Can we predict and prevent the postthrombotic syndrome?

VASA ◽  
2021 ◽  
Vol 50 (1) ◽  
pp. 11-21
Author(s):  
Tomasz Urbanek ◽  
Nicos Labropoulos
Keyword(s):  
Risk Factor ◽  
Prediction Models ◽  
Late Complications ◽  
Current Approach ◽  
Chronic Venous Disease ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Risk Factor Modification ◽  
Vein Thrombosis ◽  
Prediction And Prevention

Summary: Postthrombotic syndrome (PTS) remains one of the major late complications of deep vein thrombosis (DVT) with a reported prevalence from 10 to 50%. Many factors were found to be related with the development and severity of PTS such as ipsilateral recurrent DVT, advanced age, obesity, ilio-femoral DVT and primary chronic venous disease presence. Some PTS prediction models have been proposed based on risk factor weight. However, it is still difficult to predict which patient with DVT will develop PTS and thus, the clinical application of these models remains limited. Among the identified problems the heterogeneity of the DVT patient population together with the variety of PTS clinical presentations and difficulties concerning PTS severity assessment should be mentioned. Difficulties on the implementation of the specific and objective PTS identification method have also the significant influence on the research focusing on PTS prevention modalities including risk factor modification, compression treatment, anticoagulation and invasive DVT treatment. In this review, the current approach and knowledge on PTS prediction and prevention are presented, including the conservative and invasive DVT treatment possibilities.

scholarly journals Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic – The Venous and Lymphatic Triage and Acuity Scale (VELTAS)

2020 ◽  
Vol 35 (8) ◽  
pp. 550-555
Author(s):  
Kurosh Parsi ◽  
Andre M van Rij ◽  
Mark H Meissner ◽  
Alun H Davies ◽  
Marianne De Maeseneer ◽  
...  
Keyword(s):  
Massive Pulmonary Embolism ◽  
Vascular Anomalies ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
International Consensus ◽  
Vein Thrombosis ◽  
Venous Compression ◽  
Global Pandemic ◽  
Lymphatic Diseases ◽  
Clinical Conditions

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

scholarly journals Post-thrombotic syndrome prevention – do we really know the predictive factors?

Phlebologie ◽  
2019 ◽  
Vol 48 (04) ◽  
pp. 245-250
Author(s):  
Tomasz Urbanek
Keyword(s):  
Predictive Factors ◽  
Current Knowledge ◽  
Late Complication ◽  
Early Mobilization ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stocking ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
The Individual

AbstractDespite an increasing knowledge and experience regarding deep vein thrombosis (DVT) treatment, the rate of post-thrombotic syndrome (PTS) remains still relatively high. According to the current knowledge it is still difficult to predict on the individual basis, who of the DVT patients will develop PTS as late complication of the vein thrombosis. Among the factors influencing the higher prevalence of PTS, the ipsilateral DVT recurrence is of the highest importance. The other factors which should be mentioned are age, obesity, previous chronic venous disease as well as a proximal DVT location or lack of symptoms’ resolution in the early treatment. Looking for the most effective PTS prevention method several clinical trials were performed regarding pharmacological DVT treatment, use of early mobilization and medical compression stocking as well as an implementation of the thrombectomy and thrombolysis. This paper presents a review of the current knowledge regarding the PTS predictive factors and prevention.

Static foot disorders: a major risk factor for chronic venous disease?

2011 ◽  
Vol 27 (1) ◽  
pp. 13-18 ◽  
Author(s):  
J-F Uhl ◽  
M Chahim ◽  
F-A Allaert
Keyword(s):  
Risk Factor ◽  
Daily Practice ◽  
Chronic Venous Disease ◽  
Venous Stasis ◽  
Venous Disease ◽  
Prolonged Standing ◽  
Flat Feet ◽  
Study Population ◽  
Ceap Classification ◽  
Standardized Measurement

Objective To study the relationship between the static foot disorders (SFDs) and chronic venous disease (CVD). Material and methods A retrospective study of 824 feet in unselected 412 patients seen by one phlebologist using a standardized record form. A complete clinical, aetiological, anatomical and pathological elements (CEAP) classification was determined. Alleged venous symptoms were recorded using a 10-point visual analogue scale and scored using a customized questionnaire. A standardized measurement of the Djian-Annonier angle was used to quantify and identify the presence of any static disorder of the foot. Results There were 156 men (37.8%) and 256 women (62.2%) who were included in this study. A majority of patients (59.3%) had a CEAP classification of C3 or greater. Static disorders of the feet were found to be very common in the study population: 137 feet were hollow feet (16.6%) and 120 flat feet (14.5%). Thus, 31% of all of the feet had some form of SFD. A significant correlation was found between the incidence of SFD and body mass index ( P < 0.01), the presence of symptoms ( P<0.001) and prolonged standing during the day (>5 hours, P < 0.05). The severity of the CVD, represented by the CEAP clinical classes, was also found to be very significantly related to the SFD ( P < 0.001). This correlation was found to be independent of age. Conclusion Static disorders of the foot can be considered as an important risk factor that negatively affects CVD. In daily practice, it is often underestimated. This emphasizes the crucial importance of the detection of SFD during the clinical exam of all CVD patients. Correction of static disorders of the feet will improve symptoms due to the SFD, as well as those related to venous stasis. These results can easily be explained by improvement of foot pump efficacy during walking.

