周围血管疾病急性深静脉血栓课件

PeripheralVascularDisease

(周围血管疾病)PeripheralVascularDiseasePeripheralVascularDisease1DiseasesofbloodvesselsoutsidetheheartandbrainDisordersoftheveinsPeripheralarterialdisease(PAD)2PeripheralVascularDisease急性深静脉血栓AcuteDeepVenousThrombosis0102AcuteDeepVenousThrombosisVenousThromboembolism(VTE)AcuteDeepVenousThrombosisAcutedeepvenousthrombosis(DVT)Pulmonaryembolism(PE)Post-thromboticsyndromeAcuteDeepVenousThrombosisRiskFactorsforAcuteDeepVenousThrombosis(DVT)andPulmonaryEmbolism(PE)

RiskFactorsforAcuteDeepVenousThrombosis(DVT)andPulmonaryEmbolism(PE)Pregnancy…AcuteDeepVenousThrombosisPrimaryHypercoagulableStatesOralContraceptivesandHormonalTherapy12345SignsandsymptomsAcuteDeepVenousThrombosisSymptomsAbsenceofsymptomsMassiveswellingCalfpain,edema,erythema,feverCyanosiswithimpendingvenousgangrene(phlegmasiaceruleadolens，股青肿)SignsProminentsuperficialveinsHypertoniaandtendernessofcalfHomans’sign(painwithpassivedorsiflexionofthefoot)VascularLabAcuteDeepVenousThrombosisVenography(“goldstandard”,historically)DuplexUltrasonographyComputedtomographyvenography(CTV)D-DimerAssaysMay-ThurnersyndromeAcuteDeepVenousThrombosisAscendingvenographySensitivity：97%Specificity：94%,Positivepredictivevalues：97%Negativepredictivevalues：98%,AcuteDeepVenousThrombosisDuplexUltrasonographyNormalThrombosedpoplitealveinAcuteDeepVenousThrombosisDuplexUltrasonographyAcuteDeepVenousThrombosisComputedtomographyvenography(CTV)ElevatedD-dimervaluesareassociatedwith：Thrombosis（sensitivity96.8%）DICMalignancyPostoperativestatesPreeclampsiaInfectionRecenttraumaAcuteDeepVenousThrombosisD-DimerAssaysPreventionofVenousThromboembolismLow-molecular-weightheparin(LMWH)IntermittentpneumaticlegcompressionGraduated-CompressionStockingsOralAnticoagulantsAcuteDeepVenousThrombosisTreatmentEighthACCPConferenceonAntithromboticandThrombolyticTherapy，2008AcuteDeepVenousThrombosisAnticoagulantTherapyThrombolytictreatmentInpatientswithDVT,werecommendagainsttheroutineuseofIVthrombolytictreatment(Grade1A)IVCfilterplacementFormostpatientswithDVT,werecommendagainst

theroutineuseofavenacavafilterinadditiontoanticoagulants(Grade1A)AnticoagulantTherapyforVTEAcuteDeepVenousThrombosisObjectivesoftreatmentinpatientswithVTEare:TopreventdeathfromPETopreventrecurrentVTETopreventthepost-thromboticsyndromeAnticoagulantdrugsLMWH(0.1ml/10kgbodyweight,SC,q12h)Heparin(100U/kgbodyweight,SC,q12h)Warfarin(KeepINR2.0-3.0)AcuteDeepVenousThrombosisAnticoagulantTherapyforVTEContraindicationsofAnticoagulantTherapyPatientswhohaveundergonesurgerywithintheprevious2weeksPatientswithaprevioushistoryofpepticulcerdiseaseorgastrointestinalorgenitourinarybleeding.Patientswithrecentstroke(i.e.,thromboticstrokewithin2weekspreviously)Patientswithaplateletcount<150×109/LPatientswithmiscellaneousreasonsforahighrisk