Development of Postthrombotic Syndrome After Acute Unilateral Iliofemoral Thrombosis: Clinical Dynamics and Hemodynamic Changes

Abstract

Four hundred thirty-six patients with acute unilateral thrombosis in the iliofemoral venous segment were followed up to establish the relationship between changes in the veins and clinical dynamics of postthrombotic syndrome. Physical examination and ascending phlebography were performed at the time of admission and 1 month later. Follow-up visits (physical examination and venous ultrasound study) were performed annually during 10 years. Cumulative rate of class 0 extremities decreased from 89% at the first year to 59% after 10 years. Progressive dynamics was seen in 41% of cases; 17% of these extremities had occlusions, and 83% had proximal reflux; 59% of the extremities demonstrated stable-type clinical dynamics. Occlusions were found in 41% and reflux in 59% of these cases. Recanalization and valvular incompetence at the site of the initial deep vein thrombosis are more likely to lead to progressive type of the disease. Valvular incompetence in the distal veins does not correlate with severity of the disease.

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References

1. Caprini JA , Arcelus JI , Hoffman KN , et al: Venous duplex imaging follow-up of acute symptomatic deep vein thrombosis of the leg. J Vasc Surg 21:472-476, 1995.

2. Caps MT , Manzo RA , Bergelin RO , et al: Venous valvular reflux in veins not involved at the time of deep vein thrombosis. J Vasc Surg 22:524-531, 1995.

3. Franzeck UK , Schalch I , Jager KA , et al: Prospective 12-year follow-up study of clinical and hemodynamic sequelae after deep vein thrombosis in low-risk patients (Zurich study). Circulation 93:74-79, 1996.

4. van Haarst EP , Liasis N . van Ramshorst B , et al: The development of valvular incompetence after deep vein thrombosis: A 7-year follow-up study with duplex scanning. Eur J Vasc Endovasc Surg 12:295-299, 1996.

5. Johnson BF , Manzo RA , Bergelin RO , et al: Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: A 1-to 6-year follow-up. J Vasc Surg 21:307-313, 1995.

6. Plate G , Akesson H . Einarsson E , et al: Long-term results of venous thrombectomy combined with a temporary arteriovenous fistula. Eur J Vasc Surg 4:483-489, 1990.

7. Prandoni P . Lensing A , Cogo A , et al: The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 125:1-7, 1996.

8. Strandness DE , Langiois Y , Cramer M , et al: Longterm sequelae of acute venous thrombosis. JAMA 250:1289-1292, 1983.

9. Kistner RL , Eklof B . Masuda EM : Diagnosis of chronic venous disease of the lower extremities: the CEAP classification. Mayo Clin Proc 71:338-345, 1996.

10.

10. Lawless JF : Statistical Models and Methods for Lifetime Data. New York: Wiley & Sons, 1982.

11.

11. Linder DJ , Edwards JM , Phinney ES , et al: Long-term hemodynamic and clinical sequelae of lower extremity deep vein thrombosis. J Vasc Surg 4:436-442, 1986.

12.

12. Meissner MH , Manzo RA , Bergelin RO , et al: Deep venous insufficiency: Relationship between lysis and subsequent reflux. J Vasc Surg 18:596-608, 1993.