Podcasts about venous thrombosis

In this episode of RCP Medicine podcasts Dr Racheal Cheek and Dr Ben Chadwick discuss a challenging case of Deep Venous Thrombosis in a young patient. We discuss potential causes, and options for treatment, with reference to NICE guidance Dr Ben Chadwick is an Acute Medicine Consultant at Southampton General Hospital. He has a specialist interest in Medical Education and has previously been Training Programme Director for Acute Internal Medicine in Wessex and has chaired the Acute Internal Medicine Specialist Advisory Committee. He has recently been appointed to the Deputy Registrar role at the Royal College of Physicians.Dr Racheal Cheek is an Acute Internal Medicine Registrar training in Wessex. She has been Chief Resident at University Hospitals Dorset, leading projects focused on improving patient safety. She is embracing new adventures whilst currently on maternity leave.   ReferencesEditor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis - https://www.ejves.com/article/S1078-5884(20)30868-6/fulltextNICE: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing - https://www.nice.org.uk/guidance/ng158RCP LinksEducation and learning | RCP Events | RCP Membership | RCP Improving care | RCP Policy and campaigns | RCP CreditsMusic:bensound.com

In this week's episode, unravelling follicular lymphoma subtypes. Researchers dissect the biological diversity of follicular lymphoma and introduce a new prognostic mode, that could change the way this B-cell neoplasm is subtyped and treated. Then, concerning stroke rate trends in sickle cell disease. A new report shows increasing rates of cerebrovascular events among people with SCD in California. Finally, procoagulant platelet activation promotes venous thrombosis. Investigators report finding procoagulant platelets in the circulation and in thrombi of patients and mice with DVT or PE. Featured Articles:Follicular lymphoma comprises germinal center–like and memory-like molecular subtypes with prognostic significanceRates of strokes in Californians with sickle cell disease in the post-STOP eraProcoagulant platelet activation promotes venous thrombosis

Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Ana I. Casanegra, M.D., M.S. Venous thrombosis is an under diagnosed and potentially serious health condition, yet in many cases its preventable and certainly treatable when found.  Its most serious potential complication is embolization, most commonly to the lung. As a medical condition, venous thrombosis has been known for many years. In fact, the triad of contributing factors to venous thrombosis including venous stasis, vascular injury and hypercoagulability were discovered in the mid-1800's. Despite the long duration we've been diagnosing and treating the health problem, there's still much we need to learn about it. The topic for today's podcast is venous thrombosis and we'll discuss its risk factors, how to diagnose a DVT and the best management recommendations. My guest will be Ana I. Casanegra, M.D., M.S., a vascular medicine specialist at the Mayo Clinic. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

A cerebral sinus venous thrombosis (CSVT) is a blood clot in the venous system of the brain that can result in headache, emesis, double vision, and even coma. Listen to this episode to hear more from Dr. Lauren Beslow about the key risk factors for CSVT, important findings on physical exam that suggest CSVT, and the best imaging to diagnose a CSVT in your patient!

Although we look very different from many of the other creatures on this planet, we're more connected than you might think. Our evolutionary history means we share many of the same genes and physiology, and that's not just cool to think about — it's useful. Because it means that, to learn about the things we lack or wish we could do better, we can study the exceptional abilities of other animals.In today's episode, Sam and Deboki cover two species with extreme lifestyles— brown bears and Mexican cave fish — and what they are teaching us about avoiding blood clots and fatty liver disease, and how that could unlock the potential for new treatments. In this week's Tiny Show and Tell, Sam asks "What is a species?" and Deboki ponders how a mushroom could grow out of a living frog.Links to the Tiny Show & Tell stories are here and here. Support the show by picking up a Tiny Matters mug here! All Tiny Matters transcripts are available here.

On this, the tenth episode of OncoSnacks, Josh and Michael discuss the management of a common but no less important problem: superficial venous thrombosis and thrombophlebitis. While for the majority of cases the treatment is purely symptomatic, in a small minority of cases superficial venous thromboses can be a precursor of more serious thromboembolic events. This broad range of possible outcomes makes the management and risk stratification of apparently minor thromboses all the more important, particularly in the oncology patient population. Listen on as Josh and Michael aim to shed some light in this dark topic.Useful Links:BMJ Guidelines on Management of Superficial Thrombophlebitis: ttps://bestpractice.bmj.com/topics/en-us/335Scott, Mahdi, Alikhan (BMJ Haem): https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.13255 Evidence-Based Medicine Guidelines on Management of Superficial Thrombophlebitis: https://www.ebm-guidelines.com/ebmg/ltk.free?p_artikkeli=ebm00920#:~:text=The%20recommended%20treatment%20For more episodes, resources and blog posts, visit www.inquisitiveonc.comFind us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of Music Unlimited: https://pixabay.com/users/music_unlimited-27600023/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.

