周围血管疾病急性深静脉血栓ppt课件

Peripheral Vascular Disease(周围血管疾病)Peripheral Vascular DiseasePeripheral Vascular Diseasen nDiseases of blood vessels outside the heart and brainn nDisorders of the veinsn nPeripheral arterial disease(PAD)Peripheral Vascular DiseaseAcute Deep Venous Thrombosis急性深静脉血栓急性深静脉血栓Acute Deep Venous ThrombosisVenous Thromboembolism(VTE)n nAcute deep venous thrombosis(DVT)n nPulmonary embolism(PE)n nPost-thrombotic syndrome Acute Deep Venous ThrombosisRisk Factors for Acute Deep Venous Thrombosis(DVT)Risk Factors for Acute Deep Venous Thrombosis(DVT)and Pulmonary Embolism(PE)and Pulmonary Embolism(PE)Acute Deep Venous ThrombosisRisk Factors for Acute Deep Venous Thrombosis(DVT)Risk Factors for Acute Deep Venous Thrombosis(DVT)and Pulmonary Embolism(PE)and Pulmonary Embolism(PE)n nPrimary Hypercoagulable Statesn nPregnancy n nOral Contraceptives and Hormonal Therapy n nAcute Deep Venous ThrombosisSigns and symptoms n nS Sy ymmp pt to omms sn nA Ab bs se en nc ce e o of f s sy ymmp pt to omms sn nMMa as ss si iv ve e s sw we el ll li in ng gn nC Ca al lf f p pa ai in n,e ed de emma a,e er ry yt th he emma a,f fe ev ve er rn nC Cy ya an no os si is s w wi it th h i immp pe en nd di in ng g v ve en no ou us s g ga an ng gr re en ne e (p ph hl le eg gmma as si ia a c ce er ru ul le ea a d do ol le en ns s，股股青青肿肿)n nS Si ig gn ns sn nP Pr ro ommi in ne en nt t s su up pe er rf fi ic ci ia al l v ve ei in ns sn nH Hy yp pe er rt to on ni ia a a an nd d t te en nd de er rn ne es ss s o of f c ca al lf fn nH Ho omma an ns s s si ig gn n (p pa ai in n w wi it th h p pa as ss si iv ve e d do or rs si if fl le ex xi io on n o of f t th he e f fo oo ot t )Acute Deep Venous ThrombosisVascular Labn nVenography(“gold standard”,historically)n nDuplex Ultrasonography n nComputed tomography venography(CTV)n nD-Dimer AssaysAcute Deep Venous ThrombosisAscending venography May-Thurner syndromeAcute Deep Venous ThrombosisDuplex Ultrasonographyn nSensitivitySensitivity：97%97%n nSpecificitySpecificity：94%,94%,n nPositive predictive Positive predictive valuesvalues：97%97%n nNegative predictive Negative predictive values values：98%,98%,Acute Deep Venous ThrombosisDuplex UltrasonographyNormalThrombosed popliteal veinAcute Deep Venous ThrombosisComputed tomography venography(CTV)Acute Deep Venous ThrombosisD-Dimer Assays n nElevated D-dimer values are associated withElevated D-dimer values are associated with：n nThrombosis Thrombosis（sensitivity 96.8%sensitivity 96.8%）n nDICDICn nMalignancyMalignancyn nPostoperative statesPostoperative statesn nPreeclampsiaPreeclampsian nInfectionInfectionn nRecent traumaRecent traumaAcute Deep Venous ThrombosisPrevention of Venous ThromboembolismLow-molecular-weight heparin(LMWH)Intermittent pneumatic leg compressionGraduated-Compression Stockings Oral Anticoagulants Acute Deep Venous ThrombosisTreatmentn nA An nt ti ic co oa ag gu ul la an nt t T Th he er ra ap py yn nT Th hr ro ommb bo ol ly yt ti ic c t tr re ea at tmme en nt tn nI In n p pa at ti ie en nt ts s w wi it th h D DV VT T,w we e r re ec co ommmme en nd d a ag ga ai in ns st t t th he e r ro ou ut ti in ne e u us se e o of f I IV V t th hr ro ommb bo ol ly yt ti ic c t tr re ea at tmme en nt t (GGr ra ad de e 1 1A A)n nI IV VC C f fi il lt te er r p pl la ac ce emme en nt tn nF Fo or r mmo os st t p pa at ti ie en nt ts s w wi it th h D DV VT T,w we e r re ec co ommmme en nd d a ag ga ai in ns st t t th he e r ro ou ut ti in ne e u us se e o of f a a v ve en na a c ca av va a f fi il lt te er r i in n a ad dd di it ti io on n t to o a an nt ti ic co oa ag gu ul la an nt ts s (GGr ra ad de e 1 1A A)Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy，2008Acute Deep Venous ThrombosisAnticoagulant Therapy for VTEn nObjectives of treatment in patients with VTE are:n nT To o p pr re ev ve en nt t d de ea at th h f fr ro omm P PE E n nT To o p pr re ev ve en nt t r re ec cu ur rr re en nt t V VT TE E n nT To o p pr re ev ve en nt t t th he e p po os st t-t th hr ro ommb bo ot ti ic c s sy yn nd dr ro omme e Acute Deep Venous ThrombosisAnticoagulant Therapy for VTEn nAnticoagulant drugsn nHeparin (100U/kg body weight,SC,q12h)Heparin (100U/kg body weight,SC,q12h)n nLMWH (0.1ml/10kg body weight,SC,q12h)LMWH (0.1ml/10kg body weight,SC,q12h)n nWarfarin(Keep INR 2.0-3.0)Warfarin(Keep INR 2.0-3.0)Acute Deep Venous ThrombosisContraindications of Anticoagulant Therapy n nPatients who have undergone surgery within the Patients who have undergone surgery within the previous 2 weeksprevious 2 weeksn n Patients with a previous history of peptic ulcer disease Patients with a previous history of peptic ulcer disease or gastrointestinal or genitourinary bleeding.or gastrointestinal or genitourinary bleeding.n nPatients with recent stroke(i.e.,thrombotic stroke within Patients with recent stroke(i.e.,thrombotic stroke within 2 weeks previously)2 weeks previously)n nPatients with a platelet count 150 10Patients with a platelet count 150 109 9/L/Ln nPatients with miscellaneous reasons for a high risk of Patients with miscellaneous reasons for a high risk of bleeding(e.g.,hepatic failure,renal failure,or vitamin K bleeding(e.g.,hepatic failure,renal failure,or vitamin K deficiency)deficiency)Acute Deep Venous ThrombosisPE and Inferior vena cava filter Acute Deep Venous Thrombosis