by Liu Kin Hung. / Thesis submitted in: Dec, 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 87-95). / Abstract also in Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Literature Review --- p.3 / Chapter 2.1 --- Venous anatomy --- p.3 / Chapter 2.2 --- Arterial anatomy --- p.6 / Chapter 2.3 --- Deep vein thrombosis --- p.8 / Chapter 2.3.1 --- Clinical Examination --- p.11 / Chapter 2.3.2 --- Contrast Venogram --- p.12 / Chapter 2.3.3 --- Color duplex ultrasound --- p.13 / Chapter 2.4 --- Arterial resistance --- p.24 / Chapter 2.5 --- Basis for study --- p.28 / Chapter 3 --- Method --- p.30 / Chapter 3.1 --- Subjects --- p.30 / Chapter 3.2 --- Equipments --- p.30 / Chapter 3.3 --- Procedure --- p.31 / Chapter 3.4 --- Data analysis --- p.38 / Chapter 4 --- Results --- p.40 / Chapter 4.1 --- Arterial resistance changes in different groups --- p.40 / Chapter 4.1.1 --- Symptomatic with no DVT versus asymtomatic with no DVT --- p.40 / Chapter 4.1.2 --- Symptomatic with DVT versus symptomatic with no DVT --- p.43 / Chapter 4.1.3 --- Symptomatic acute DVT versus symptomatic chronic DVT --- p.46 / Chapter 4.1.4 --- Symptomatic proximal-DVT versus symptomatic calf-DVT --- p.49 / Chapter 4.1.5 --- symptomatic occlusive DVT versus symptomatic non- occlusive DVT --- p.52 / Chapter 4.2 --- Diagnosis of DVT by arterial resistance changes --- p.57 / Chapter 4.2.1 --- Detection of presence of symptomatic DVT --- p.57 / Chapter 4.2.2 --- Differentiation of characteristics of symptomatic DVT --- p.60 / Chapter 5 --- Discussion --- p.64 / Chapter 5.1 --- Investigation of arterial resistance changes --- p.64 / Chapter 5.1.1 --- Symptomatic with no DVT versus asymtomatic with no DVT --- p.66 / Chapter 5.1.2 --- Symptomatic with DVT versus symptomatic with no DVT --- p.69 / Chapter 5.1.3 --- Symptomatic acute DVT versus symptomatic chronic DVT --- p.72 / Chapter 5.1.4 --- Symptomatic proximal-DVT versus symptomatic calf-DVT --- p.74 / Chapter 5.1.5 --- symptomatic occlusive DVT versus symptomatic non- occlusive DVT --- p.76 / Chapter 5.2 --- Detection and differentiation of DVT by arterial resistance --- p.80 / Chapter 5.2.1 --- Detection of symptomatic DVT --- p.80 / Chapter 5.2.2 --- Differentiation of occlusive DVT from non-occlusive DVT --- p.82 / Chapter 6 --- Conclusion --- p.85 / Chapter 7 --- References --- p.87

Thesis (doctoral)--University of Lund, 1983. / Includes bibliographical references.

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Thesis (M.S.)--Rochester Institute of Technology, 2008. / Typescript. Includes bibliographical references (leaves 54-58).

Made available in DSpace on 2014-08-13T14:50:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-10Bitstream added on 2014-08-13T18:00:54Z : No. of bitstreams: 1 000750720.pdf: 1924735 bytes, checksum: 19212f3bbe0c1eba4272b5f12ecc5764 (MD5) / A trombose do cateter de longa permanência (CVCp) em pacientes em hemodiálise (HD) é complicação mecânica comum e pode ocasionar mudanças freqüentes dos locais de cateter, que levam à eliminação de sítios vasculares. Avaliar a incidência da obstrução trombótica dos CVCp nos pacientes em HD e a eficácia do tratamento da oclusão com o uso da alteplase, além de identificar os fatores associados à oclusão trombótica. Estudo tipo coorte prospectivo realizado em dois centros que avaliou o diagnóstico e tratamento da oclusão trombótica de CVCp de pacientes em HD durante 24 meses consecutivos. A oclusão do cateter foi definida como a dificuldade de infundir ou retirar líquido das suas vias e assim que diagnosticada a dose de alteplase foi infundida conforme o volume da luz do cateter, permanecendo por 50 minutos. Não havendo a desobstrução do cateter, o procedimento foi repetido. A criopreservação da alteplase foi realizada, sendo o frasco de 50mg diluído em 50ml de água estéril e posteriormente dividido em doses individuais e armazenadas a -20°C. Estatística: Inicialmente foi realizada análise descritiva da população estudada e estabelecido como variável dependente a ocorrência de oclusão trombótica do cateter, utilizando para as variáveis categóricas, o teste Qui-quadrado e, para as variáveis contínuas, o teste t quando dados paramétricos e o teste de Mann- Whitney quando não-paramétricos. Posteriormente, foi realizada análise multivariada utilizando-se modelo de regressão logística. Foi considerada diferença estatística quando p <0,05. Foram avaliados e seguidos 339 CVCp em 247 pacientes totalizando 67.244 CVCp/dia. A mediana de idade foi de 58(47-66) anos, predomínio de sexo masculino (54%), nefropatia diabética como a principal causa de doença renal crônica terminal (44%), veia jugular interna como principal sítio de implante (82%), tempo em tratamento dialítico até o implante do CVCp ... / Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty to infuse or withdraw fluid from their paths. Alteplase dose was infused to fill the lumen of occluded catheter and remained for 50 minutes. Since there was no obstruction of the catheter, the procedure was repeated. Alteplase cryopreservation was performed (50mg dissolved in 50ml of sterile water and subsequently divided into individual portions and stored at -20 ° C). Statistical analysis: Initially descriptive analysis of the population was performed and the occurrence of catheter thrombotic occlusion was established as dependent variable. For categorical variables, the Chisquare Test was used and for continuous variables, t Test or Mann - Whitney test. Subsequently, multivariate analysis was performed using logistic regression model. Difference was considered when p < 0.05. Three hundred thirty nine CVC in 247 patients were evaluated and followed totaling 67,244 CVC/ day. The median age was 58 (47-66) years , predominantly male (54 %) , diabetic nephropathy as the main cause of chronic kidney disease ( 44 % ) , internal jugular vein as the main site of implantation (82 %) , dialysis duration before CVC implantation of 119 (41.5 to 585.5) days . Eight hundred fifteen occlusion episodes were diagnosed (12 episodes per 1000 CVCP - day), with primary success with alteplase in 596 episodes (77 %) and secondary in 81 cases (10 %). In 99 episodes (13%) success was not ...