In this episode PICUDoc On Call, we discuss the case of a six-month-old ex-preemie with bacterial meningitis who presents with symptoms of cerebral sinus venous thrombosis. We explore the anatomy of the venous distribution in the brain and the clinical syndromes associated with sinus venous thrombosis. Our focus is on the imaging techniques, laboratory tests, and management strategies involved in diagnosing and treating this challenging condition.You will learn:A six-month-old ex-preemie presents with persistent fever, recurrent emesis, and increased somnolence.The patient experiences eye rolling and decreased oxygen saturation, prompting a visit to the emergency department.Physical examination reveals rigidity in all four limbs, and a head CT shows dilated ventricles and encephalomalacia.Lumbar puncture confirms an infection, and the patient is admitted to the hospital.After a 14-day course of antibiotics, the patient's clinical status worsens, leading to intubation and neurosurgery consultation.An MRI confirms cerebral venous sinus thrombosis.Anatomy of Venous Distribution in the Brain:Dural venous sinuses serve as conduits for venous blood return from the brain to the internal jugular veins.The superior sagittal sinus, cortical veins, transverse sinus, sigmoid sinus, and internal jugular vein are key components of the venous drainage system.Clinical Syndromes of Sinus Venous Thrombosis:Symptoms can be related to elevated intracranial pressure or focal brain damage from venous ischemia, infarction, or hemorrhage.Headache, seizures, focal neurologic deficits, and cranial nerve paralysis are common presentations.Cavernous sinus thrombosis can cause periorbital pain, ocular chemos, and paralysis of cranial nerves passing through the sinus.Risk Factors for Cerebral Sinus Venous Thrombosis:Dehydration, CNS or sinus infections, intracranial surgery, autoimmune disorders, genetic syndromes, metabolic syndromes, medications, and genetic thrombophilic states can predispose children to thrombosis.Thorough evaluation for risk factors, including thrombophilia, is recommended in children with cerebral venous thrombosis.Imaging and Laboratory Tests:CT and MRI with contrast-enhanced venography are preferred imaging tools to detect cerebral sinus venous thrombosis.Non-enhanced CT scans and T1/T2-weighted MRI scans show characteristic signs of thrombosis.Lab tests include CBC with differential, DIC panel, comprehensive metabolic panel, ESR, and specific thrombophilia tests.Management...

In Part 4 of a 4-part series, Ava L. Liberman, MD, discusses her article, "Diagnosis and Treatment of Cerebral Venous Thrombosis" from the April Continuum Cerebrovascular Disease issue. This article and accompanying Continuum Audio interview are available to subscribers at continpub.com/CVTDiagnosis. This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

In Part 3 of a 4-part series, Ava L. Liberman, MD, discusses her article, "Diagnosis and Treatment of Cerebral Venous Thrombosis" from the April Continuum Cerebrovascular Disease issue. This article and accompanying Continuum Audio interview are available to subscribers at continpub.com/CVTDiagnosis.

In Part 2 of a 4-part series, Ava L. Liberman, MD, discusses her article, "Diagnosis and Treatment of Cerebral Venous Thrombosis" from the April Continuum Cerebrovascular Disease issue. This article and accompanying Continuum Audio interview are available to subscribers at continpub.com/CVTDiagnosis.  

In Part 1 of a 4-part series, Ava L. Liberman, MD, discusses her article, "Diagnosis and Treatment of Cerebral Venous Thrombosis" from the April Continuum Cerebrovascular Disease issue. This article and accompanying Continuum Audio interview are available to subscribers at continpub.com/CVTDiagnosis.

In this episode, Dr. Roy Baskind and Dr. Ahmit Shah answer such questions as: when is an opening pressure on LP required? When should we pull the trigger on ordering a CT venogram in the patient with unexplained headache? Which older patients who present with headache require an ESR/CRP? How do the presentations of cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) compare and contrast? When is it safe to start steroids in the ED for patients suspected of giant cell arteritis (GCA); will starting steroids affect the accuracy of a temporal artery biopsy? How soon should patients suspected of GCA get a temporal artery biopsy? When should we consider posterior reversible encephalopathy syndrome (PRES) and pituitary apoplexy in the peripartum patient? How should we think about the differential diagnosis of vascular headaches? and many more...  The post Ep181 Cerebral Venous Thrombosis, Idiopathic Intracranial Hypertension, Giant Cell Arteritis and Peripartum Headaches appeared first on Emergency Medicine Cases.

What if we told you there was a type of stroke that affected young people, caused more seizures than "typical arterial strokes", and the typical ED imaging does not diagnose it. Scared yet? You should be. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Cite this podcast as: Husain, Iltifat. Episode 171. Cerebral Venous Thrombosis: Sneaky Stroke. https://www.emboardbombs.com/podcasts/171-cerebral-venous-thrombosis-sneaky-stroke. April 3nd, 2023. . Accessed [date]

In this 1217th episode of Toronto Mike'd, Mike shares his story of having a blood clot on his brain. Yep, that happened. Toronto Mike'd is proudly brought to you by Great Lakes Brewery, Palma Pasta, Canna Cabana, Ridley Funeral Home and Electronic Products Recycling Association.

