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PubMed2005

Radionuclide assessment of the treatment by compression of patients with chronic venous insufficiency.

A study was made of the efficacy of the compression medical tricot in the treatment of chronic venous insufficiency (CVI). To evaluate the treatment by compression, the authors, in addition to the clinical examination, used radionuclide techniques such as examination of the regional blood volumes and phleboscintigraphy. The results of the given work have shown that the compression products under test are effective agents for the treatment of CVI by compression which improves venous return and the patients' quality of life. The data obtained point out that in addition to the lowering of blood filling, the medical tricot influences the interstitial element of the edematous syndrome, leading to the elimination of the latter one. The use of elastic bandages creates the known difficulties (the necessity of the patient training in bandaging, complexity of creating an adequate bandage, quick depreciation). In view of this fact the use of the compression tricot which possesses the fixed grade of compression for a concrete form and stage of CVI is preferable in the therapy of chronic venous diseases.

Adult↗

PubMed1994

[Saphenous vein stripping in post-thrombotic syndrome].

Some patients with a history of deep venous thrombosis have intact valves in the deep venous system. For these patients a diagnostical examination is important to prove the falling high venous pressure. According to several functional tests the decline of venous pressure indicates the surgical treatment of the insufficient superficial veins. Step by step we show the diagnostical and therapeutical procedure in a patient with a history of deep venous thrombosis. Then we discuss an alternative decision and ask the question, if the absence of increasing venous pressure according to the phlebodynamometry indicates the surgical sanitation of the insufficient superficial veins.

Follow-Up Studies↗

PubMed1996

Pathogenesis and pathophysiology of the post-thrombotic syndrome: clinical implications.

Anticoagulant therapy can successfully prevent pulmonary embolism and rethrombosis in most cases, but cannot affect either early morbidity or the late post-thrombotic sequelae. In carefully selected cases, early clot removal by thrombolysis or thrombectomy may be justified by improved outcome because of the significant role early and late outflow obstruction plays in determining the ultimate severity of post-thrombotic sequelae. Nevertheless, it is recognized that anticoagulant therapy will continue to be used in the majority of patients because of serious intercurrent disease, sedentary lifestyle, limited extent of thrombosis, lack of tissue loss and, unfortunately, delay in referral for treatment.

Anticoagulants↗

PubMed1994

[Artificial edema of the extremity].

Our report describes a 46-year-old woman with self-inflicted oedema of the left leg and the left arm. She induced leg oedema by an elastic bandage tourniquet and arm oedema by holding her arm dependent and immobile. A preexisting disorder of the affected leg (postthrombotic syndrome) and of the affected arm (hypoesthesia subsequent to surgical injury of the plexus brachialis) delayed the diagnostic proceedings. Our case report shows that: Confirmed presence of organic disease does not exclude limb oedema of self-inflicted origin. Oedema resulting from a tourniquet and "hysterical oedema" can be developed by one and the same patient. Effective care of such patients is only possible if dermatologist and psychiatrist work together all the time (liaison psychiatry).

Diagnosis, Differential↗

PubMed2001

[Reconstructive venous valve surgery].

The indication for venous valves surgery has to consider morphological and functional aspects. 36 reconstructive valve repair procedures and the long-term results are reported. The procedures need surgical skill and a meticulous operation technique. Primary idiopathic valvular incompetence can be treated with a direct valvuloplasty (Kistner). The leaflets of the floppy valve become shortened either by an open repair or with a closed procedure. Patients suffering from post-thrombotic syndrome showing intact valves in the deep femoral vein may undergo a transposition operation. In this case the superficial femoral vein is implanted end to side into the deep femoral vein distally to a proximal valve. The best results in post-thrombotic syndrome are achieved with a free transplantation of a venous valve from the axillary vein into the superficial femoral or into the popliteal vein (Taheri). Postoperatively the patients are anticoagulated and have to wear a compressing stocking (Grade III). The results of direct valvuloplasty (Kistner) and valve transplant (Taheri) are satisfactory, whereas the results of transposition seem to be disappointing. Good results are depending mostly on a correct indication for the operation and on avoiding the contraindications.

Adult↗

PubMedDate not supplied

[Clinical, diagnostic and therapeutic problems in the postthrombotic syndrome. Our experience].

An analysis is presented, of the experience acquired in the II-nd Surgical Clinic of Cluj-Napoca in connection with 150 cases of postthrombotic syndrome followed and treated over the last 5 years (1983-1987). Considerations are made concerning terminology, and evaluation of diagnostic and therapeutic means applied. The post-thrombotic syndrome develops in a variable interval after the thrombophlebitis (months and even years). A series of factors prevent of enhance the development of the syndrome (98% diagnostic errors and therapeutic failures). Phlebography is mandatory in cases where surgery is considered. Noninvasive explorations (Doppler, plethysmography) limit the use of phlebography. The most efficient treatment is prophylaxis (consisting in the prophylaxis and the correct treatment of thromboembolic disease). The usual treatment is mainly medical and conservative (59.4%). Surgery is carried out in cases where the superficial, the communicating and the deep venous systems are involved.

