**6. References**

Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H & Singh Y. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol. 2000; 11: 1309-1314.

risk of filter deployment. In terms of safety and efficacy, there is no significant difference between the two types of devices (Nazir et al., 2009). Complications associated with the device include those encountered at the time of insertion such as access site haematoma, pneumothorax, inadvertent arterial puncture and misplacement. Delayed complications

The incidence of deep venous thrombosis is increasing, not just in the lower limb but also within the deep veins of the upper limb, where malignancy and central venous catheter placement are the major precipitating factors. Ultrasound provides a rapid and readily available assessment, and can be portably used at the bedside in critically ill patients. There is however limitations to ultrasound, particularly the poor visualisation of below knee clot. In high risk patients, a short interval repeat scan is indicated to exclude the 25% of such clots

The iliac veins within the pelvis are also inaccessible to ultrasound in almost every patient. If DVT is strongly suspected within the pelvis, MRI should be considered. This modality has seen the greatest advancements in recent times, with current protocols able to visualise the venous system in very high spatial resolution. CT angiography of the limbs, whilst sensitive and easily incorporated into routine CT pulmonary angiograph in suspected PE, should be avoided in view of the radiation burden. The major advantage of MRI is the lack of radiation exposure. MRI will almost certainly feature more commonly in DVT evaluation in the near future with new "blood pool" contrast agents allowing a comprehensive examination for PE and DVT in the same scan. One specific application is in relatively young patients with abnormal CXR precluding a V/Q scan. However, CT is currently the "gold standard" for

There are a number of endovascular treatment options in DVT which aim to achieve thrombus removal, restoring patency and potentially limiting the acute complications associated with DVT. It is important to appreciate there are limitations to these treatments, with a relative lack of randomised controlled trials evaluating their true efficacy. They should however be given consideration in selected patients as outlined

We would like to thank Dr Iain Robertson & Dr Richard Edwards, consultant interventional radiologists, Gartnavel hospital, Glasgow for kindly providing the images of catheter

Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H & Singh Y. Venous thrombosis

associated with the placement of peripherally inserted central catheters. J Vasc

include IVC thrombosis, occlusion, venous insufficiency and pulmonary embolism.

**4. Conclusion** 

diagnosing PE.

thrombectomy.

**6. References** 

**5. Acknowledgements** 

Interv Radiol. 2000; 11: 1309-1314.

above.

which can propagate above the knee.


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**6** 

**Emerging Issues in Deep Vein Thrombosis;** 

This chapter addresses a new and emerging aspect of health in developing countries—one that poses a serious and growing burden on individuals, health systems, and economies of poor countries but is largely preventable. Deep Vein thrombosis (DVT) is a major medical, social and economic problem in developed countries, but in developing countries scanty information is available. Blood clots such as thrombus in a deep vein in the lower limb is the most serious unexpected killer of hospitalized patients in developed countries and over the years this has led to elaboration of numerous strategies directed towards reducing the risks of formation of such thrombi and treating them when they occur. This area has been covered extensively in the literature emerging from developed countries, and little is known

Another area that will be covered in this chapter relates to hypercoagulation in chronic liver disease which is poorly understood till recently. Because of the relatively uncommon occurrence of overt clinical thrombosis in patients with liver disease, and the complexity of the haemostatic mechanism, in addition to the fact that clinicians often perceive that these patients are at a reduced risk for venous thromboembolism, DVT in liver disease is an understudied problem. In this chapter, we aim to discuss DVT from two aspects; DVT in

Chronic liver diseases in the United States account for 400,000 hospitalizations and 27,000 deaths (Kochanek et al., 2004, Kozak et al. 2005). This area needs to be revisited with respect to DVT in liver disease, where viral liver disease is more common in developing countries than in developed countries (Williams,2006.). Patients with advanced liver disease (a failing liver) display a complexity of haemostatic abnormalities often occurring concurrently including coagulopathic, hypercoagulable, and hyperfibrinolytic disorders and increased platelet activation. Recent literature has revealed that hypercoagulability plays an important role in many aspects of acute and chronic liver disease (Nieuwdrop et al .2005, 2004). The resulting clinical state is determined by which component of these complex haemostatic

about the pattern and scale of problem in developing countries.

liver disease, and DVT in developing countries.

**2. Deep vein thrombosis in liver disease** 

mechanisms predominates.

**1. Introduction** 

**(DVT) in Liver Disease and in** 

Farjah H. AlGahtani and Abdel Galil Abdel Gader *College of Medicine and King Khalid University Hospital* 

**Developing Countries** 

*Kind Saud University, Riyadh Kingdom of Saudi Arabia* 

acute iliofemoral deep vein thrombosis with use of adjunctive catheter directed intrathrombus thrombolysis. J vasc Interven Rad. 2004; 20 (Suppl 7):332-335.

Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D'Ovidio R, Cogo A, Prandoni P, Girolami A & Jinsberg A. Accuracy of clinical assessment of deep venous thrombosis. Lancet. 1995; 345: 1315-1380.