In this episode of the JIM Podcast, Editor-in-Chief Richard McCallum speaks with Dr. Mateo Porres-Aguilar about thrombosis and anticoagulants. Dr. Porres-Aguilar is a current Fellow of the American College of Physicians (FACP), he holds a National Board Certification of Anticoagulation Care Providers in the USA (NCBAP), is an academic Member of the International Society for Thrombosis and Heamostasis (ISTH), and he currently serves as an international representative in North America for the Mexican Society of Thrombosis and Hemostasis (SOMETH), and is part of the Latin-american chapter of Venous Thrombosis for the Latin-American Collaborative Group for Hemostasis and Thrombosis (Grupo CLAHT)

Take Home Points SVT >5cm or

Dr. Lily Zhou discusses her abstract, "Mortality and One-Year Readmission Rates Following Hospital Discharge in a Large Canadian Cerebral Venous Thrombosis Cohort". Show references: https://index.mirasmart.com/aan2022/  

Andrew Nickinson and Aminder Singh discuss what vascular trainees should know about venous disease with Mr. Manj Gohel.  This podcast is aimed at preparing UK vascular trainees for the Fellowship of Royal College (FRCS) vascular examination but should apply to any vascular surgery exams. Mr. Manj Gohel MD FRCS FEBVS (@ManjGohel) is a consultant vascular and endovascular surgeon at Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. He is also an Honorary Senior Lecturer at Imperial College, London, and the honorary secretary of the Royal Society of Medicine's Venous Forum. Mr. Gohel has a specialist interest in venous disease and has been actively involved in venous research for over 15 years, speaking regularly at national and international conferences. He spearheaded the landmark EVRA and ESCHAR trials and has recently co-chaired the European Society of Vascular Surgery Venous Thrombosis Guidelines. Hosts: Mr. Andrew Nickinson (@AndrewNickinson)is a vascular specialty trainee in the Wessex Deanery and the SAC representative for the Rouleaux Club. Mr. Aminder Singh (@AminderASingh)is an NIHR Academic Clinical Fellow in Vascular Surgery at the University of Cambridge, a Vascular trainee in East of England and European/Venous representative for the Rouleaux Club. Selected papers: Gohel et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial BMJ 2007; 335(7618) Gohel et al; EVRA Trial Investigators. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. NEJM. 2018; 378(22):2105-2114. Kakkos et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. EJVES. 2021 Jan;61(1):9-82. Vedantham et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. NEJM. 2017;377(23):2240-2252. Brittenden et al. A randomized trial comparing treatments for varicose veins. NEJM. 2014;371(13):1218-27. Please share your feedback through our Listener Survey! Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation. Credits: Authors: Andrew Nickinson, Aminder Singh Editor: Leanna Erete Reviewers: Adam Johnson, Rachael Forsythe

In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis? Access show notes at: https://gpnotebookpodcast.com.

In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis?

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover cerebral venous thrombosis. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Atypical headache=SAH w/u right? Except sometimes it is CVT. This is a critical diagnosis to make and to treat properly. Today I interview @caseyalbin on EMCrit 304 - cerebral venous thrombosis

Is the Johnson & Johnson COVID-19 vaccine effective against the Delta variant? Find out about this and more in today's PV Roundup podcast.

Is the Johnson & Johnson COVID-19 vaccine effective against the Delta variant? Find out about this and more in today's PV Roundup podcast.

In this episode of the JIM Podcast, Editor-in-Chief Richard McCallum speaks with Dr. Mateo Porres-Aguilar about thrombosis and anticoagulants. Dr. Porres-Aguilar is a current Fellow of the American College of Physicians (FACP), he holds a National Board Certification of Anticoagulation Care Providers in the USA (NCBAP), is an academic Member of the International Society for Thrombosis and Heamostasis (ISTH), and he currently serves as an international representative in North America for the Mexican Society of Thrombosis and Hemostasis (SOMETH), and is part of the Latin-american chapter of Venous Thrombosis for the Latin-American Collaborative Group for Hemostasis and Thrombosis (Grupo CLAHT)

