[Incidence of post-thrombotic syndrome following systemic fibrinolysis of deep venous thrombosis].
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Follow-Up Studies↗
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Results for “Postphlebitic Syndrome”
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[Surgical treatment of the postthrombotic syndrome at the stage of decompensation of regional blood circulation].
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Adult↗
[Quality assurance in phlebography of the extremities].
By interdisciplinary cooperation with the German Societies for Radiology, Phlebology and Vascular Surgery, recommendations have been worked out which address the indication of phlebography of the veins of the extremities and which define the quality standards of phlebographic techniques. The specific clinical questions in primary varicose, acute thrombosis and postthrombotic syndrome have to be answered by employing adequate phlebographic technique, documentation, and description of relevant morphologic and functional findings.
Contraindications↗
Safety and efficiency of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/or oral anticoagulation with phenprocoumon.
BACKGROUND: The positive effects of perilesional sclerotherapy for venous leg ulcers is well documented. Although many patients with venous leg ulcers require oral anticoagulation or have had a deep vein thrombosis, the effects of these factors on perilesional sclerotherapy are unknown. The aim of this study was to review effects of oral anticoagulation and/or postthrombotic syndrome on perilesional sclerotherapy. PATIENTS AND METHODS: 28 patients with venous leg ulcers were observed. 12/28 had a postthrombotic syndrome, 5/12 were on oral anticoagulants (phenprocoumon with INR 2-3). During each treatment session, 1 ml sclerosing foam (1:5, polidocanol 2 %, method of Tessari) was injected. Treatment was continued until all extrafascial veins in the 15cm surrounding the ulcer were closed. RESULTS: Closure of the perilesional veins was achieved in all patients with 2.5 +/- 1.8 injections. In 10 of 28 patients (35.7 %), just one injection was needed. More injections were needed, both in patients with postthrombotic syndrome (3.3 +/- 2.1 vs. 1.8 +/- 1.3) and on anticoagulation with phenprocoumon (4.2 +/- 1.2 vs. 2.1 +/- 1.7). There were only two complications: an ascending phlebitis up to the accessory saphenous vein and a superficial erosion at an injection site which healed within 1 week. CONCLUSIONS: Perilesional sclerotherapy with foam is a safe and efficient therapy for patients with chronic venous leg ulcers even with postthrombotic syndrome and/ or ongoing anticoagulation.
Administration, Oral↗
Surgical management of the post-phlebitic leg syndrome.
Twenty-five patients (32 limbs) with severe retrograde ejection venous syndrome (post-phlebitic leg syndrome) were surgically treated from 1971 to 1986 using a "very complete fasciotomy" with or without other individualized procedures. Clinical data, venographic findings, operative choices, and outcome were analyzed retrospectively. The theoretic benefit of adopting this new and conceptually accurate diagnostic label and the principle of "no incompetent perforators, no ulcers" is discussed. The patients generally had been managed for 10 to 20 years with conservative neglect or operative inadequacy. With correct conceptual understanding, anatomic stratification, defined indications for surgery, and individualization of procedures, an excellent result has been obtained with a low rate of serious complications. The very complete fasciotomy should be suitable for general use in treating this difficult and controversial syndrome.
Adult↗
Compression therapy for treating stage I and II (Widmer) post-thrombotic syndrome.
BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis characterised by chronic complaints, swelling, and skin changes in the affected limb. One in every three patients with deep vein thrombosis develops post-thrombotic complications within five years. OBJECTIVES: To assess the effectiveness of compression therapy in patients with stage I and II post-thrombotic syndrome according to the classification of Widmer. Interventions of interest included elastic compression stockings and mechanical devices, compared with no intervention and with each other. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Specialised Trials Register (last searched April 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003). In addition, journals, conference proceedings and bibliographies were hand searched. Personal contact with other investigators involved in the clinical area was sought to get information about missed or unpublished studies. SELECTION CRITERIA: Trials that evaluated compression therapy for stage I and II (Widmer) post-thrombotic syndrome. Primary outcomes were leg ulceration, or deterioration of post-thrombotic syndrome. There were no restrictions on date or language. One reviewer (DNK) assessed titles and abstracts for relevance. This was verified independently by a second reviewer (MWCS). DATA COLLECTION AND ANALYSIS: Details of eligible studies were extracted and summarised using data extraction sheets. Data extraction was undertaken by one reviewer (DNK) and verified by a second reviewer (MHP). MAIN RESULTS: Only two trials were identified that addressed physical treatment of post-thrombotic syndrome. Both trials were initiated by the same group of investigators. A cross-over study lasting two months compared low and high pressure with intermittent compression units for severe post-thrombotic syndrome. This showed a beneficial effect of higher pressures. The second study, in patients with mild to moderate post-thrombotic symptoms, showed no effect of elastic compression stockings (30-40 mm Hg at the ankle region) when compared to 'placebo' stockings that were one to two sizes too large. REVIEWER'S CONCLUSIONS: There is some evidence of a beneficial effect of intermittent pneumatic compression units, but the study was too small and of too short a duration to draw strong conclusions. Further research is needed in order to assess whether intermittent pneumatic compression units give long term reduction and relief of the symptoms caused by post-thrombotic syndrome, and prevent deterioration and leg ulceration. The use of elastic compression stockings to treat post-thrombotic syndrome cannot be supported on the basis of the currently available data.
