A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb

Introduction Acute thrombus removal therapies may reduce post-thrombotic syndrome in certain deep venous thrombosis patients. The LET classification is designed to identify patients at high risk for developing post-thrombotic syndrome in the acute phase using thrombus location and extent. This study evaluates the use of the LET classification to predict post-thrombotic syndrome in a cohort of patients after deep venous thrombosis. Methods A cohort of 660 deep venous thrombosis patients was invited to participate and fill out a questionnaire with Quality of life questionnaires, basic information, a modified self-assessment version of the Villalta scale for post-thrombotic syndrome and potential confounders. Original data on thrombus extension was available, and the LET classes were determined. Obtained information was analysed using ANOVA and in a multiple logistic regression model to correct for confounders. All different LET classes were compared to post-thrombotic syndrome occurrence, post-thrombotic syndrome prediction and disease specific quality of life scores (VEINES-Sym/Qol). Results Three hundred and fifteen patients responded, and in 309 a post-thrombotic syndrome score was distilled. LET I,II,III ( n = 63) had an odds ratio of 3.4(1.2–9.2) for predicting severe post-thrombotic syndrome, and LET II ( n = 17) had an odds ratio of 5.1(1.3–20.8) compared to LET class I ( n = 97). Both the VEINES-Sym and VEINES-Qol score were significantly lower for LET I,II,III compared to LET I, and LET II compared to LET I. Conclusion The LET classification can be used to classify patients according to acute thrombus location and extent. Extensive and centrally located (LET I,II,III) deep venous thrombosis showed the highest probability in developing severe post-thrombotic syndrome and lower disease specific quality of life.

Download Full-text

Recanalization of chronic femoropopliteal deep venous thrombosis in patients suffering from post thrombotic syndrome: a safe and effective approach to improving quality of life

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.041 ◽

2014 ◽

Vol 25 (3) ◽

pp. S18 ◽

Cited By ~ 1

Author(s):

C.J. Grilli ◽

C. Wrigley ◽

M. McGarry ◽

M.M. Ali ◽

D.J. Agriantonis ◽

...

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Post Thrombotic Syndrome

Download Full-text

The Burden of Post-Thrombotic Syndrome in a Long-Term Retrospective Cohort in Northern Portugal

Acta Médica Portuguesa ◽

10.20344/amp.13567 ◽

2020 ◽

Vol 33 (13) ◽

Author(s):

Inês Mendes-Andrade ◽

Marina Dias-Neto ◽

João Rocha-Neves ◽

Armando Mansilha

Keyword(s):

Quality Of Life ◽

Relative Risk ◽

Confidence Interval ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Retrospective Cohort ◽

Post Thrombotic Syndrome ◽

Northern Portugal

Introduction: Post-thrombotic syndrome is a frequent and disabling complication of deep venous thrombosis. Its incidence is not described in the Portuguese population. The objective of this study is to report the incidence and severity of post-thrombotic syndrome after the initial episode of deep venous thrombosis.Material and Methods: This is an observational, unicentric, retrospective cohort of patients who had a first episode of deep venous thrombosis in the lower limb, documented with duplex ultrasound (n = 101). The modified Villalta score was applied by phone interview for the diagnosis and staging of post-thrombotic syndrome. The quality of life of patients was measured with the modified CIVIQ 14 classification.Results: Median follow-up time was six years (interquartile range 1). Severe post-thrombotic syndrome was present in 27% of patients and moderate in 33%. Performing physical activity at the time of the interview was associated with lower incidence of post-thrombotic syndrome (relative risk 0.489; 95% confidence interval = 0.320 - 0.748). Body weight gain after deep venous thrombosis (relative risk 2.188; 95% confidence interval 1.137 - 4.210) and lower education levels (relative risk 2.005; 95% confidence interval 1.297 - 3.098) were associated positively with post-thrombotic syndrome. Quality of life was 90 ± 17 vs 64 ± 18 vs 43 ± 15 in patients without postthrombotic syndrome, with moderate post-thrombotic syndrome and with severe post-thrombotic syndrome, respectively (p < 0.001).Discussion: The long-term incidence of post-thrombotic syndrome in a cohort of patients from Northern Portugal is higher than in other studies and correlates with worse adjusted CIVIQ-14 scores.Conclusion: Large studies of prospective nature could provide more definitive evidence.