Welcome to Ask Stago, the Podcast dedicated to provide expert answers to your expert questions in coagulation.  In today’s episode, our expert our expert François Depasse, Clinical development Director, will help us to clarify when thrombophilia testing is appropriate and how to perform it according to international standards.   As usual, don’t forget to send any question you may have to ask@stago.com we will be glad to answer to it.  Literature sources:  https://www.cochranelibrary.com/advanced-search/mesh;jsessionid=DED8CB403679070FD38E81E38E5A7ECA accessed March 17, 2021  Montagnana M, Lippi G, Danese E. An Overview of Thrombophilia and Associated Laboratory Testing. Methods Mol Biol. 2017;1646:113-135. doi: 10.1007/978-1-4939-7196-1_9.  Merriman L, Greaves M. Testing for thrombophilia: an evidence-based approach. Postgrad Med J. 2006 Nov;82(973):699-704. doi: 10.1136/pgmj.2006.048090.   Gruel Y et al, Thrombophilia testing: Proposals of the 2020 GFHT. Rev Francoph Hémost Thromb 2020 ; 2 (3) : 93-126  Delluc A, Antic D, Lecumberri R, Ay C, Meyer G, Carrier M. Occult cancer screening in patients with venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2017 Oct;15(10):2076-2079. doi: 10.1111/jth.13791. Epub 2017 Aug 29. Erratum in: J Thromb Haemost. 2017 Dec;15(12 ):2471.  D'Astous J, Carrier M. Screening for Occult Cancer in Patients with Venous Thromboembolism. J Clin Med. 2020 Jul 27;9(8):2389. doi: 10.3390/jcm9082389  Connors JM. Thrombophilia Testing and Venous Thrombosis. N Engl J Med. 2017 Sep 21;377(12):1177-1187. doi: 10.1056/NEJMra1700365.  National Institute for Health and Care Excellence. Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. NG 158, London 2020  De Stefano V, Rossi E. Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. A review of the Guidelines from Scientific Societies and Working Groups. Thromb Haemost. 2013 Oct;110(4):697-705. doi: 10.1160/TH13-01-0011.  Moll, S. Who should be tested for thrombophilia?. Genet Med 13, 19–20 (2011).  Cooper PC, Pavlova A, Moore GW, Hickey KP, Marlar RA. Recommendations for clinical laboratory testing for protein C deficiency, for the subcommittee on plasma coagulation inhibitors of the ISTH. J Thromb Haemost. 2020 Feb;18(2):271-277. doi: 10.1111/jth.14667.   Marlar RA, Gausman JN, Tsuda H, Rollins-Raval MA, Brinkman HJM. Recommendations for clinical laboratory testing for protein S deficiency: Communication from the SSC committee plasma coagulation inhibitors of the ISTH. J Thromb Haemost. 2021 Jan;19(1):68-74. doi: 10.1111/jth.15109.  Van Cott EM, Orlando C, Moore GW, Cooper PC, Meijer P, Marlar R; Subcommittee on Plasma Coagulation Inhibitors. Recommendations for clinical laboratory testing for antithrombin deficiency; Communication from the SSC of the ISTH. J Thromb Haemost. 2020 Jan;18(1):17-22.   Devreese KMJ, de Groot PG, de Laat B, Erkan D, Favaloro EJ, Mackie I, Martinuzzo M, Ortel TL, Pengo V, Rand JH, Tripodi A, Wahl D, Cohen H. Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis: Update of the guidelines for lupus anticoagulant detection and interpretation. J Thromb Haemost. 2020 Nov;18(11):2828-2839. doi: 10.1111/jth.15047.  Sevenet PO, Cucini V, Hervé T, Depasse F, Carlo A, Contant G, Mathieu O. Evaluation of DOAC Filter, a new device to remove direct oral anticoagulants from plasma samples. Int J Lab Hematol. 2020 Oct;42(5):636-642. doi: 10.1111/ijlh.13267.  Exner T, Michalopoulos N, Pearce J, Xavier R, Ahuja M. Simple method for removing DOACs from plasma samples. Thromb Res. 2018;163:117-122  Related podcasts:   S1E13 - The Lupus Anticoagulant Diagnosis Work up - https://www.podcastics.com/episode/54015/link/ ____________________________________________________________________________________________________________ Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice. 

Take Home Points SVT >5cm or

In this month's EM Quick Hits podcast: Justin Morgenstern on which patients to consider cerebral venous thrombosis in, Maria Ivankovic on diphenhydramine alternatives, Brit Long on abdominal compartment syndrome, Sarah Reid on neonatal "constipation" - when to worry, and Anand Swaminathan on intubating the patient with metabolic acidosis... The post EM Quick Hits 25 Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis appeared first on Emergency Medicine Cases.

In this episode of Critical Matters, we will discuss thrombosis in COVID-19. We will discuss the pathophysiology, diagnosis, and management of arterial and venous thrombosis in COVID-19. Our guest is Dr. Gregory Piazza, a cardiovascular medicine specialist at Brigham and Women’s Hospital in Boston. Dr. Piazza is the Director of the Vascular Medicine Section, in the Division of Cardiovascular Medicine, and Associate Professor of Medicine, at Harvard Medical School. Additional Resources: Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19: https://jamanetwork.com/journals/jama/fullarticle/2773516 Registry of Arterial and Venous Thromboembolic Complications in Patients with COVID-19: https://www.jacc.org/doi/full/10.1016/j.jacc.2020.08.070 ACCP Guidelines for Management Thromboembolism in COVID-19: https://journal.chestnet.org/article/S0012-3692(20)31625-1/fulltext ISTH Guidelines for Management of Thromboembolism in COVID-19: https://onlinelibrary.wiley.com/doi/10.1111/jth.14929 Books Mentioned in this Episode: Dune by Frank Herbert: https://www.amazon.com/Dune-Frank-Herbert

Quick Summary Cerebral Venous Thrombosis - Article A brief summary of a clinical review on Cerebral Venous Thrombosis

In this episode, we cover the DVT of the Brain... Cerebral Venous Thrombosis. Lace up your shoes, start washing those dishes, do whatever you need to do while we remind you about presentation, workup and most of all, treatment. As 1% of all strokes and the most common cause of stroke in young patients, you'll want to know this one cold.

Here is the JournalFeed Podcast for the week of August 3-7, 2020. We cover ketamine vs etomidate-related hypotension during induction, beta-blockers for refractory v-fib or v-tach, cerebral venous thrombosis score, and the end of the GI cocktail.

Tristan Morichau-Beauchant, MD joins JAMA Network Open Editors to discuss a case series that reports a systematic assessment of deep vein thrombosis among patients in an intensive care unit in France with severe coronavirus disease 2019 (COVID-19). Read the article here: https://ja.ma/307784k. JNO Live is a weekly broadcast featuring conversations about the latest research being published in JAMA Network Open. Follow us on Facebook, Twitter and YouTube for details on the next broadcast.

Tristan Morichau-Beauchant, MD joins JAMA Network Open Editors to discuss a case series that reports a systematic assessment of deep vein thrombosis among patients in an intensive care unit in France with severe coronavirus disease 2019 (COVID-19). Read the article here: https://ja.ma/307784k. JNO Live is a weekly broadcast featuring conversations about the latest research being published in JAMA Network Open. Follow us on Facebook, Twitter and YouTube for details on the next broadcast.

