Endovascular management of symptomatic Deep Vein Thrombosis (DVT) with Combined Approach

The primary goal of this treatment is the restoration of venous outflow and can be achieved by combined endovascular techniques. We report a case of 38 years-old female, with leg pain and edema, skin changes, venous claudication and dyspnea for polmunary embolism.

Incidence and severity of postthrombotic syndrome after iliofemoral thrombosis – results of the Iliaca-PTS – Registry

Summary: Background: Deep venous thrombosis (DVT) and in particular, iliofemoral thrombosis (IFT) can lead to recurrent thrombosis and postthrombotic syndrome (PTS). Data on the prevalence, predictors and outcome of IFT are scarce. Patients and methods: We retrospectively searched our database of outpatients who had presented with DVT and IFT including the iliac veins from 2014 until 2017. In addition, we performed a prospective registry in a subgroup of patients with IFT. These patients received duplex ultrasound, magnetic resonance venography and measurement of symptom-free walking distance using a standardized treadmill ergometry. The severity of PTS was analyzed using the Villalta-Scale (VS) and quality of life was assessed using the VEINES-QOL/Sym Questionnaire. Results: 847 patients were retrospectively identified with DVT and 19.7% (167/847) of these presented with IFT. 50.9% (85/167) of the IFT-patients agreed to participate in the prospective registry. The majority of these patients (76.5%: 65/85) presented with left-sided IFT. In 53.8% (35/65) May-Thurner syndrome was suspected. 27.1% (23/85) underwent invasive therapy. Moderate or severe PTS (VS ≥ 10) occurred in 10.6% (9/85). The severity of PTS is correlated with a reduced quality of life (ρ (CI 95%) = −0.63 (−0.76; −0.46); p < 0.01). None of the patients presented with a venous ulcer at any time. A high body mass index was a significant predictor (OR (CI 95%) = 1.18 (1.05; 1.33), p = 0.007) for the development of clinically relevant PTS (VS ≥ 10) and venous claudication. Conclusions: Every fifth patient with DVT presented with an IFT. The majority developed left sided IFT. Every 10th patient developed moderate or severe PTS (VS ≥ 10). A high body mass index was predictive for the development of PTS and venous claudication.

Antithrombotic Therapy after Venous Stent Placement

Chronic deep venous disease (CVD) affects millions of Americans and can result in significant morbidity, such as debilitating lower extremity oedema, venous claudication, and in severe cases, venous ulcers. CVD can be caused by thrombotic and non-thrombotic disease processes, such as deep venous thrombosis and iliac compression syndrome. Recently, endovascular intervention with percutaneous transluminal angioplasty and venous stent placement has become the mainstay therapy for these patients, with several studies demonstrating its safety and efficacy. However, anticoagulation management following venous stent placement is largely unstudied, and there are no large randomised controlled trials or official guidelines establishing an optimal regimen. Most published studies are plagued with data heterogeneity and incomplete reporting. This is further complicated by rapidly evolving improvements in technique and dedicated devices in endovenous intervention. In this article, the authors discuss the current literature to date and offer an approach to anticoagulation and antiplatelet management following venous stent placement in CVD.

Pain in chronic venous insufficiency (including venous claudication)

SummaryPain in chronic venous insufficiency can indicate an acute complication in the form of superficial thrombosis or deep venous thrombosis of the leg or chronic symptoms associated with venous leg ulcers or venous claudication. Up to 80 % of patients with venous leg ulcers report pain. This pain is a principal cause of the reduced quality of life of such patients. A distinction must be made between the acute pain arising from dressing changes, wound cleaning and debridement and pain occurring between these procedures. The pain should be evaluated systematically using visual analogue scales, as any increase in pain can be a warning sign of wound infections, irritation or allergic reactions to the wound dressings or exacerbation of a vascular disorder (e.g. additional peripheral arterial occlusive disease). Venous claudication occurs in the form of leg pain with a sensation of constriction on physical exertion, which subsides with rest. In the majority of cases, it is a symptom of reduced iliofemoral venous outflow. It occurs in up to 43.6 % of patients after iliofemoral thromboses.