Download Full-text

Successful Treatment of Post Thrombotic Syndrome with Sequential Lumbar Sympathetic Block

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e65 ◽

2015 ◽

Vol 18;1 (1;1) ◽

pp. E65-E69

Author(s):

Anita Gupta

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Blood Clot ◽

Key Words Pain ◽

Post Thrombotic Syndrome ◽

History Of ◽

Sympathetic Blocks

An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. Thus far there has been a paucity in the medical literature in how to treat post thrombotic pain. Post thrombotic syndrome (PTS) can cause a significant decrease in quality of life in individuals who have had a history of a DVT. Symptoms will typically include edema, pain, heaviness of the affected limb, skin changes, ulcers, varicosities, and gait abnormality. An underappreciated approach to treating PTS is the utilization of lumbar sympathetic blocks (LSB). A 68-year-old male who had a history of recurrent right lower extremity deep venous thrombosis presented with complaints of excruciating pain, discomfort, and erythema in his right lower extremity, which was negatively affecting his quality of life and prohibiting him from mobility. The patient attributed his lack of mobility secondary to the thrombotic pain. Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient’s pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient’s symptoms and improved the patient’s ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS. Key words: Pain, edema, lumbar, sympathetic, thrombosis, venous

Download Full-text

Successful Treatment of Post Thrombotic Syndrome with Sequential Lumbar Sympathetic Block

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e66 ◽

2015 ◽

Vol 18;1 (1;1) ◽

pp. E65-E69

Author(s):

Anita Gupta

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Blood Clot ◽

Nerve Blocks ◽

Post Thrombotic Syndrome ◽

History Of ◽

Sympathetic Blocks

An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. Thus far there has been a paucity in the medical literature in how to treat post thrombotic pain. Post thrombotic syndrome (PTS) can cause a significant decrease in quality of life in individuals who have had a history of a DVT. Symptoms will typically include edema, pain, heaviness of the affected limb, skin changes, ulcers, varicosities, and gait abnormality. An underappreciated approach to treating PTS is the utilization of lumbar sympathetic blocks (LSB). A 68-year-old male who had a history of recurrent right lower extremity deep venous thrombosis presented with complaints of excruciating pain, discomfort, and erythema in his right lower extremity, which was negatively affecting his quality of life and prohibiting him from mobility. The patient attributed his lack of mobility secondary to the thrombotic pain. Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient’s pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient’s symptoms and improved the patient’s ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS.

Download Full-text

Post-thrombotic syndrome, functional disability and quality of life after upper extremity deep venous thrombosis in adults

Thrombosis and Haemostasis ◽

10.1160/th04-10-0640 ◽

2005 ◽

Vol 93 (03) ◽

pp. 499-502 ◽

Cited By ~ 72

Author(s):