Orientador: Daniela Ponce / Banca: Etienne Maria Vasconcellos de Macedo / Banca: Paula Schmidt Azevedo Gaiolla / Resumo: A trombose do cateter de longa permanência (CVCp) em pacientes em hemodiálise (HD) é complicação mecânica comum e pode ocasionar mudanças freqüentes dos locais de cateter, que levam à eliminação de sítios vasculares. Avaliar a incidência da obstrução trombótica dos CVCp nos pacientes em HD e a eficácia do tratamento da oclusão com o uso da alteplase, além de identificar os fatores associados à oclusão trombótica. Estudo tipo coorte prospectivo realizado em dois centros que avaliou o diagnóstico e tratamento da oclusão trombótica de CVCp de pacientes em HD durante 24 meses consecutivos. A oclusão do cateter foi definida como a dificuldade de infundir ou retirar líquido das suas vias e assim que diagnosticada a dose de alteplase foi infundida conforme o volume da luz do cateter, permanecendo por 50 minutos. Não havendo a desobstrução do cateter, o procedimento foi repetido. A criopreservação da alteplase foi realizada, sendo o frasco de 50mg diluído em 50ml de água estéril e posteriormente dividido em doses individuais e armazenadas a -20°C. Estatística: Inicialmente foi realizada análise descritiva da população estudada e estabelecido como variável dependente a ocorrência de oclusão trombótica do cateter, utilizando para as variáveis categóricas, o teste Qui-quadrado e, para as variáveis contínuas, o teste t quando dados paramétricos e o teste de Mann- Whitney quando não-paramétricos. Posteriormente, foi realizada análise multivariada utilizando-se modelo de regressão logística. Foi considerada diferença estatística quando p <0,05. Foram avaliados e seguidos 339 CVCp em 247 pacientes totalizando 67.244 CVCp/dia. A mediana de idade foi de 58(47-66) anos, predomínio de sexo masculino (54%), nefropatia diabética como a principal causa de doença renal crônica terminal (44%), veia jugular interna como principal sítio de implante (82%), tempo em tratamento dialítico até o implante do CVCp ... / Abstract: Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty to infuse or withdraw fluid from their paths. Alteplase dose was infused to fill the lumen of occluded catheter and remained for 50 minutes. Since there was no obstruction of the catheter, the procedure was repeated. Alteplase cryopreservation was performed (50mg dissolved in 50ml of sterile water and subsequently divided into individual portions and stored at -20 ° C). Statistical analysis: Initially descriptive analysis of the population was performed and the occurrence of catheter thrombotic occlusion was established as dependent variable. For categorical variables, the Chisquare Test was used and for continuous variables, t Test or Mann - Whitney test. Subsequently, multivariate analysis was performed using logistic regression model. Difference was considered when p < 0.05. Three hundred thirty nine CVC in 247 patients were evaluated and followed totaling 67,244 CVC/ day. The median age was 58 (47-66) years , predominantly male (54 %) , diabetic nephropathy as the main cause of chronic kidney disease ( 44 % ) , internal jugular vein as the main site of implantation (82 %) , dialysis duration before CVC implantation of 119 (41.5 to 585.5) days . Eight hundred fifteen occlusion episodes were diagnosed (12 episodes per 1000 CVCP - day), with primary success with alteplase in 596 episodes (77 %) and secondary in 81 cases (10 %). In 99 episodes (13%) success was not ... / Mestre