Jeffrey S. Klein, MD, Editor of RadioGraphics, discusses six articles from the May-June 2020 issue of RadioGraphics. ARTICLES DISCUSSED: 0:26-0:24 Bone Marrow Edema at Dual-Energy CT: A Game Changer in the Emergency Department.  RadioGraphics 2020; 40:859–874. 4:10- 8:34 MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children. RadioGraphics 2020; 40:791–814. 8:35- 12:23 Complications after Liver Transplant Related to Preexisting Conditions: Diagnosis, Treatment, and Prevention. RadioGraphics 2020; 40:895–909. 12:24- 17:31 Current Imaging Techniques for and Imaging Spectrum of Prostate Cancer Recurrence and Metastasis: A Pictorial Review. RadioGraphics 2020; 40:709–726. 17:32-21:46 Fundamentals of Radiation Oncology for Neurologic Imaging. RadioGraphics 2020; 40:827–858. 21:47-26:00 Venous Thrombosis and Hypercoagulability in the Abdomen and Pelvis: Causes and Imaging Findings. RadioGraphics 2020; 40:875–894. 

This is a podcast article summary of "Venous thrombotic events in ANCA-associated vasculitis: Incidence and risk factors" by Duvuru Geetha and Andreas Kronbichler.

Take Home Points on SVT Superficial venous thrombosis refers to a clot and inflammation in the larger, or “axial” veins of the lower extremities and... The post REBEL Core Cast 14.0 – Superficial Venous Thrombosis appeared first on REBEL EM - Emergency Medicine Blog.

Shownotes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we're tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Fear not, this will not simply be “who needs a head CT episode”; we'll cover much more than that. Listen closely as this is an important topic, with huge consequences for mismanagement. Jeff: Absolutely. As some quick background - headaches account for 3% of all ED visits in the US, with 90% being benign primary headaches and less than 10% being secondary to other causes like vascular, infectious, or traumatic etiologies. It's within these later 10% that we are looking for the red flag signs to identify the potentially life-threatening headaches. Nachi: And to do so, Dr. David Zodda and Dr. Amit Gupta, PD and APD at Hackensack University Medical and Trauma Center, and their colleague Dr. Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all. Jeff: We would be remiss to not also mention Dr. Mert Erogul of Maimonides Medical Center and Dr. Steven Godwin, Chair of Emergency Medicine at the University of Florida College of Medicine. Nachi: Alright, so let's get started with some definitions and pathophysiology. The international classification of headache disorders 3, or ICHD-3, classifies headaches into primary, secondary, and cranial neuropathies. Jeff: Primary headache disorders include migraine, tension, and cluster headaches. Secondary headaches include those secondary to vascular disorders, traumatic disorders, and disorders in hemostasis. These are the potentially life threatening headaches that can have a mortality has high as 50%. Nachi: And the final category includes cranial neuropathies, such as trigeminal neuralgia. Jeff: And I think we can safely say that that wraps up our discussion in this episode on cranial neuropathies, moving on…. Nachi: Headaches result from traction to or irritation of the meninges and blood vessels, which are the only innervated central nervous system structures. Activation of specific nerve ganglion complexes by neuropeptides like -- substance P and calcitonin gene-related peptide -- are thought to contribute to head pain. Jeff: It is important to note that all headache pain shares common pain pathways, thus response to pain medications does not exclude potential life threatening secondary causes of headache. This led to the ACEP guideline which states just that.. Nachi: I feel like that deserves ding sound as it's a critically important point. To repeat, just because a pain medication relieves a headache, that does not exclude dangerous secondary causes! Jeff: And what are the life threatening headaches? Life-threatening headaches include subarachnoid hemorrhage, cervical Artery Dissection, which includes both vertebral Artery Dissection and carotid artery dissection, cerebral Venous Thrombosis, idiopathic intracranial hypertension, giant cell arteritis, and posterior reversible encephalopathy syndrome, or PRES. Nachi: Slow down for a second and let's not skip over your favorite section.. Let's talk pre hospital care for headache patients. Jeff: Good call! Pre-hospital care is fairly straightforward and includes a primary survey, conducting a focused neurologic exam, and assessing for red flag signs, which include focal neurologic deficits, sudden onset headache, new headache in those over 50, neck pain or stiffness, changes in visual Acuity, fever or immunocompromised State, history of malignancy, pregnancy or postpartum status, syncope, and seizure. That's quite a list.

