Study On Smoke-Like Echo Pattern Of The Lower Limb Veins And Its Relationship With Thrombosis And Abnormal Coagulation Parameters

Objective:To investigate the relationship of smoke-like ultrasonographic appearance in the lower limb veins with the vein thrombosis and abnormal blood coagulation parameters, and to investigate the clinical diagnostic value of smoke-like ultrasonographic appearance in the lower limb veins between the vein thrombosis and the hypercoagulability state of prothromboticMethods:108patients in the case group and75patients in the control group from April2010to August2011were reviewed. The patients in the two groups whose lower limbs were examed by ultrasonography.Collected and analyzed86cases from the case group in which smoke-like echo pattern was found in their lower limb veins by ultrasonography. According to whether there were thrombosis in the ultrasound images, the patients were divided into2groups:thrombosis group and non-thrombosis group. According to the position where the thrombosis exists, the thrombosis group were divided into2groups:unilateral thrombosis group and bilateral thrombosis group.Blood coagulation parameters which were tested the same day with or most near the day of ultrasound examination were recorded. The coagulation parameters include D-dimer(DD), fibrinogen (Fib), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin standardized ratio (PT-INR), prothrombin ratio (PT-ratio), activated partial thromboplastin ratio (APTT-ratio). Coagulation parameters of the two groups were statistically analyzed. Through comparing the patients with smoke-like echo in the lower limbs, to find out the relationships between whether the place where thrombosis were existed and blood coagulation parameters; the relationship of the place where thrombosis exist and the place where the smoke-like echo exist.Results:The prevalence rate of Smoke-like echo in the lower limbs of the case group was79.63%(86/108), higher than that of the control group25.33%(19/75)(p<0.05). Among the86cases with smoke-like echo pattern in lower limb veins,54.65%(47/86) had thrombus and73.26%(63/86) had abnormal coagulation parameters.87.21%(75/86) had thrombus or had abnormal coagulation parameters,12.79%(11/86) hadn’t thrombus and hadn’t abnormal coagulation parameters. But there was no statistically significant difference of coagulation parameters between the thrombosis group and non-thrombosis group (P>0.05), the appearance of smoke-like echo in the lower limb veins suggests that the patients were in the hypercoagulable state, which was similar with the patients of thrombosis, even though there were not thrombosis in the lower limb veins. in addition,there was no statistically significant difference of Smoke-like echo’s location in the lower limb between the unilateral thrombosis group and bilateral thrombosis group(P>0.05). On the one hand, if the smoke-like echo was found in the one of the lower limb veins, the thrombosis may not be formed in the same side, the thrombosis may be found in the other one of the lower limb veins; On the other one hand, the formed of Smoke-like echo was influenced by kinds of factors, the change of the local limb vien hemodynamics may be played an important role.Conclusion:1.When ultrasound examination was performed, smoke-like echo pattern in the lower limb veins in the ultrasonic examination suggests that the patients were in the hypercoagulable state, the abnormal blood Coagulation parameters were included or the thrombosis were formed in the lower limb vein.smoke-like echo may be existed in the lower limb vein where the thrombosis was formed or that may be existed in the other lower limb vein where the thrombosis was not formed. therefore,If smoke-like echo was existed in the one lower limb vein and thrombosis was not formed in the other lower limb vein, the other lower limb vein was examed by ultrasound carefully2. The lower limb veins ultrasound examination was combined with the blood coagulation parameters, even if thrombosis was not formed in the the lower limb veins, the careless behavior should not be existed, the lower limb veins ultrasound examination was combined with the clinical,The treatment of anticoagulant therapy was considered in time, Which was to prevent the existed of thrombosis. Especially the patients who were in the condition of hypercoagulable.for example, the patients were in the bed for a long time after the operation、the patients were injured with multiple fractures、the patients were suffered from cancer、the patients may be suffered from pulmonary thromboembolism, ultrasound examination on diagnosis of hypercoagulability has higher value, especially helpful for the patients without venous thrombosis so as to take anticoagulation therapy.3. Color doppler ultrasound as a noninvasive vascular examination that had important clinical value in examing the thrombosis in the lower limb veins, not only could the color doppler ultrasound examination display directly,but also color doppler ultrasound examination was combined with the the appearance of smoke-like echo in the lower limb veins, which may be judged the state of Coagulation indirectly and which could be the foundation of the diagnosis of some atypical the thrombosis in the lower limb veins.but, Ultrasonic Diagnosis of smoke-like echo that had not the specifications of technical and the methods of operate, Ultrasonic Diagnosis of smoke-like echo that was dependent on the examer and the adjustment of the device, the quantitative or the semi-quantitative technique of smoke-like echo should be further discussed, the operation of the specification should be further researched.