Adult↗

PubMed1990

[Surgical therapy of acute and embolizing deep venous thrombosis--indication, technical principle, results].

Between 1977 and 1986, 185 patients with deep venous thrombosis (117 with acute occlusive and 68 with embolizing deep venous thrombosis) underwent venous thrombectomy with arterio-venous fistula. The early patency rate was 96%, and the perioperative mortality rate, 3.8%. Of the 157 patients in whom extremities were involved, 147 were examined 12-118 months postoperatively (mean 43 +/- 23 months) clinically, by Doppler ultrasound and by light reflexion rheography (LRR). In 49% of the patients, various kinds of swelling or oedema of the involved extremities were present. There were no hemodynamical disturbances in 53% (LRR-examination); competent venous valves were found in 44%. According to the severity of symptoms and hemodynamical findings, postthrombotic syndrome was absent in 47%, mild in 20%, moderate in 28%, and severe in 5% (7 patients, 4 with venous ulcers). Six of the 7 patients with severe postthrombotic syndrome belonged to the group operated for embolizing thrombosis, where no selection of cases was performed. The best long-term results were achieved in patients operated for acute occlusive thrombosis of the iliac and iliofemoral veins. Venous thrombectomy with av fistula can achieve sufficient early and long-term results in the treatment of deep venous thrombosis, provided strict selection of patients and a meticulous technique are practised.

Adolescent↗

PubMed2004

Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial.

BACKGROUND: Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used. OBJECTIVE: To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT. DESIGN: Randomized, controlled clinical trial. SETTING: University hospital. PATIENTS: 180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment. INTERVENTIONS: Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years. MEASUREMENTS: The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale. RESULTS: Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% CI, 29.9% to 50.1%) versus 21.1% (CI, 12.7% to 29.5%) after 6 months, 46.7% (CI, 36.4% to 57.0%) versus 22.2% (CI, 13.8% to 30.7%) after 1 year, and 49.1% (CI, 38.7% to 59.4%) versus 24.5% (CI, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (CI, 0.29 to 0.84; P = 0.011). LIMITATIONS: This study lacked a double-blind design. CONCLUSIONS: Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.

Adult↗

PubMed1989

[Clinical aspects and treatment of post-thrombotic syndrome].

The treatment of the postthrombotic syndrome is determined by the individual clinical symptoms and signs. As long as there is no alteration of the skin nor edema or varicosis but only uncomplicated lesions in the deep veins basic therapy is sufficient. In this case the physiological venous reactions should be supported by the avoidance of standing or sitting for long times and of high environmental temperatures. Local cooling and other measures as defined by Robert May are advisable. In the case of symptoms compression therapy is necessary which in most cases will be lifelong.

Combined Modality Therapy↗

PubMed1988

[Clinical aspects of venous diseases and diagnostic demands on radiology].

The author deals with the clinical signs and treatment of the valvular incompetence of the venae saphenae in varicosis of the lower extremities, varicosis or insufficiency of the venae perforantes (an insufficiency of the deep venous system, manifested by an insufficiency of the valvular system of the vena femoralis and venae saphenae but not representing a post-thrombotic syndrome), phlebothrombosis and postthrombosis. Routine phlebography for diagnosing a number of venous diseases has become redundant especially by the use of noninvasive methods such as Doppler ultrasound and light reflection rheography. However, if there is a suspicion of a deep thrombosis in the leg, phlebography is imperative. Dermatological phlebography specialists would like the radiologists to supply them with phlebographic criteria for the disease pattern of the insufficiency of the venae perforantes, vena fermalis and venae saphenae as mentioned above. Whether Duplex scanning can replace phlebography in the long run remains to be seen.

Humans↗

PubMed1994

[Compression therapy in post-thrombotic syndrome].

The most important aim of compression therapy in postthrombotic legs is prevention of dermatosclerosis and ulcus cruris. For the acute stage of leg swelling and for venous ulceration we prefer compression bandages ("therapy phase"). The effect of compression therapy with bandages depend on the material of the used bandages (short or long-stretch bandages), the stretching the bandages are applied with, the number of layers, the local pads and on well done application of the bandages. After removal of oedema compression therapy should be continued with medical compression stockings ("maintenance phase"). Compression stockings should be fit on carefully and be checked from time to time to guarantee their application by the patient.

Bandages↗

PubMed1994

[The value of measuring reflux by color duplex in post-thrombotic syndrome].

Until now, the diagnosis of the postthrombotic syndrome is based upon venography. This study compares the diagnostic value of the CW-Doppler with the sonographic signs in the deep venous system observed in B-mode sonography and with the quantitative measurement of venous reflux by color Doppler sonography. 84 venous sections of 21 patients with phlebographically diagnosed PTS and substantial clinical signs were examined. CW- Doppler and B-mode sonography did not show significant differences compared to phlebographic findings. Color doppler sonography, however, showed signs which significantly went beyond those seen in venography.

