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Results for “Postphlebitic Syndrome”

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PubMed1994

[The pathophysiology of post-thrombotic syndrome].

The acute stage of venous thrombosis is characterized by an inflammatory process, therefore the term phlebitis is often erroneously equated with venous thrombosis. In most cases, however, the inflammatory reaction or phlebitis is a secondary phenomenon, associated with the process of fibrinolysis and phlebitis as a primary cause is rare. Postthrombotic sequelae such as edema, varicose veins and ulcers usually are late complications and can take a long time to develop. The primary cause of the postthrombotic syndrome is related to an injured venous wall, including damaged valves or stenosis due to incomplete recanalisation. The amount of damage is dependent on the extent of the primary thrombosis and the degree and rapidity of thrombolysis. When postthrombotic changes are suspected, functional evaluation can be performed with ambulatory venous pressure measurement in a foot vein or with the aid of non-invasive methods such as volumetry.

Humans↗

PubMedDate not supplied

[Blood groups as a risk factor in venous thrombosis].

We report 173 patients with venous thrombosis (or post-thrombotic syndrome) demonstrated by phlebography. We show up the importance of blood groups as risk factor, being very significant the A group. Female sex is associated with a high incidence of this pathology. A frequent location is the left lower limb.

Acute Disease↗

PubMed1994

[Duplex ultrasound of post-thrombotic syndrome--quantification of venous flow parameters].

In the last years Duplex-Sonography established itself in the diagnosis of venous diseases. This noninvasive method combines Doppler-ultrasound and real-time sonography. In this way an exact quantitative interpretation of the Dopplersounds in relation to the examined blood vessel is possible. Especially the venous bloodflow of postthrombotic veins will be explored. It will be discussed whether the data measured by Duplex-sonography allow a staging of venous diseases.

Blood Flow Velocity↗

PubMed1995

[Causes of postoperative recurrent varicose veins of lower extremities].

We analysed venograms of recurrent varicose veins in 180 cases (206 lower limbs). Deep vein valvular insufficiency resulted in varicose veins in 52.9% cases, and post-thrombotic syndrome in 18.9%. The causes of postoperative recurrent varicose veins varied: blindly performed single superficial veins operation, low ligation of the long saphenous trunk, incomplete stripping of varicose veins, missing of the short varicose saphena or incomplete ligation of the perforating veins and failure of deep vein valvular repairs. Venography is of value in making correct diagnosis and choosing appropriate operations.

Adult↗

PubMedDate not supplied

Are the phlebotonic properties shown in clinical pharmacology predictive of a therapeutic benefit in chronic venous insufficiency? Our experience with Daflon 500 mg.

In 3 controlled clinical trials, double blind versus placebo, the activity of Daflon 500 mg, a new micronised flavonoid fraction, has been evaluated on venous tone using venous plethysmography. A double-blind, randomized cross-over Phase II pharmaco-clinical trial has shown that Daflon 500 mg is statistically more effective than placebo on pathological legs, as well as normal legs. In this study, which included 20 patients suffering from post-thrombotic syndrome, Daflon 500 mg decreased: 1) venous capacity (p less than 0.001); 2) venous distensibility (p less than 0.001); 3) venous outflow time, measured by the two parameters total emptying venous time (p less than 0.001) and T2p (p less than 0.001). These modifications have been observed 2 hours after administration without any significant change in T50 outflow, cardiad index, capillary filtration index, blood pressure, cardiac or respiratory rate. The same acute effect of increasing venous tone has been demonstrated in another pharmacoclinical trial, 1 and 2 hours after ingestion in 3 groups of 10 women suffering from venous insufficiency: group I without varicose, group II during pregnancy and group III with a post-thrombotic syndrome. Finally, in a Phase III clinical trial, in 2 parallel groups of 20 patients each with functional chronic venous insufficiency, Daflon 500 mg has been compared to placebo. It was then demonstrated after 1 and 2 months treatment an improvement in the functional symptoms and edema accompanied by a statistically significant increase of the venous tone. (ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗

PubMedDate not supplied

[The epidemiology and socio-economics of venous diseases in Germany].

The author reports the conclusions of a multicentre investigation lead in Germany. According to this study, varicose veins are more frequent in women than in men, either in ordinary population or in in-patients. Adults are not exclusively the only ones who suffer from varicose veins; children often suffer from them too. People suffer equally from phlebitis or post phlebitis syndromes. Moreover, heredity and obesity tend to favour this tendency. Thus, the socio-economic impact is so important that the cost of treatment, hospitalization and the social cost of sick-leave must be taken into consideration. So, it is necessary for the Authorities to prevent venous diseases and be aware of the importance of phlebology.

