周围血管疾病急性深静脉血栓ppt课件.ppt

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1、Peripheral Vascular Disease(周围血管疾病),Peripheral Vascular Disease,Peripheral Vascular Disease,Diseases of blood vessels outside the heart and brainDisorders of the veinsPeripheral arterial disease(PAD),Peripheral Vascular Disease,Acute Deep Venous Thrombosis,急性深静脉血栓,Acute Deep Venous Thrombosis,Venous

2、 Thromboembolism(VTE),Acute deep venous thrombosis(DVT)Pulmonary embolism(PE)Post-thrombotic syndrome,Acute Deep Venous Thrombosis,Risk Factors for Acute Deep Venous Thrombosis(DVT)and Pulmonary Embolism(PE),Acute Deep Venous Thrombosis,Risk Factors for Acute Deep Venous Thrombosis(DVT)and Pulmonary

3、 Embolism(PE),Primary Hypercoagulable StatesPregnancy Oral Contraceptives and Hormonal Therapy,Acute Deep Venous Thrombosis,Signs and symptoms,SymptomsAbsence of symptomsMassive swellingCalf pain,edema,erythema,feverCyanosis with impending venous gangrene(phlegmasia cerulea dolens，股青肿)SignsProminent

4、 superficial veinsHypertonia and tenderness of calfHomans sign(pain with passive dorsiflexion of the foot),Acute Deep Venous Thrombosis,Vascular Lab,Venography(“gold standard”,historically)Duplex Ultrasonography Computed tomography venography(CTV)D-Dimer Assays,Acute Deep Venous Thrombosis,Ascending

5、 venography,May-Thurner syndrome,Acute Deep Venous Thrombosis,Duplex Ultrasonography,Sensitivity：97%Specificity：94%,Positive predictive values：97%Negative predictive values：98%,Acute Deep Venous Thrombosis,Duplex Ultrasonography,Normal,Thrombosed popliteal vein,Acute Deep Venous Thrombosis,Computed

6、tomography venography(CTV),Acute Deep Venous Thrombosis,D-Dimer Assays,Elevated D-dimer values are associated with：Thrombosis（sensitivity 96.8%）DICMalignancyPostoperative statesPreeclampsiaInfectionRecent trauma,Acute Deep Venous Thrombosis,Prevention of Venous Thromboembolism,Low-molecular-weight h

7、eparin(LMWH),Intermittent pneumatic leg compression,Graduated-Compression Stockings,Oral Anticoagulants,Acute Deep Venous Thrombosis,Treatment,Anticoagulant TherapyThrombolytic treatmentIn patients with DVT,we recommend against the routine use of IV thrombolytic treatment(Grade 1A)IVC filter placeme

8、ntFor most patients with DVT,we recommend against the routine use of a vena cava filter in addition to anticoagulants(Grade 1A),Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy，2008,Acute Deep Venous Thrombosis,Anticoagulant Therapy for VTE,Objectives of treatment in patients with V

9、TE are:To prevent death from PE To prevent recurrent VTE To prevent the post-thrombotic syndrome,Acute Deep Venous Thrombosis,Anticoagulant Therapy for VTE,Anticoagulant drugsHeparin(100U/kg body weight,SC,q12h)LMWH(0.1ml/10kg body weight,SC,q12h)Warfarin(Keep INR 2.0-3.0),Acute Deep Venous Thrombos

10、is,Contraindications of Anticoagulant Therapy,Patients who have undergone surgery within the previous 2 weeks Patients with a previous history of peptic ulcer disease or gastrointestinal or genitourinary bleeding.Patients with recent stroke(i.e.,thrombotic stroke within 2 weeks previously)Patients with a platelet count 150 109/LPatients with miscellaneous reasons for a high risk of bleeding(e.g.,hepatic failure,renal failure,or vitamin K deficiency),Acute Deep Venous Thrombosis,PE and Inferior vena cava filter,Acute Deep Venous Thrombosis,