Term
| What is the general risk of PE in upper extremity DVT? |
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Definition
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Term
What is Paget Schroetter Syndrome? What is the cause? Name some common anatomical reasons for it to occur What are some basic treatment principles? |
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Definition
Acute axillary subclavian thrombosis Compression of the vein at the thoracic outlet Compression between the first rib and hypertrophied scalene or subclavius tendon Clavicle and first rib compression Congenital web Acute thrombolysis/angioplasty as tolerated/surgery to fix the underlying problem usually once inflammation has resolved Stenting if necessary only after surgical correction of the problem |
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Term
What is the diagnostic accuracy in pelvic congestion syndrome in % for: laparoscopy MRV ultrasound |
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Definition
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Term
Thrombophilia is responsible for what % of cases in idiopathic DVT? Superficial thrombophlebitis? Factor V Leiden is responsible in what % of cases? Prothrombin gene mutation? |
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Definition
20-40% 18-35% Factor V Leiden 14% Prothrombin GM 3% |
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Term
In the presence of a lower extremity venous ulcer what % would demonstrate: Reflux in a perforator Superfical reflux Deep venous reflux No local venous abnormality |
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Definition
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Term
| Recurrent episode of DVT results in what increase incidence of postphlebitic syndrome? |
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Definition
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Term
| In patients with severe chronic venous insufficiency is the O2 content in the femoral vein higher or lower than in the unaffected limb? |
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Definition
| Higher. Hypoxia in veins is not the etiology of chronic venous stasis changes |
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Term
| Summarize how venous HTN causes varicosities and skin changes |
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Definition
Venous HTN causs a shear stress dependent leukocyte-endothelial interaction which appears like chronic inflammation. Leukocytes adhere and then migrate through the endothelium into the parenchyma of vein walls and valves. There macrophages elaborate matrix metalloproteases which destroy elastin and collagen. Vein walls become stretched and valves become perforated and torn and scarred. |
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Term
| Describe how leukocytes play a role in the skin changes of chronic venous insufficiency |
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Definition
| Leukocytes are trapped in the venous microcirculation of the skin. These trapped leukocytes become activated resulting in release of toxic metabolites causing damage to the microcirculation and overlying skin. The primary injury in the skin is extravasation of macromolecules and rbc's into the dermal interstitium. RBC degradation products and protein represent the initial chronic inflammatory signal responsible for leukocyte recruitment |
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Term
What percentage of patients with symptomatic VTE will suffer a recurrent episode in 8 years? What percentage of patients who suffer a DVT will develop a postthrombotic syndrome? |
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Definition
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Term
What is the trade name for fondaparinux? What is its molecular structure? What is its mechanism of action? Binds to what molecule? What is the prophylactic dose? Therapeutic? What complication of the heparins is not seen? In what group of surgical patients has this been found to be more effective? |
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Definition
Arixtra Pentasaccharide Xa inhibitor. Binds to antithrombin III 2.5m sq qd 7.5mg sq qd Heparin induced thrombocytopenia Cancer patients undergoing surgery |
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Term
In untreated general surgical patients, what is the risk of DVT PE Fatal PE |
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Definition
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Term
| In VTE categories of risk for hospitalized patients list the # of risk factors putting it in each category |
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Definition
Low risk 1 factor Moderate risk 2 factors High risk 3-4 factors Highest risk >5 factors |
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Term
What is the recommendation for prophylaxis in low risk surgical patients? Moderate risk? |
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Definition
Early ambulation Graduated compression stockings or Intermittant pneumatic compression |
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Term
| What is the recommendation for prophylaxis in high risk surgical patients? |
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Definition
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Term
| What is the recommendation for prophylaxis in highest risk surgical patients? |
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Definition
UFH TID LMWH Fondaparinux all with GPC orIPC |
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Term
IVC filters reduce the rate of PE from what incidence in surgical patients? Fatal PE |
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Definition
2.6% down to 0.3% 3.8% to 1.9% ????? |
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Term
| What is the incidence of DVT in surgical patients receiving LMWH? |
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Definition
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Term
| Where anatomically do most DVTS begin? |
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Definition
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Term
| What percent of calf vein DVT will propagate centrally if untreated? |
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Definition
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Term
| What percent of PE comes from upper extremity veins? |
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Definition
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Term
In treated DVT what % will have complete clearing Asymptomatic extension |
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Definition
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Term
What is the annual VTE incidence in the US Is gender a DVT risk factor? What is the ratio incidence of DVT to PE What is the incidence of VTE in hospitalized patients? What is the relationship of VTE to race? |
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Definition
1 in 10,000 No 2:1 1-2% Lower incidence in Asians and Hispanics Higher in caucasians and blacks |
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Term
| What percent of new VTE cases are considered idiopathic? |
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Definition
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Term
What percent of initial PE's are fatal? Recurrent? What is the mortality of untreated PE? Treated PE? |
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Definition
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Term
| What % of PE comes from upper extremity veins? |
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Definition
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Term