Elyssa Elman ◽

Chantal Bornais ◽

Mark Blostein ◽

Phillip Wells ◽

Susan Kahn

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Upper Extremity ◽

Functional Disability ◽

Physical Component Score ◽

Dash Score ◽

Post Thrombotic Syndrome ◽

Sf 36

SummaryThe post-thrombotic syndrome (PTS) after upper extremity deep venous thrombosis (UEDVT) has not been well characterized. The objective of our study was to describe and quantify residual symptoms, functional disability and quality of life associated with PTS after UEDVT in adults. Twenty-four patients with objectively diagnosed UEDVT (bilateral in 1 patient) at least 6 months previously were recruited from two Canadian thrombosis clinics. Data were collected on demographic characteristics, DVT risk factors and affected venous segments. The Villalta PTS scale, modified for the upper extremity, was used to diagnose PTS. Patients completed questionnaires on degree of functional disability (DASH questionnaire), and generic (SF-36) and disease-specific (VEINES-QOL) quality of life. Results were compared in patients with and without PTS. Patients were assessed a median of 13 months after the diagnosis of UEDVT. Daily ipsilateral arm or hand swelling was reported by 52% of patients and daily ipsilateral arm pain by 20% of study patients, compared with 0% and 0%, respectively, in the contralateral arm. PTS was present in 11/25 (44%) limbs (11/24 patients). One patient had severe PTS. Patients with PTS, compared with those without PTS, had significantly more functional disability (mean DASH score 20.9 vs. 3.7, p= 0.009) and poorer quality of life (mean VEINES-QOL score 45.6 vs. 53.6; p=0.001; mean SF-36 Physical Component Score (PCS) 40.8 vs.50.2; p= 0.12). PTS scores were higher and quality of life was poorer when PTS involved the dominant arm. In conclusion, PTS occurs frequently after UEDVT and is associated with significant functional disability and reduced quality of life. Patients with dominant arm PTS appear to fare worse than those with non-dominant arm PTS. Larger, prospective studies to identify prognostic factors that lead to PTS after UEDVT are warranted.

Download Full-text

Post-Thrombotic Syndrome, Functional Disability and Quality of Life after Upper Extremity Deep Venous Thrombosis in Adults.

Blood ◽

10.1182/blood.v104.11.3514.3514 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3514-3514

Author(s):

Susan R. Kahn ◽

Elyssa Elman ◽

Chantal Bornais ◽

Mark Blostein ◽

Philip S. Wells

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Upper Extremity ◽

Functional Disability ◽

Physical Component Score ◽

Arm Pain ◽

Post Thrombotic Syndrome ◽

Sf 36

Abstract Background: The post-thrombotic syndrome (PTS) after upper extremity deep venous thrombosis (UEDVT) has not been well characterized. Objectives: To describe and quantify residual symptoms, functional disability and quality of life associated with post-thrombotic syndrome after UEDVT in adults. Methods: Twenty-four patients with objectively diagnosed UEDVT (bilateral in 1 patient) at least 6 months previously were recruited from two thrombosis clinics in Canada (Montreal and Ottawa). Data were collected by interview and chart review on demographic characteristics, DVT risk factors and affected venous segments. The Villalta PTS scale, modified for the upper extremity, was used to diagnose PTS and to quantify its severity (score >4=PTS; score >14=severe PTS). Patients completed questionnaires on type and severity of symptoms, degree of functional disability (DASH questionnaire) (higher scores=greater disability), and generic (SF-36) and disease-specific (VEINES-QOL) quality of life (lower scores=worse QOL). Results of these measures were compared in patients with and without PTS. Results: The mean age of study patients was 51 years and 54% were female. The average time since diagnosis of UEDVT was 13 months and median duration of warfarin treatment was 5 months. At the time of assessment, daily ipsilateral arm or hand swelling was reported by 52% of patients and daily ipsilateral arm pain by 20% of study patients, compared with 0% and 0%, respectively, in the contralateral arm. PTS was present in 11/25 (44%) limbs (11/24 patients). One patient had severe PTS. Patients with PTS had significantly higher mean DASH scores than those without PTS (23.3 vs. 3.9, p= 0.009) and poorer quality of life than those without PTS (mean VEINES-QOL score 45.6 vs. 53.6; p=0.001; mean SF-36 Physical Component Score (PCS) 40.8 vs. 50.2; p= 0.12). Although the overall frequency of PTS did not differ according to whether the initial UEDVT was in the dominant arm, PTS scores were higher and quality of life was poorer when PTS involved the dominant arm. Conclusion: PTS occurs frequently after UEDVT at a rate that is similar to that of lower limb DVT. PTS of the upper extremity is associated with significant functional disability and has a measurable, adverse impact on quality of life. Patients with dominant arm PTS appear to fare worse than those with non-dominant arm PTS. Larger, prospective studies to identify prognostic factors that lead to PTS after UEDVT are warranted.

Download Full-text