Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

Iliofemoral deep vein thrombosis can lead to post-thrombotic syndrome, a costly and morbid condition. Endovascular treatment is increasingly used for symptomatic relief, but clinical success depends on accurate patient evaluation and selection. This case describes the diagnostic and technical challenges in the care of a complex patient with post-thrombotic syndrome following stroke and extensive deep vein thrombosis. It highlights the multi-disciplinary work-up for a patient with post-thrombotic syndrome presenting with confounding symptoms, as well as the importance of considering alternative access for successful lower extremity venous recanalization.

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Diosmin 600 in adjunction to rivaroxaban reduces the risk of post-thrombotic syndrome after femoropopliteal deep vein thrombosis: results of the RIDILOTT DVT study

International Angiology ◽

10.23736/s0392-9590.20.04356-4 ◽

2020 ◽

Vol 39 (5) ◽

Author(s):

Ilya Schastlivtsev ◽

Kirill Lobastov ◽

Victor Barinov ◽

Irina Kanzafarova

Keyword(s):

Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

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Post-thrombotic syndrome after deep vein thrombosis: The role of follow-up Doppler ultrasound

Medicina Clínica (English Edition) ◽

10.1016/j.medcle.2020.01.024 ◽

2021 ◽

Vol 156 (5) ◽

pp. 251-252

Author(s):

Francisco Galeano-Valle ◽

Jorge del-Toro-Cervera ◽

Pablo Demelo-Rodríguez

Keyword(s):

Deep Vein Thrombosis ◽

Doppler Ultrasound ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

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Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

Thrombosis Journal ◽

10.1186/s12959-020-00253-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Marit Engeseth ◽

Tone Enden ◽

Per Morten Sandset ◽

Hilde Skuterud Wik

Keyword(s):

Deep Vein Thrombosis ◽

Proximal Deep Vein Thrombosis ◽

Cross Sectional ◽

Clinical Criteria ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Younger Age ◽

Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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Diagnosis of deep-vein thrombosis: Adherence to guidelines and outcomes in real-world health care

Thrombosis and Haemostasis ◽

10.1160/th09-06-0385 ◽

2009 ◽

Vol 102 (12) ◽

pp. 1234-1240 ◽

Cited By ~ 18

Author(s):

Horst Gerlach ◽

Viola Hach-Wunderle ◽

Eberhard Rabe ◽

Hanno Riess ◽

Heike Carnarius ◽

...

Keyword(s):

Health Care ◽

Deep Vein Thrombosis ◽

Ambulatory Care ◽

Real World ◽

Diagnostic Methods ◽

World Health ◽

Vein Thrombosis ◽

Deep Vein ◽

Work Up ◽

Current Guidelines

SummaryCurrent guidelines recommend optimised algorithms for diagnosis of suspected deep-vein thrombosis (DVT). There is little data to determine to what extent real-world health care adheres to guidelines, and which outcome in terms of diagnostic efficiency and safety is achieved. This registry involved patients with clinically suspected DVT of the leg recruited in German ambulatory care between October and December 2005. Registry items were: diagnostic methods applied; diagnostic categories at day 1; and venous thromboembolic events up to 90 days in patients without firmly established DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%).The rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]: 0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50% (95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.The TULIPA registry was funded by GlaxoSmithKline GmbH und Co KG, Munich.

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