostic Dilemma – A Case Report 215 Ivanka Djordjevic and Tatjana Pejcic Chapter 13 Hypothetical Mechanism of the Formation of Dural Arteriovenous Fistula – The Role and Course of Thrombosis of Emissary Vein and Sinuses 223 Shigeru Miyachi Preface The venous thrombosis care and profession has evolved considerably over the past 20 years. This book reflects the current practice, both technical and professional, of physicians from different fields. Venous thromboembolism became treatable with the discovery of heparin at the beginning of the 20th century. The presence of an effective therapy increased the importance of diagnosing venous thromboembolism, fueling a plethora of medical research and technological developments over the next century. Despite the advances made, venous thromboembolism remains an elusive entity because of its atypical presentations and associated diagnostic challenges. This book is a fresh synthesis of venous thromboembolism care and considers the opinions and studies from different fields of medicine. As venous thrombosis spectrum is wide and can affect many organ systems, from deep veins of the leg to the cerebral venous system, our intent is for this to be a comprehensive, up-to-date and readable book. Section 1 covers the etiology of venous thrombosis and specific disease conditions that are largely associated with venous thrombosis. Section 2 is a review of the current catheter-based therapy and late complications of the venous thrombosis. Section 3 covers all aspects of assessment of the patients with cerebral venous thrombosis and venous thrombosis of the eye. Section 4 focuses on venous thrombosis in general surgery patients and catheter-related venous thrombosis in cancer patients. Section 5 covers special issues about venous thrombosis, clinical experiences and perspectives of the authors about the special topics. We sought the best contributing authors to write these chapters. Many of them are not only experts in their assigned topics, but also have extensive teaching experience. We encouraged all contributors to present a new synthesis of the existing material infused with new ideas and perspectives, their own clinical studies and even case-reports. So, we present to you the fruits of our efforts. We all hope that this book will be a significant contribution to the scientific knowledge about venous thrombosis. Dr. Ertugrul Okuyan Istanbul Bagcilar Education and Research Hospital Cardiology Clinic, Istanbul Turkey [...]... (prepared and drawn by the author) 14 Venous Thrombosis – Principles and Practice Fig 5 Factor V molecule showing the site of amino acid 506 where FVL is present and how this leads to APC-R and VTE (prepared and drawn by the author) The identification of APC-R/FVL and its high risk value have exploded a massive rush in researches to study this new disease, its prevalence and its relationship with VTE in... found in 2-8% of patients with thrombosis (Aoki et al., 1978; Dolan et al., 1988; Heijboer et al., 1990; Brandt, 2002; Song et al., 2003) Thus, more studied maybe needed before definitely 12 Venous Thrombosis – Principles and Practice linking plasminogen deficiency with VTE, and establishing Plasminogen Deficiency Registry databases may help to determine the prevalence and risk of this defect Another... embryonic stage and before birth due to haemorrhagic and intravascular thrombi Human embryos with TFPI deficiency may suffer a similar problem and this may explain why no cases with TFPI deficiency has been identified so far (Broze, 1998; Chan, 2001; Maroney & Mast; 2008) 10 Venous Thrombosis – Principles and Practice 3.5 Heparin Cofactor II (HCII) deficiency HCII was first detected and isolated in... thousand years old and this is why it is present in Caucasians only The next question is: where in Europe has it happened? Since 1997 Castoldi et al suggested that FVL probably occurred outside Europe It was observed that FVL was very rare in the Aetiology of Venous Thrombosis Fig 7 Molecular studies exploring the origin of FVL (prepared and drawn by the author) 17 18 Venous Thrombosis – Principles and. .. treatment of thrombosis Current Opinion in Drug Discovery and Development, Vol.11, No.4, (July 2008), pp 480-486, ISSN 1367-6733 Carmeliet, P.; Stassen, JM.;, Schoonjans, L.; Ream, B.; van den Oord, JJ.; De Mol, M.; Mulligan, RC & Collen, D (1993) Plasminogen activator inhibitor-1 gene-deficient 26 Venous Thrombosis – Principles and Practice mice II Effects on hemostasis, thrombosis, and thrombolysis... can activate other clotting factors and form many positive feedback loops in the Coagulation process Therefore, the clotting process may continue 6 Venous Thrombosis – Principles and Practice forever and the clot may enlarge until it blocks the whole lumen of the blood vessel Therefore, the Coagulation process should be limited to the area of blood vessel injury and should be prevented from extending... patients with VTE and normal populations in different East Mediterranean countries Fig 9 Map of the Mediterranean area showing decrease in prevalence of FVL as moving from East Mediterranean to North and West Europe This made many believe that the origin of FVL is somewhere in the Eastern Mediterranean region (prepared and drawn by the author) 20 Venous Thrombosis – Principles and Practice Other mutations... several studies reported a 22 Venous Thrombosis – Principles and Practice number of individuals who had FVL in addition to other accompanying genetic defect(s) like hereditary AT, PC or PS deficiency Both FV and AT genes are located on chromosome 1 As a result, a segregated inheritance pattern of APC-R and AT deficiency can persist in families for several generations (Ireland et al, 1995; Koeleman et... many 4 Venous Thrombosis – Principles and Practice processes, two of which are “The Coagulation Process” and “The Fibrinolysis Process” In both processes, blood clotting factors are the crucial constituents Clotting factors are enzymatic proteins that are synthesised mostly in the liver and circulate in the blood in an inactive form When a blood vessel gets injured, these factors get activated and start... Japanese, American Indians (native nations of America), Greenland Inuit (Eskimos) and native populations of Australia (table 2 and figure 6) Fig 6 Prevalence of FVL worldwide in different ethnic groups (prepared and drawn by the author) 15 Aetiology of Venous Thrombosis Country European UK Sweden VTE patients (%) -41.5-50 Poland Netherlands -21 Germany 30 Belgium Slovakia 22 29.5-37.0 Austria Hungary . VENOUS THROMBOSIS – PRINCIPLES AND PRACTICE Edited by Ertugrul Okuyan Venous Thrombosis – Principles and Practice Edited by Ertugrul Okuyan. complications of the venous thrombosis. Section 3 covers all aspects of assessment of the patients with cerebral venous thrombosis and venous thrombosis of the eye. Section 4 focuses on venous thrombosis. clotting factors and form many positive feedback loops in the Coagulation process. Therefore, the clotting process may continue Venous Thrombosis – Principles and Practice 6 forever and the clot