Absenteeism↗

PubMedDate not supplied

[Unique forms of the postthrombotic syndrome].

A prospective study was made with a view to analyse and to identify two particular forms of the post-thrombotic syndrome. The post-thrombotic syndrome of the shank can be recognized on the basis of the clinical and of the phlebographic examination. It has a serious prognosis and can be treated either conservatively or by surgery according to case. Its frequency is probably higher than it was presumed on the basis of the first observations. The post-thrombotic venous obstruction may be a cause of arterial ischemia during effort but this occurs only in very few cases. This particular syndrome is manifested as intermittent claudication which occurs in the clinical picture of chronic orthostatic venous failure. The probable mechanism is the direct effect of increased pressure in the arterial and venous circulation in vessels with normal walls, as a result of an important obstruction in the return circulation. Lumbal sympathectomy appears to improve durable claudication and hyperhidrosis.

Adult↗

PubMed2001

[Stent or bypass? Treatment results in benign central venous obstruction].

PURPOSE: Surgical treatment of central venous obstruction is difficult and sometimes hazardous, but not always successful. Sufficient palliation of malign stenoses can often be achieved by stent implantation. Thus it seems necessary to define the relative value of stenting in comparison to surgical reconstruction for the treatment of benign obstructions, with special respect to the long-term results. METHODS: Between 1990 and 1999, 64 central venous stents were implanted. Mediastinal vein obstructions in 23 hemodialysis patients were treated with a total of 35 stents. 29 iliofemoral stents were implanted following operative or conservative treatment of 21 venous thromboses. During the same time period, only 6 surgical bypasses were performed (all in hemodialysis patients). All patients were followed-up prospectively. Patency rates were calculated according to the life table-method. RESULTS: Following stent implantation one asymptomatic pulmonary stent embolism (2.3%) and three stent misplacements (6.8%) were documented. Two of the latter were successfully treated with another stent. In the surgical group, one patient died at eight weeks due to late complications of a cephalosporine-associated Lyell syndrome. One to five year patency rates were not significantly different among the three groups. CONCLUSION: For benign central venous stenoses in hemodialysis patients and following iliofemoral venous thrombosis, stent implantation can be recommended as a simple, safe, and durable means to restore patency. Still there is a role for surgery in severely symptomatic central venous occlusions when stent implantation is impossible or has failed.

Arm↗

PubMed1992

[Expert assessment of so-called post-thrombotic syndrome in compulsory accident insurance].

Expertising a late damage after thrombosis requires most careful investigation of the findings, a detailed description of the damage, and a definition of the impairment of functions. This is imperative for arriving at an administrative decision to implement the conclusions arrived at by the expert without committing a legal error by such implementation. Estimation and determination of the damage and of awarding a reasonable compensation requires a detailed consideration of the circumstances of each case and observance of the legal principle of equal rights.

Disability Evaluation↗

PubMed2002

Treatment of subclavian-axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis.

OBJECTIVE: To investigate long-term clinical and morphological outcome of patients with subclavian-axillary vein thrombosis treated with systemic thrombolysis compared to anticoagulation in a retrospective, nonrandomised study. METHODS: We studied 95 consecutive inpatients with subclavian-axillary vein thrombosis treated either with systemic urokinase thrombolysis and subsequent oral anticoagulation (n=33) or with anticoagulation only (n=62). Anticoagulation was performed with heparin and phenprocoumon. Patients were followed for median 40 months (IQR 14 to 94) for symptomatic upper extremity post-thrombotic syndrome and for venous recanalisation by duplex ultrasound. RESULTS: Primary technical success rate of the systemic thrombolysis was 88% (n=29) with seven peri-intervention bleeding complications (21%). No complication was observed in patients with anticoagulation only (p<0.0001). At the time of follow-up, duplex sonography showed a thrombotic subclavian vein in 40 of 83 patients (48%), but only 9 of 95 patients (10%) had a symptomatic upper extremity post-thrombotic syndrome. Patients with systemic thrombolysis exhibited a 60% adjusted reduced risk for a thrombotic subclavian vein at the time of follow-up compared to patients with anticoagulation only (95% CI: 0.2 to 0.9, p=0.03). However, the frequency of symptomatic post-thrombotic syndrome after thrombolysis and anticoagulation was similar (adjusted p=0.6). CONCLUSION: Systemic thrombolysis of subclavian-axillary vein thrombosis has an acceptable primary technical success rate and improves venous recanalisation rates compared to anticoagulation. However, the high rate of complications during thrombolysis and the lack of clinical benefit suggest that conservative treatment may be favoured.