Natural history of treated DVT by venogram in 6 months What % have complete resolution? Parital resolution Asymptomatic extension Still have filling defects after 1 year What is the clearance rate with anticoagulation after 7 days, how does this change with thrombolysis |
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Definition
38% complete 54% partial 6% asymptomatic extension 50% have residual filling defects 17% clear with anticoagulation in 7 days compared to 80% with thrombolysis |
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Term
The use of compression stockings will decrease the incidence of postthrombic syndrome by what % Does the incidence of PTS peak after 6 months, 1 year? What % of all cases of DVT will have severe PTS (CEAP 5,6)? |
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Definition
50% Incidence increases with time from 17% after 1 year to 30% after 8 years 10% |
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Term
| Name the Grade 1 A ACCP recommendations for thromboprophylaxis |
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Definition
Prophylactic anticoagulation for high and moderate risk GS patients Major gyn surgery open GU surgery Elective knee/hip Hip fracture Trauma patients with one risk factor Severely ill medical patients with CHF, immobility and one other risk factor Aspirin is not prophylaxis |
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Term
D-dimer is what percent specific in DVT? Sensitive? |
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Definition
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Term
What is the incidence of recurrent DVT with post thrombotic syndrome? Without? Name the 3 major risk factors for PTS in DVT |
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Definition
7.4% 1.6% Male gender proximal DVT D-dimer > 500 |
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Term
Where is the most common site of reflux in patients with C5 C6 ulceration? After DVT,where is the most common site of reflux? |
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Definition
Superficial reflux followed by combination superficial and deep deep veins In all patients with CVI the most common pattern is the combination of the two |
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Term
What % improvement is seen in incompetent perforators when superficial reflux is corrected? In what circumstance won't you see an improvement? |
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Definition
50% of IP's will become incompetent If the patient has persistent deep reflux |
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Term
| In post DVT CEAP 5 & 6 patients which physiological abnormality was most common, reflux or obstruction? |
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Definition
Reflux and obstruction Only 3% patients with reflux alone had ulcers |
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Term
In a CEAP study by Kistner what percent of ulcer patients were due to primary disease? secondary? |
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Definition
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Term
| Deaths from DVT are higher than what 2 well know diseases? |
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Definition
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Term
| What % of symptomatic PE's are fatal in the first hour? |
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Definition
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Term
| What % of PE patients will go on to develop pulmonary HTN at 2 years? |
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Definition
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Term
What is the recommended duration of treatment in patients with DVT in the following situations: (How do they change with PE) Situational Idiopathic DVT and CA DVT and APLA DVT and 1 thrombophilic condition More than 2 episodes of DVT |
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Definition
Situational 3 months Idiopathic 6-12 months but consider long term DVT and Ca LMWH for 3-6 months or until Ca resolved DVT and APLA or > 2 thrombophilic conditions recommend 12 months but suggest indefinite DVT and 1 thrombophilic condition 6-12 months >2 episodes DVT--indefinite Rx |
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Term
What is the definition of HIT? What is the treatment? What drug is to be avoided as monotherapy? Why? |
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Definition
Platelet count< 150,000 or drop of 50% from baseline within 5-15 days of UFH or LMWH Stop heparin and start direct thrombin inhibitor Warfarin can not be started without direct thrombin inhibitor and the DTI's must be continued until INR therapeutic Cutaneous necrosis can develop if warfarin is started alone |
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Term
What % of superficial thrombophlebitis will develop into a DVT? If SVT involves the SFJ what is the incidence of concurrent DVT? What is the treatment recommendation for spontaneous DVT? |
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Definition
9% 40% For spontaneous superficial thrombophlebitis (not in varicosities) 4 weeks of UFH or LMWH is recommended |
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Term
| What is the treatment recommendation for superficial thrombophlebitis due to an infusion? |
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Definition
| topical diclofenac (Grade 1B or oral diclofenac (Grade 2B) |
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Term
| Based on two studies, what is the healing rate of ulcers after the SEPS procedure? |
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Definition
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Term
What is principle should be followed when treating incompetent perforators with foam sclerotherapy? What is the immediate occlusion rate of treating perforators with foam sclerotherapy? The recurrence rate? Guex's occlusion rate after 3 sessions? |
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Definition
Use a higher concentration of solution with a lower volume Immediate occlusion rate (Vein Book) 98% Recurrence rate(same source) 23% Guex 90% occlusion after 3 sessions |
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Term
| What % of patients with venous ulcers were found to have calf pump failure by air plethysmography? |
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Definition
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Term
According to the REVAS study what was the most common source of recurrent varicose veins? The second most common etiology? |
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Definition
Type 1 reflux through SFJ, high tributary or neovascularization due to inadequate aggressive surgery Type 2 either from the pelvis or an incompetent perforator |
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Term
What % of patients develop recurrent varicose veins after properly performed aggressive surgery? Where do these recurrences occur? |
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Definition
60% Reconnections occur at the site of a properly performed ligation of the SFJ or other deep veins in the immediate neighborhood |
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Term
| What % of patients who underwent only flush ligation had reflux after 5yr followup? |
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Definition
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Term
| Is the surgical data now conclusive that neovascularization after surgery is the cause of recurrent VV's? Yes or No |
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Definition
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Term
| Do IVC filters lower the mortality rate from pulmonary embolism? |
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Definition
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