Bandages↗
[Involvement of the lymphatic system in post-thrombotic syndrome].
The involvement of the lymphatic drainage in patients with postthrombotic syndrome can be verified by (quantitative) isotopic lymphography (99m Tc labelled microcolloids) and by indirect lymphography (water-soluble contrast medium Iotrolan). Both methods point to an augmented praefascial lymph-transport. In the region of lipodermatosclerotic skin changes dermal backflow can be explained by a local damage of peripheral skin-lymphatics ("localized lymphoedema"). No working lymphatics can be found in the border of ulcers. As could be demonstrated by intramuscular injection of the radioactive tracer subfascial lymphtransport is decreased not only in the postthrombotic stage but already in the acute phase of a deep vein thrombosis. The alterations of the lymph-drainage in a postthrombotic syndrome may have some pathophysiological importance for the development of the tissue changes and may also explain some clinical signs.
Humans↗
[Therapy of deep leg vein thrombosis. When is surgical therapy indicated?].
In spite of quite a few clinical trials the benefit of venous thrombectomy is seen controversially. The primary objectives of treating venous thrombosis are survival rate, prevention of pulmonary embolism and of postthrombotic syndrome. We report our experience with 47 patients who underwent venous thrombectomy. The mortality rate was 0%. We did not observe clinically relevant pulmonary embolism. After two years 90% of thrombectomised veins were patent. The mortality rates given in the literature of conservative treatment with heparin and following oral anticoagulation are 0.4 to 1.6%. Fibrinolysis shows mortality rates of 1 to 2.4, and thrombectomy of 3.8%, respectively. Venous thrombectomy is an effective treatment to prevent pulmonary embolism. In our own experience we saw no clinically significant pulmonary event. The danger of embolism rises with the proximity of the venous thrombus. Therefore those patients may have the greatest potential benefit from thrombectomy who present with a mobile inguinal thrombus or a thrombus in the iliac vein. So far there are no statistically sufficient data to support the indication of thrombectomy to prevent a postthrombotic syndrome.
Adult↗
A straightforward venous ulcer. Or is it?
Venous ulcers are common in clinical practice. They are due to end stage skin and subcutaneous damage from sustained venous hypertension. The common cause may be post thrombotic syndrome or primary superficial venous insufficiency. This case illustrates the need to think of inherited thrombophilia as a primary cause.
Blood Protein Disorders↗
Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux.
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Adult↗
[Surgery of the perforating veins in chronic venous diseases of the lower limbs].
After a brief anatomical reminder, the author discusses the place of surgery of the perforating veins in chronic venous deficiency, in three distinct aetiological and clinical circumstances: A first-hand prospective study of 220 successive operations for primary varices is analysed. In 14.5% of the cases, ligation of the perforators was associated with the stripping. In a retrospective analysis relating to 100 surgical reoperations on primary varices, the ligation of the perforators was associated with a different procedure in 13 of these patients. Finally, the author specifies the place of surgery of the perforators in the treatment of post-phlebitic syndrome. As regards the relapsing ulcer, 81% of the patients who had benefitted from this procedure never suffered relapsed ulcers (27 patients).
Chronic Disease↗
[Endoscopic correction of crural venous blood flow].
A technique of subfascial electrocoagulation of the communicating shin veins through an endoscope in 53 patients with varicose dilatation of the lower extremity veins and postthrombophlebitis syndrome is described. The technique is not complicated and gives good cosmetic results.
Electrocoagulation↗
Treatment of deep vein thrombosis: is thrombosis regression a desirable endpoint?
Recent studies on the treatment of acute deep vein thrombosis (DVT) with low-molecular-weight heparins have demonstrated that a certain degree of early recanalization of thrombosed veins can be obtained which is higher than that observed under standard heparin treatment. Thrombolytic treatment of DVT is mainly advocated because a reduction of late sequelae of DVT is expected from early thrombolysis. It has been made likely by several small long-term studies that this expectation is true, but conclusive evidence is still missing. There are also large differences in the reported incidence of late postthrombotic syndrome after acute DVT. It seems likely that there is a minimal reopening rate which is required to be of possible clinical value to the individual patient. A 30% or higher reduction of the Marder score is at present used in several clinical trials as a sign of individual response to the treatment and may prove to be a useful clinical endpoint in these and in future studies. Validated methods to predict the late sequelae of acute DVT, mainly severe postthrombotic syndrome, do not yet exist. Foot plethysmography, air plethysmography, duplex sonography (peak velocity of venous reflux, valve competence), and venous pressure reduction under exercise are possible candidates to be used in future prospective trials. From the existing evidence it is very likely that a marked or total reduction of thrombi will reduce the incidence of postthrombotic syndromes. Clinical studies aiming at a high rate of venous recanalization by prolonged treatment with low-molecular-weight heparins are ongoing.
