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Venous thromboembolism (VTE) is the most common cause of preventable in-hospital mortality and all hospitalized patients should be VTE risk assessed. The VTE risk should be weighed up against risk of bleeding on an individualized basis to guide choice of prophylaxis. The most common method of mechanical thromboprophylaxis is graduated compression stockings, although others, such as intermittent pneumatic devices, are available. Stockings have the greatest benefit when used in combination with pharmacological prophylaxis. However, stockings are contraindicated in some patients, including those with stroke or peripheral arterial disease. Various options for pharmacological thromboprophylaxis are available. The most commonly used agents are the low-molecular-weight heparins, but newer orally active agents may play an increasing role in the future. [ABSTRACT FROM AUTHOR]

Intra-arterial thrombolysis is an alternative treatment to surgery for acute limb ischemia. We report our own experiences by retrospectively assessing initial and long-term outcomes using this strategy. Patients (n = 48; 50 events) underwent thrombolysis according to our protocol (64.6% male, median age 68.5 years). Using thrombolysis as an initial treatment strategy, overall limb survival on index admission was 84%. Of this group who had successful limb salvage, 76% was attributable to thrombolysis alone, and 24% had limb salvage attributable to subsequent surgery after failed thrombolysis or anticoagulation. Significant complications occurred in 8% of cases, and no deaths were attributed to thrombolysis. Patients alive at 6 and 24 months after index admission who had limb salvage attributable to thrombolysis alone had limb survival rates of 89% and 82%, respectively. The majority of these patients had not required subsequent secondary procedures to maintain limb survival. Thrombolysis is an acceptable and less invasive treatment of acute limb ischemia, with many patients not needing subsequent surgery. [ABSTRACT FROM AUTHOR]

This is a study of 97 patients who underwent 106 femoropopliteal bypass grafts (9 bilateral bypasses) for short-distance claudication and critical ischemia. Patients were divided into 2 groups. The first group (n = 64) was followed up by use of duplex scans. The second group (n = 42) was followed up in clinic without duplex surveillance. Twenty-three patients from the surveillance group developed stenoses of the grafts. Of these, 14 underwent successful angioplasty. A total of 43 grafts became blocked. Graft occlusion was significantly more common in the nonsurveillance group (n = 29) as compared to the surveillance group (n = 14) after both 1 and 3 years of observation (p = 0.001). Patients with critical ischemia showed a higher rate of graft occlusion than the claudicants (p = 0.0075). Sixteen patients in the nonsurveillance group underwent above/below-knee amputation compared to I in the surveillance group. There was no significant difference in the mortality rate in the 2 groups. Graft surveillance helped to improve patency of grafts by identifying the correctable lesions. [ABSTRACT FROM AUTHOR]