Shownotes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Fear not, this will not simply be “who needs a head CT episode”; we’ll cover much more than that. Listen closely as this is an important topic, with huge consequences for mismanagement. Jeff: Absolutely. As some quick background - headaches account for 3% of all ED visits in the US, with 90% being benign primary headaches and less than 10% being secondary to other causes like vascular, infectious, or traumatic etiologies. It’s within these later 10% that we are looking for the red flag signs to identify the potentially life-threatening headaches. Nachi: And to do so, Dr. David Zodda and Dr. Amit Gupta, PD and APD at Hackensack University Medical and Trauma Center, and their colleague Dr. Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all. Jeff: We would be remiss to not also mention Dr. Mert Erogul of Maimonides Medical Center and Dr. Steven Godwin, Chair of Emergency Medicine at the University of Florida College of Medicine. Nachi: Alright, so let’s get started with some definitions and pathophysiology. The international classification of headache disorders 3, or ICHD-3, classifies headaches into primary, secondary, and cranial neuropathies. Jeff: Primary headache disorders include migraine, tension, and cluster headaches. Secondary headaches include those secondary to vascular disorders, traumatic disorders, and disorders in hemostasis. These are the potentially life threatening headaches that can have a mortality has high as 50%. Nachi: And the final category includes cranial neuropathies, such as trigeminal neuralgia. Jeff: And I think we can safely say that that wraps up our discussion in this episode on cranial neuropathies, moving on…. Nachi: Headaches result from traction to or irritation of the meninges and blood vessels, which are the only innervated central nervous system structures. Activation of specific nerve ganglion complexes by neuropeptides like -- substance P and calcitonin gene-related peptide -- are thought to contribute to head pain. Jeff: It is important to note that all headache pain shares common pain pathways, thus response to pain medications does not exclude potential life threatening secondary causes of headache. This led to the ACEP guideline which states just that.. Nachi: I feel like that deserves ding sound as it's a critically important point. To repeat, just because a pain medication relieves a headache, that does not exclude dangerous secondary causes! Jeff: And what are the life threatening headaches? Life-threatening headaches include subarachnoid hemorrhage, cervical Artery Dissection, which includes both vertebral Artery Dissection and carotid artery dissection, cerebral Venous Thrombosis, idiopathic intracranial hypertension, giant cell arteritis, and posterior reversible encephalopathy syndrome, or PRES. Nachi: Slow down for a second and let’s not skip over your favorite section.. Let’s talk pre hospital care for headache patients. Jeff: Good call! Pre-hospital care is fairly straightforward and includes a primary survey, conducting a focused neurologic exam, and assessing for red flag signs, which include focal neurologic deficits, sudden onset headache, new headache in those over 50, neck pain or stiffness, changes in visual Acuity, fever or immunocompromised State, history of malignancy, pregnancy or postpartum status, syncope, and seizure. That’s quite a list. For a visual reference, see Table 3 in the print issue. Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Tylenol should be offered for pain management. Avoid opioids and nsaids. Jeff: Upon arrival to the emergency department, history and physical should include your standard vitals, testing neurologic function, cranial nerve testing, head and neck exam, as well as a fundoscopic exam. As was the case for your pre-hospital colleagues, you should also assess for red flag signs for life-threatening headaches. Check out tables 2, 3, and 4 for more details here. Nachi: With respect to Vital Signs, in the setting of an acute headache, severe hypertension should prompt a search for signs of end-organ damage such as hypertensive encephalopathy, intracranial Hemorrhage, PRES, and preeclampsia in pregnant women. Additionally, fever, and especially fever and neck stiffness, should raise concern for CNS infection. Jeff: For your neurologic examination, make sure to include assessments of motor strength, coordination, reflexes, sensory function, and gait. Don't forget that lesions involving the anterior circulation, such as dysarthria, cognitive impairment, and Horner syndrome may be indicative of a carotid artery dissection, whereas dizziness, vision changes, and limb weakness may be due to a vertebral Artery Dissection. Nachi: And for cranial nerve testing - pay particular attention to cranial nerves 2, 3 and 6. For cranial nerve 2 - look out for an afferent pupillary defect, or a marcus-gunn pupil, which is seen in optic neuritis, giant cell artertitis, and central retinal artery occlusion. For CN3, oculomotor nerve palsies raise concern for a posterior communicating aneurysm and SAH. And lastly, CN6 palsies, which often presents with diplopia on lateral gaze , are often seen with intracranial idiopathic hypertension and cerebral venous thrombosis, in addition to impaired visual acuity, visual field defects, and tunnel vision. Jeff: For the head and neck exam, remember that a partial horner syndrome, with miosis and ptosis without anhidrosis, may be indicative of a cervical artery dissection. Unfortunately, if the patient presents acutely, their only complaint may be pain, as the neurologic sequelae may take days to develop. Nachi: Additionally, with respect to the head and neck exam, evaluate the patient for tenderness and beading along the temporal artery. Jeff: One review noted that temporal artery beading actually had the highest likelihood ratio for GCA, 4.6, whereas temporal artery tenderness only had a LR of 2.6 Nachi: And the last physical exam maneuver you should ideally perform is a fundoscopic exam for papilledema, which is often seen in IIH, malignant hypertension, and CVT. Jeff: Perfect so that rounds out the physical, next we have diagnostic studies. Most importantly, routine lab testing is typically of low utility in aiding in the diagnosis of headache. Nachi: Even ESR and CRP in the setting of possible giant cell arteritis have poor sensitivity and specificity to diagnose it. So even if the ESR and CRP are negative, if the suspicion for GCA is high enough, it should be treated and you should get a biopsy. Jeff: Do consider adding on a venous or arterial carboxyhemoglobin in the right clinical scenario, as CO poisoning represents an important cause of headache you wouldn’t want to miss. This is especially important at this time of year when heating systems are working overtime here in the states. Nachi: And hopefully you have a co-oximeter, so you can even check this non-invasively. Jeff: Interestingly, there may be a unique role for a d-dimer here as well. Several small studies have used the d-dimer to risk stratify patients with possible CVT. In one study a d-dimer level < 500 mcg/L had a 97% sensitivity and a negative predictive value of 99% - not bad! Nachi: Pretty impressive performance characteristics. I think that about wraps up lab work. Let’s talk radiology. Jeff: Though low yield, CT utilization is estimated at 2.5-10% of non-traumatic headaches. A non-con CT should be reserved for those with suspicion for an intracranial hemorrhage, while a contrast CT would be required in those in whom there is concern for an infectious process or space occupying lesion. Nachi: CT angio or MRI should be used in cases of possible cervical artery dissection. MRI also is the neuroimaging of choice for PRES, which is more sensitive for cerebral edema than CT. Jeff: Similarly, MRV is recommended in those with a concerning story for CVT. Nachi: To help guide your emergent neuroimaging utilization, ACEP suggests imaging in those with headache and an abnormal finding on neuro exam, those with new and sudden-onset severe headache, HIV positive patients with new headache, and those over 50 with a new headache. Jeff: With that in mind, let’s dive a bit deeper into the use of CT for SAH, a topic which doesn’t get a ding sound, but is certainly critically important. Recent literature have found that a CT within 6 hours of symptom onset has a sensitivity and specificity and negative predictive value of 100%. In addition, one 2016 study demonstrated a LR of 0.01 in those with a negative HCT within 6 hours. These are really important results because that means SAH is essentially ruled out with a negative study. Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Luckily the ACEP guideline is currently being revised so your decision to forego the LP with a negative HCT in the first 6 hours will likely also be backed by ACEP in the near future. Jeff: That’s a nice transition into our next test - the LP. Since LP carries a risk of herniation, in those with signs of increased ICP, make sure to get appropriate neuroimaging before attempting the puncture. In those without signs of increased ICP, no imaging is necessary. Nachi: While the position in which the LP is performed doesn’t matter as much when ruling out infection or SAH, in those with suspected IIH, make sure to obtain an opening pressure with the patient lying in the lateral decubitus position. An opening pressure of greater than 25 is often seen in IIH. Jeff: And the LP in the setting of IIH is not only diagnostic but also potentially therapeutic, as the removal of 1 ml of CSF can lower the pressure by 1 cm of H20 and potentially relieve the patient’s symptoms. Nachi: Always rewarding to diagnose and treat simultaneously... Jeff: Absolutely. But back to the LP for SAH for a second or two. When evaluating for a subarachnoid hemorrhage, you’ll often note an opening pressure of greater than 20 with persistent RBC in all tubes. Nachi: While there are no RBC cutoffs, one study found no patients with a SAH with less than 100 RBC in the final tube. In contrast, greater than 10,000 RBC increased the odds by a factor of 6. In addition, one 2015 study found that patients without xanthrochromia and less than 2000 RBC were effectively ruled out of having a SAH with a combined sensitivity of 100% Jeff: Lots of 100% sensitivities and specificities being thrown around today, which is definitely not the norm. No complaints here, I’ll take it. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. Nachi: Examining the optic nerve sheath 3 mm posterior to the globe, an optic nerve sheath diameter of 5 mm or greater is predictive of an ICP greater than 20. Jeff: Keep in mind that this may expedite the work up, though a normal diameter does not rule out increased ICP, so a head CT may still be indicated. Nachi: Alright, so we’ve talked a lot about testing, both lab and imaging, and we’ve mentioned a bunch of pathologies, but let’s spend a few minutes going over the specifics of each. Jeff: Let’s start with SAH. SAH account for 1% of all headache visits to the ED. Most nontraumatic SAH are caused by aneurysm rupture. A missed diagnosis of SAH can have a case-fatality rate as high as 50% Nachi: Although 75% of SAH patients report an abrupt onset, objective neck stiffness has the highest likelihood ratio of 6.6. Other important features include LOC, neurologic deficit, subjective neck stiffness, photophobia, and onset during exertion or intercourse. Jeff: Additionally, approximately 20% of patients with a SAH have warning signs of a sentinel bleed including headaches, cranial nerve palsies, neck pain, or nausea and vomiting. Nachi: In order to aid you in diagnosing a SAH, you should consider the ottawa SAH Rule which has a 100% sensitivity and a 15% specificity. To use this rule you must be between 15 and 40 with a GCS of 15 and present with a headache with maximal intensity within 1 hour of onset. If you meet those inclusion criteria, and you have no neurologic deficits, no neck pain or stiffness, no witnessed LOC, no onset during exertion, no limitation of neck flexion, and no thunderclap onset, you can essentially rule out a SAH. Jeff: While the ottawa SAH rule has been prospectively validated, know that this study has been challenged for its interobserver variability, but in any case it still provides helpful red flags to consider. If your patient is found to have a SAH, a CT angiogram and neurosurgical consultation should be considered immediately. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. Also consider elevating the head of the bed to 30 deg, which may also improve venous drainage and decrease ICP. Jeff: In terms of BP management, guidelines from the american stroke association recommend targeting a SBP of 160 with a titratable agent like nicardipine or clevidipine. Nachi: In addition, nimodipine, 60 mg q4h, should be given to those with aneurysmal SAH to improve outcomes. Jeff: and any role for anti-epileptics? Nachi: That’s controversial and the authors state it may be considered in the immediate post-hemorrhagic period and should be limited to a 3-7 day course with longer courses required in special populations. Jeff: The next pathology to discuss is cervical artery dissections, which account for 2% of all strokes and nearly 20% of strokes in those 50 and under. cervical artery dissections are most commonly due to trauma, but can occur spontaneously. Nachi: Risk factors include Ehlers-Danlos syndrome, osteogenesis imperfecta, and Marfan syndrome. Jeff: Regardless of the etiology, the management of cervical artery dissections is primarily medical with IV heparin followed by warfarin or a direct oral anticoagulant in those with extracranial dissections, and antiplatelet therapy like aspirin or clopidogrel in those with intracranial dissections. Nachi: Thanks to the CADISP study, we know there is no difference in mortality or neurologic outcome when choosing between antiplatelet therapy and anticoagulation. Jeff: Next we have cerebral venous thrombosis. This typically presents with a gradual onset headache. Though it can happen to anybody, cerebral venous thrombosis typically results from thrombotic disease. Nachi: Important risk factors include oral contraceptive use, pregnancy and postpartum states, Factor V Leiden deficiency, and lupus. Jeff: Treatment for CVT is controversial due to a high risk of hemorrhage and hemorrhagic transformation. According to the best available evidence, anticoagulation is the standard therapy with full dose anticoagulation of low-molecular weight heparin or heparin as a bridge to warfarin. Nachi: Yeah, it’s really a tough spot to be in as one third end up having some form of hemorrhage too…. Jeff: Perhaps yet another good place for shared decision making? Nachi: Honestly, it’s a good thought, but anticoagulation is the guideline recommendation, so I think that is likely the best route in this case. Jeff: Great point. Next we have idiopathic intracranial hypertension. This is typically associated with obese women of childbearing age. It may also be due to hypervitaminosis A from excessive dietary intake and even drugs like the retinoids used in treating dermatologic conditions and cancers. Nachi: idiopathic intracranial hypertension can be diagnosed by the modified dandy criteria which are found in table 8 on page 11. Let’s just run through the criteria. Jeff: The modified Dandy criteria for idiopathic intracranial hypertension include: signs and symptoms of increased ICP, no other neurologic abnormalities or altered level of consciousness, ICP > 20 on LP with normal CSF composition, neuroimaging without another etiology for intracranial hypertension, and lastly no other identified cause of intracranial hypertension. Nachi: And as we mentioned a few minutes ago, an LP can be both diagnostic and therapeutic, though the relief is likely temporary Jeff: For more permanent treatment, weight loss is the key. Acetazolamide, 250 mg to 500 BID is the first line pharmacotherapy. Combined with weight loss, acetazolamide and a low sodium diet has been shown to improve visual field function. Nachi: And if this fails, topiramate, furosemide, and in the worst case surgical options like CSF shunting, venous sinus stenting, and optic sheath fenestration are all options. Jeff: I imagine taking a diuretic for a headache could be a real hindrance on quality of life, though I suppose it’s better than risking vision loss or having a significant neurosurgery. Nachi: Agreed. Next we have giant cell arteritis. GCA is rare, with a prevalence of