scholarly journals CHRONIC VENOUS INSUFFICIENCY

10.23856/3217 ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 131-136
Author(s):  
Antoni Stadnicki ◽  
Martin Rusnák ◽  
Anna Stadnicka
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Compression Stockings ◽  
Venous Leg Ulcer ◽  
Color Flow ◽  
Clinical Disorder

Chronic venous insufficiency (CVI) is a common, but underdiagnozed clinical disorder associated with a variety of signs and symptoms. The presence of leg edema in association  with varicose veins, and venous leg ulcer in later disease stages defines the disease. The pathogenesis of chronic venous disease  is based on venous reflux, obstruction, or a combination thereof.  Prior postthrombotic syndrome   is one of risk factor for CVI which may explain observed  prevalence of thrombophilia in CVI. Color flow duplex ultrasound is the gold standard for nearly all diagnostic issues related to chronic venous disease. Compression stockings are the mainstay for conservative management. Earlier use of venous ablation therapy should be considered in symptomatic patients with superficial tortuous vein

Estimated Annual Costs of Prophylaxis and Treatment of Venous Thromboembolic Events Associated With Major Orthopedic Surgery in France

2006 ◽  
Vol 12 (4) ◽  
pp. 473-484 ◽  
Author(s):  
Patrick Tilleul ◽  
Antoine LaFuma ◽  
Xavier Colin ◽  
Yves Ozier
Keyword(s):  
Orthopedic Surgery ◽  
Sickness Fund ◽  
Major Complication ◽  
Direct Costs ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Number Of Patients ◽  
Venous Thromboembolic Events ◽  
Major Orthopedic Surgery

Venous Thromboembolism (VTE) remains a major complication following orthopedic surgery despite heparin prophylaxis. Clinical consequences associated with this complication are deep vein thrombosis (DVT), pulmonary embolism, and long-term consequences of DVT, especially Postthrombotic syndrome (PTS). The purpose of the present study was to estimate the annual direct costs of VTE following major orthopedic surgery of the lower limb in France. This cost of illness study was performed by using available information from health system databases (1999) and literature and specific surveys (2002). Direct costs were calculated by using estimates of the number of patients with major orthopedic surgery in France during one year. Patients presenting with VTE were identified from the national disease-related group inpatient database. Additional resource consumption was identified by comparison with disease-related groups without the VTE complications. Ambulatory care costs after hospitalization, for recurrences and PTS, were estimated from specific surveys of general practitioners and venous disease specialists. Total annual costs of VTE associated with major orthopedic surgery for the French Sickness Fund were estimated to be approximately 60 million euros over 1 year with 28 million euros for inpatient care and 30 million euros for recurrences and PTS.

scholarly journals Sonography’s Role in the Diagnosis of May–Thurner Syndrome

2017 ◽  
Vol 34 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ashley Barry
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Anatomic Variant ◽  
Left Lower Extremity ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

Anatomy of the Hunter’s canal and its role in the venous outlet syndrome of the lower limb

2014 ◽  
Vol 30 (9) ◽  
pp. 604-611 ◽  
Author(s):  
JF Uhl ◽  
C Gillot
Keyword(s):  
Femoral Condyle ◽  
Femoral Vein ◽  
Arterial Occlusion ◽  
Anatomical Study ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Adductor Canal ◽  
Compressive Neuropathy ◽  
Deep Vein

Background The “Adductor canal syndrome” has been described as an unusual cause of acute arterial occlusion inside the Hunter’s canal in young sportsmen. It may also produce a compressive neuropathy of the saphenous nerve. To our knowledge, femoral vein compression in the canal has never been reported. Objective To describe the anatomy, to propose a physiology of this canal, and to show that the femoral vein is much more exposed than the artery to compression inside this adductor hiatus, particularly at the outlet. Material and methods The whole adductor canal was exposed in 100 limbs for anatomical study following latex injection. A series of 200 phlebographies and 100 CT venograms were also analyzed. Results Anatomically, we found a musculotendinous band called the “vastoadductor membrane,” which jointed the adductor tendon to the vastus medialis in all the cases. The femoral vein, located more posteriorly, was frequently narrowed at this level. This band can create a notch with a venous stenosis at the outlet of the Hunter’s canal, usually located 12–14 cm above the femoral condyle. Two femoral valves constitute the landmark of the canal on the venograms: the lower is just below the outlet, 9 cm above the condyle. The second valve is 3 cm higher inside the canal. Functionally, the cadaveric simulations showed that the contraction of the adductor longus closes the hiatus, while the adductor magnus opens it. Our hypothesis is that Hunter’s canal prevents femoropopliteal axis reflux by synchronizing with calf pump ejection during ambulation. Conclusion Compression of the femoral vein inside the adductor’s canal is an underestimated and misdiagnosed cause of postural stenosis of the femoral vein. Ultrasound investigation of both limbs in patients with chronic venous disease (CVD) should be systematically carried out at this precise level in order to prevent future occlusion and onset of acute deep vein thrombosis.

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