Hemodynamics↗

PubMed1997

[Involvement of the lymphatic system in primary non-lymphogenic edema of the leg. Studies with 2-compartment lymphoscintigraphy].

Two-compartment lymphoscintigraphy was developed to examine the sub- and epifascial lymphatics of the leg. Digital images were evaluated visually and semiquantitatively by calculating the uptake of activity within the lymph nodes. The data from patient groups with four different types of leg edema were compared with those of the control group to prove the involvement of the lymphatics in the non-lymphatic edema. The cyclic idiopathic edema demonstrated an accelerated transport of the lymph consistent with a high volume insufficiency. In phlebedema the high volume insufficiency was epifascially so distinct, that it could be detected scintigraphically. In post thrombotic syndrome the transport of the lymph was reduced dramatically corresponding to a safety valve insufficiency. Epifascially however, an accelerated lymph flow was observed due to compensatory mechanisms. The lipedema did not show any scintigraphic abnormalities. These results show that two-compartment lymphoscintigraphy can detect alterations in lymphatic function secondary to non-lymphogenic leg edema. The lymphatic function is changed according to the underlying pathophysiology which may be facilitate the differential diagnosis of such a leg edema.

Adult↗

PubMed2000

[Increased prevalence of APC-resistance (factor V Leiden mutation) in patients with postthrombotic syndrome].

BACKGROUND AND OBJECTIVE: APC resistance (Factor V Leiden mutation) is the most often diagnosed hereditary thrombolytic defect. Data about the prevalence in patients with leg ulcers, especially postthrombosis, are limited of this defect. PATIENTS/METHODS: APC resistance was determined in 100 patients with venous leg ulcers. 53 patients had ulcers caused by postthrombotic syndrome and 47 patients ulcers associated with primary varicosities. A control group of 96 healthy volunteers was also studied. RESULTS: 19 of 53 patients (36%) with postthrombotic ulcers and 3 of 47 patients (6%) with varicosity-related ulcers had APC resistance. In the control group APC resistance was detected in 5 of 96 volunteers (5%). CONCLUSIONS: APC resistance should be considered as a risk factor for the development of venous leg ulcers.

Activated Protein C Resistance↗

PubMed1996

[Shave therapy for surgical treatment of persistent venous ulcer with large superficial dermatoliposclerosis].

Ulcers in chronic venous insufficiency, especially in postthrombotic syndrome, are often resistant to compression therapy. They can be treated effectively by the dermatologic surgeon with a fairly simple operative procedure. The removal of the ulcer together with the extensive lipodermatosclerosis by Humby knife (shave-therapy) and immediate grafting with a meshed split skin graft-possibly in combination with ligation of insufficient perforator veins-yields very good success rates. The results in 13 patients (18 legs) with an average follow up period of 11 months (up to 20 months) are reported.

Aged↗

PubMedDate not supplied

[Photoplethysmography in the diagnosis of post-thrombotic syndrome].

Photoplethysmography is an noninvasive method for the quick diagnostics of blood flow disturbances in the venous system of the lower limbs. The convenience of this method has been evaluated on two groups of subjects. The first group consisted of 30 subjects with no clinical history of vascular disease of the lower limbs and the second group consisted of 14 patients who were admitted to the hospital with phlebothrombosis. Twenty-nine subjects from the first group were found to have a normal plethysmographic curve, whereas in the second group eleven patients had the filling time below 25 seconds and three subjects had the filling time over 25 seconds. The convenience of photoplethysmography as a screening method in the diagnostics of vascular diseases of the lower limbs is discussed.

Adult↗

PubMedDate not supplied

[The transfascial excision of indurated subcutaneous fat in the postthrombophlebitic syndrome].

The authors came to the conclusion that in surgical treatment of the postthrombophlebitic syndrome it is necessary in some cases to excise the indurated fatty tissue on the leg during the operation on the veins. It should be carried out transfascially through a Felder incision in combination with ligatin of the perforating veins on the leg. The suggested method produces better results than those of excision of the changed fatty tissue through a cut made in the skin overlying it. Excision of the indurated fatty tissue removes the focus of chronic infection and autoallergy.

Adipose Tissue↗

PubMed2002

Post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a potentially disabling complication occurring in up to 67% of adult patients following deep venous thrombosis (DVT). PTS has recently been recognised in children. We present three cases of symptomatic PTS in children, which occurred following the use of central venous lines (CVLs). In two cases, no symptoms of acute thrombosis were noted. The cases highlight the clinical presentation of this syndrome. A review of the literature revealed two reports describing PTS occurring in children following DVT with an estimated incidence of 7-12%. It is concluded that PTS is an important complication of DVT in children. The clinical findings of pain, swelling, and brawny induration are similar to adult patients. The effect on growing limbs is not known. Paediatricians should be aware of the potential of PTS in all children who are at risk of DVT, including patients with malignancy, congenital heart disease, and children who have had previous CVLs, even in the absence of documented acute DVT.

Adolescent↗