For young patients who have no reason to clot, it's good to know which diagnostic tests you should send, when you should send them, and how they can be erroneously interpreted. Dr. Kristy Yuan, a vascular neurologist from the University of Pennsylvania, summarizes her approach in this week's clinical case. Produced by James E. Siegler and Kristy Yuan. Music by Chris Zabriskie, How the Night Came, Doctor Turtle, and Swelling. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES 1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC and Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-352. 2. Ho WK, Hankey GJ, Quinlan DJ and Eikelboom JW. Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Archives of internal medicine. 2006;166:729-36. 3. Cohn DM, Vansenne F, de Borgie CA and Middeldorp S. Thrombophilia testing for prevention of recurrent venous thromboembolism. The Cochrane database of systematic reviews. 2012;12:CD007069. 4. Connors JM. Thrombophilia Testing and Venous Thrombosis. The New England journal of medicine. 2017;377:1177-1187. 5. Garcia D and Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. The New England journal of medicine. 2018;378:2010-2021. 6. Mintzer DM, Billet SN and Chmielewski L. Drug-induced hematologic syndromes. Adv Hematol. 2009;2009:495863.

The recommendations of the report of the Society of Neurointerventional Surgery (SNIS) Standards and Guidelines Committee for endovascular strategies for cerebral venous thrombosis are discussed in this podcast. Editor-in-Chief of JNIS, Felipe de Albuquerque, talks to Justin Fraser (Department of Neurological Surgery, University of Kentucky, Lexington, USA) on behalf of the Society of NeuroInterventional Surgery. Read the paper on the JNIS website: https://jnis.bmj.com/content/10/8/803

Neuro Imaging Nibble: Subtle Sinus Venous Thrombosis by Brandon Foreman

You should care about superficial venous thrombosis.  If they're in the lower extremities and greater than 5 cm in length, they have increased risk of DVT and PE.  Check out the video for more info.     

Dr. Susana Seijo discusses her manuscript, "Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis."

Dr. Susana Seijo discusses her manuscript, "Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis."

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more..... The post Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection appeared first on Emergency Medicine Cases.

Prevention of venous thrombosis after knee-replacement surgery (ADVANCE-2 study).

Background Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example. Methods Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color. Results The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis. Conclusion Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.

Guest: Suzanne Cannegieter, MD Host: Gary Kohn, MD Dr. Suzanne Cannegieter, director of clinical epidemiology, and the lead international researcher for the Wright Project, from Leiden University Medical Center in the Netherlands, talks about the history of research on deep venous thrombosis and extensive air travel.

05/18/2006 | Venous Thrombosis