Heparin, Low-Molecular-Weight↗
Post-thrombotic syndrome is uncommon in childhood cancer survivors.
Deep vein thrombosis occurs in up to 50% of children with tunneled central venous catheters (CVCs). CVC-related deep vein thrombosis involving the upper extremity is usually asymptomatic but can result in post-thrombotic syndrome (swelling, pain, skin changes, and functional impairment). In a cohort of childhood cancer survivors evaluated clinically a mean of 7.5 +/- 2.8 years after completion of therapy who previously had CVCs in place for a median 15.5 months, none of 50 patients (95% CI = 0% to 6%) had these features diagnostic of post-thrombotic syndrome. Five patients had arm circumference 3% to 5% greater ipsilateral to the prior CVC.
Adolescent↗
[Dynamic popliteal phlebography].
Since 1984, dynamic popliteal phlebography is an investigative fundamental technique in chronic venous insufficiency of the lower extremities. Our experience includes more than 2,500 examinations. After an anatomical reminder, the technique and methodology of this examination are described. Then its indications are specified: a) in essential varicose veins when a surgical procedure is contemplated in the popliteal fossa: insufficient external saphenous vein, insufficient gemellar veins, etc... b) before repeated surgery for essential varicose veins, c) in the pre-operative evaluation of some post-phlebitic syndromes. Finally, the informations provided by this examination are compared with those provided by clinical examination, Doppler and ultrasonography.
Humans↗
[Clinical and functional results after transfemoral thrombectomy for iliofemoral deep venous thrombosis: a 5-year-follow-up].
PURPOSE: The optimal therapy of deep pelvic and leg venous thrombosis is still a matter of debate. The purpose of our study was to evaluate early and late results of iliofemoral thrombectomy with regard to the prevention of the development of a postthrombotic syndrome. METHODS: Between 1996 and 2000, 57 patients underwent transfemoral venous thrombectomy for acute iliofemoral thrombosis. 30 patients were reexamined after a mean of 60.4 months. At follow-up, the patency of the venous segments as well as the development of reflux was investigated by duplex-ultrasound. Furthermore, clinical signs and symptoms of chronic venous insufficiency as well as the subjective satisfaction of the patients with the operation were recorded. RESULTS: Postoperatively the veins of the lower leg were completely recanalized in 25 % of the cases, those of the thigh in 52.3 %. The patency rate at the level of the groin, the pelvis and the caval vein were 92.5, 86 and 100 %, respectively. At follow-up, the veins of the lower limb, the thigh and the pelvis were patent in 76.7 % each and in 73.3 % at groin-level. The caval vein was completely recanalized in all cases. Reflux occurred in 12 patients. 26.7 % of the patients showed no signs of a postthrombotic syndrome. 63.3 % had mild changes including dilated superficial veins and swelling tendency, and only in 10 % trophic skin changes were apparent. A healed or active ulceration did not occur in any case. Except one, all patients were satisfied with the results of the thrombectomy. CONCLUSIONS: Transfemoral thrombectomy for acute iliofemoral venous thrombosis offers good early and late results in terms of preserving venous function and reducing symptoms of venous insufficiency. In our patient population, the development of a severe postthrombotic syndrome could be reduced effectively.
Adult↗
[The reasons for the surgical correction of the regional venous hemodynamic disorders in post-thrombophlebitic pelvic syndrome in its occlusive phase].
The indications for the reconstructive operations conduction were substantiated, basing on the analysis of late follow-up results of treatment in 73 patients with the pelvic veins occlusion.
Femoral Vein↗
Effect of different compression therapies on the reflux in deep veins with a post-thrombotic syndrome.
BACKGROUND: Reflux in deep veins is an important pathophysiological factor of post-thrombotic syndrome which can be demonstrated by colour-coded duplexsonography. This study investigates the effect of different compression therapies on the reflux velocity in deep veins in patients with a post-thrombotic syndrome. PATIENTS AND METHODS: Sixty patients with a post-thrombotic syndrome-confirmed by phlebography, in the deep veins of the calf and the thigh were investigated in two groups: In group A, 30 patients (mean age 58 +/- 10 years) received compression stockings (calf compression class II and III, thigh compression class II) and in group B 30 patients (mean age 58 +/- 14 years) received a Sigg short traction bandage of the calf. The velocity at the time of the greatest reflux in the popliteal vein was determined as reflux parameter with the colour-coded duplex sonography using a cuff applied at the calf. All patients stood upright and were measured with and without different kinds of compression therapies. The reflux velocities were graded as low, moderate and high. RESULTS: A significant decrease of the reflux velocity by about more than 45% with compression therapy was found in both groups. The decrease of the refluxes in group A (mean 47.9%) did not differ significantly from the decrease of refluxes in group B (mean 55.8%). The greatest decrease of the reflux velocity under compression therapy was found in high-grade refluxes in both groups. CONCLUSION: A significant decrease of the reflux velocity in post-thrombotic syndrome can be readily demonstrated with different kinds of compression stockings as well as with bandages by means of colour-coded duplex sonography.
Adult↗