Adult↗

PubMed2005

Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis.

BACKGROUND: The post-thrombotic syndrome is a chronic, poorly understood complication of deep venous thrombosis (DVT). OBJECTIVES: To evaluate predictors of the post-thrombotic syndrome, including intensity of long-term anticoagulation, and to assess the impact of the post-thrombotic syndrome on quality of life. PATIENTS AND METHODS: The setting was 13 Canadian hospitals and one US hospital. One hundred and forty-five patients with an unprovoked episode of proximal DVT who were initially treated with 3 months of conventional-intensity warfarin [target International Normalized Ratio (INR) of 2.5] then participated in a trial comparing two intensities of long-term warfarin therapy (target INR 2.5 vs. INR 1.7). Post-thrombotic syndrome was assessed at the end of the trial using a validated clinical scale. Generic and venous disease-specific quality of life was compared in patients with and without the post-thrombotic syndrome. Multivariable regression analyses were performed to identify predictors of the post-thrombotic syndrome and of its severity. RESULTS: After an average follow-up of 2.2 years, the prevalence of post-thrombotic syndrome was 37% and of severe post-thrombotic syndrome was 4%. Quality of life was worse in patients with the post-thrombotic syndrome compared with patients who did not have it. The presence of factor (F)V Leiden or the prothrombin gene mutation was an independent predictor of both a lower risk (P = 0.006) and reduced severity (P = 0.045) of the post-thrombotic syndrome. Intensity of anticoagulation did not influence the risk of developing the post-thrombotic syndrome. CONCLUSIONS: The post-thrombotic syndrome is a frequent and burdensome complication of proximal DVT, even among patients maintained on long-term oral anticoagulation. While the presence of FV Leiden or prothrombin gene mutation appears to be associated with a reduced risk of post-thrombotic syndrome, this finding requires further evaluation in prospective studies.

Administration, Oral↗

PubMed1988

Recurrences after surgical treatment of patients with post-thrombotic syndrome of the lower extremities.

A Linton flap operation was performed in 148 patients with post-thrombotic syndrome of the lower extremities. One-hundred and five patients were followed up from 6 months to 10 years and 14.5% of cases had recurrent ulcers. The most common causes of recurrence was further deep venous thrombosis or remaining incompetent perforating veins. All patients with a recurrence of their ulcer had a further operation and incompetent perforating veins were ligated and divided with good clinical results.

Female↗

PubMed2002

Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis.

BACKGROUND: Postthrombotic syndrome (PTS) is a frequent chronic complication of deep venous thrombosis, yet its impact on health-related quality of life has not been well characterized. We compared generic and venous disease-specific quality of life in patients with and without PTS, and assessed whether quality of life correlated with severity of PTS. METHODS: Subjects with previous deep venous thrombosis were participants in a study of the effects of exercise after deep venous thrombosis. We ascertained PTS and its severity using a validated clinical scale. Subjects completed generic (the 36-Item Short-Form Health Survey) and disease-specific (Venous Insufficiency Epidemiologic and Economic Study quality-of-life questionnaire [VEINES-QOL] and its validated subscale of 10 items on venous symptoms [VEINES-Sym]) quality-of-life measures. Age- and sex-adjusted mean quality-of-life scores were compared in patients with and without PTS, and by severity of PTS. RESULTS: Of the 41 subjects (mean age, 51.2 years), 19 (46%) had PTS. Subjects with PTS had significantly worse disease-specific quality-of-life scores than those without PTS (mean +/- SD VEINES-QOL score, 44.5 +/- 11.6 vs 54.8 +/- 5.4, respectively [P<.001]; mean +/- SD VEINES-Sym score, 45.6 +/- 11.4 vs 54.1 +/- 6.7, respectively [P =.003]), which worsened significantly with increasing severity of PTS. We found no differences in generic quality-of-life scores between subject groups. CONCLUSIONS: Postthrombotic syndrome has a significant impact on disease-specific quality of life that may not be captured by generic quality-of-life measures. Patient-based quality-of-life measures correlated well with physician-assessed PTS. Further research is indicated to assess the value of including quality of life as a routine measure of outcome in clinical studies of patients with deep venous thrombosis and PTS.

Analysis of Variance↗

PubMed1991

[Thrombolysis in deep venous thrombosis: critical review].

