Comparative Study of Compression Bandages with Absolute Bed Rest versus Ambulation inTreatment of Acute Proximal Deep Vein Thrombosis

Background: In general, many patients with acute proximal deep vein thrombosis (DVT) are treated with heparin and oral anticoagulant. Many physicians have been taught to admit these patients to absolute bed rest for the first 24-48 hours due to the fear of dislodging clots that may lead to fatal pulmonary embolism (PE). Objective: The aim of this study is to compare the differences among the changing circumference of affected limb, the severity of pain, and the incidence of symptomatic PE in 3 groups of acute proximal DVT, including absolute bed rest with compression bandages (group 1), ambulation with compression bandages (group 2), and ambulation without compression bandages (group 3). Methods: Between January 2006 and March 2011, 60 patients were enrolled in this study. In this analysis, the clinical characteristics, the changes of affected limb circumference and pain score during the first week of admis- sion and the incidence of symptomatic PE among 3 groups of this study were analyzed. Results: There were no statistical differences in the characteristics among 3 groups of patients. The most gender was female and the mean age for 3 groups ranged from 55.1 to 63.7 years. Comparing among 3 groups, it showed a significant difference of calf circumferences between group 1 and group 3. None of pain score differences were statistically significant among 3 groups. In addition, there was no incidence of symptomatic PE in the three groups of the present study. Conclusion: Our findings confirm that acute proximal DVT treatment with ambulation does not increase the incidence of symptomatic PE, compared with absolute bed rest. Although there is no statistical decrease of the severity of pain between those 3 groups, the group of absolute bed rest and compression can promote the resolution of calf swelling, compared with the group of ambulation without compression bandages

Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis

Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. Methods: Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day mortality rate and intraoperative limb complications. The secondary outcomes included postoperative pelvic ischemia, freedom from reintervention, and the overall 10-year survival rate. Results: There was no significant difference in the perioperative mortality rate between the non-IIAE group (0%) and the IIAE group (2.1%), p = 0.500. The intraoperative limb complications did not differ significantly between the BBT limbs (7.5%), the IIAE + EE limbs (3.5%), and the IBD limbs (3.1%) groups, p = 0.349. The incidence of buttock claudication was significantly greater in the bilateral IIAE + EE group compared to the unilateral IIAE + EE and non-IIAE groups (25%, 11%, and 2.5%, p-value p p = 0.016). There was no significant difference in the overall 10-year survival rate between the non-IIAE and IIAE groups (51.4% vs. 55.9%, p = 0.703). Conclusions: The early and late mortality rates were similar between the non-IIAE and IIAE groups. Preserving the IIA is recommended to avoid pelvic ischemic complications. Considering the higher rate of reintervention in the BBT group, the IBD strategy may be preferred for AAIA