Thrombolytic treatment of deep vein thrombosis remains controversial. It has never been demonstrated that the late postthrombotic syndrome may be diminished by the faster dissolution of the clots induced by streptokinase or urokinase. On the other hand are the hemorrhagic side effects associated with thrombolysis well described (lethality of 0.6%). Thrombolysis should be performed preferably under controlled conditions of a clinical study. It is indicated only in young patients with symptoms for less than 7 days of a first thrombosis. Initial results from second generation fibrinolytic substances such as rt-PA (alteplase) do not change this view drastically.

Age Factors↗

PubMed1986

[Possibilities for vascular reconstruction in the post-thrombotic syndrome].

Reconstructive surgery of deep vein thrombosis is technically established. Results, however, are limited by the evolutive character of thrombotic processes and by the permanently impaired hemodynamics in veins with a postthrombotic condition. Long-term patency and functionally satisfactory reflux are not regularly achieved. Best suited are locally limited interventions in the main confluent venous trunks of the pelvic area, the groin and the popliteal groove. It ought to be kept in mind that every deep vein thrombosis simultaneously impairs the deep and superficial lymphatics. Surgical procedures in deep vein thrombosis should therefore try to prevent any further damage to lymph vessels.

Humans↗

PubMedDate not supplied

New technology applications: thrombolysis of acute deep vein thrombosis.

Treatment of deep vein thrombosis traditionally has focused on preventing the potentially life-threatening complication of pulmonary embolism rather than on removing or reducing the thrombus. Although treatment with anticoagulants may prevent thrombus propagation, the body's intrinsic thrombolytic system is left to attempt clot dissolution. Because this natural process is generally ineffective in its ability to fully recanalize a proximal vein, the risks of recurrent thrombosis as well as the disabling complication of postthrombotic syndrome increase. Moreover, the long-term consequences of postthrombotic syndrome include pain, disability, and, for many, a significant decrease in the quality of life. Recent technology using high-frequency, low-power ultrasound, or mechanical thrombectomy with catheter-directed delivery of a thrombolytic drug directly into the clot is available and showing promise. Nurses are caring for patients who receive endovascular interventions with lytic infusions. The nursing challenge is to provide safe and effective patient care.

Acute Disease↗

PubMed2001

Long term complications of inferior vena cava thrombosis.

AIM: To evaluate the long term outcome after paediatric inferior vena cava (IVC) thrombosis. METHODS: A combined retrospective and prospective study on infants and children with IVC thrombosis treated at Aachen and Maastricht University Hospitals between 1980 and 1999. RESULTS: Forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central venous saphenous lines, and an additional eight with umbilical venous catheters. Six patients died within three months of diagnosis; one patient was lost to follow up. Twelve of the remaining 33 patients had suffered from limited IVC thrombosis; during follow up (for up to nine years) none showed persisting caval obstruction (successful thrombolysis, n = 2; spontaneous recanalisation, n = 10). The remaining 21 patients presented with extensive IVC thrombosis. During follow up (for up to 18 years) complete restitution was found in only four cases (one thrombolysis, two surgery, one spontaneous recanalisation). Persisting iliac and/or caval venous obstruction occurred in 17 patients, including six with thrombolysis. Varicose veins were found in 12, and post-thrombotic syndrome in seven of these cases. According to Kaplan-Meier analysis, 30% of patients with persisting venous disease will develop post-thrombotic syndrome within 10 years of the thrombotic event. CONCLUSIONS: Infants and children with extensive IVC thrombosis are at high risk for persisting venous disease and serious long term complications. Prospective trials are urgently needed to establish effective treatment strategies and to improve long term prognosis. Central venous catheters, contributing to IVC thrombosis in the majority of cases reported here, should be inserted only if essential.

Adolescent↗

PubMedDate not supplied

Importance and advantages of intermittent external pneumatic compression therapy in venous stasis ulceration.

Venous ulcers are seen following postthrombophlebitic syndrome with venous insufficiency and can begin as a result of minor trauma. In this retrospective study the authors examined the value of external intermittent pneumatic compression therapy in chronic venous ulcers. Results in 1,250 patients with postthrombophlebitic syndromes, 235 of these patients with leg ulcers, revealed that this modality of therapy shortens the therapy duration, lowers the total therapy cost, and hastens the return to active life in comparison to the classical therapy with compression stockings and antiaggregant or low-dose oral anticoagulant therapy. In the light of their findings they propose the wider use of this adjuvant therapy.

Adult↗