This study indicates a disturbed gait and decreased calf muscle endurance in patients with severe chronic venous insufficiency. The results of this study point to a possible role for gait and strength training in the rehabilitation process of patients with severe chronic venous insufficiency.
Most patients with severe PTS had a combination of deep and superficial reflux. Reflux in the deep proximal veins contributes significantly to the PTS.
More reflux develops in previously thrombosed vein segments. As early as after the third month, patients with superficial reflux have an increased risk of development of the first clinical signs of PTS. Within 2 years, the SVPT shows no relationship with clinical signs of PTS.
1. In contrast to the extensive documentation on diagnosis and treatment of deep venous thrombosis (DVT), information about long-term complications, like the post-thrombotic syndrome (PTS), is scarce. Most studies report on clinical examination only, whereas adequate haemodynamic investigation is lacking. Therefore 81 patients with venographically confirmed lower extremity DVT were clinically and haemodynamically reexamined 7-13 years after DVT (mean 10 years) to assess PTS. Interest was focused on the relation between clinical and haemodynamic PTS and the relation between location of the initial DVT and incidence of PTS. 2. Clinical signs and symptoms of PTS were classified according to the latest consensus of the international consensus committee on chronic venous disease. Non-invasive venous vascular laboratory tests were performed to assess the venous outflow resistance and calf muscle pump function (CMP). CMP was determined by the supine venous pump function test (SVPT). 3. Clinically only 20 of 81 patients (25%) were asymptomatic, 34 (42%) had mild PTS (class 1-3), 25 (31%) moderate PTS (class 4) and 2 (2%) severe PTS (class 5-6); 57% had an abnormal CMP. Both the severity of clinical symptoms and the haemodynamic abnormalities were related to the location of the initial thrombus. Of the patients with distal DVT 11% developed moderate clinical PTS and 39% developed an abnormal CMP. CMP and difference in CMP between post-thrombotic and non-thrombotic leg were significantly related to the different classes of PTS. 4. This study indicates that 7-13 years after DVT 31% of the patients had moderate and 2% had severe clinical PTS, while 57% of the patients had abnormal haemodynamic findings (both related to the initial site of the thrombosis). Secondly, it reveals that the risk of PTS after distal DVT is not negligible, which causes concern about not diagnosing and treating patients with distal DVT. Thirdly, we have demonstrated that a functional test, such as the SVPT, is a sensitive test to assess post-thrombotic damage. Therefore its use as a screening tool after a period of DVT should be investigated to select patients at risk of PTS.
Despite the many studies on venous haemodynamics using duplex, only a few evaluated the normal values, variability and reproducibility. Therefore, the range and variability of venous diameter, compressibility, flow and reflux were measured. To obtain normal values, 42 healthy individuals (42 limbs, 714 vein segments) with no history of venous disease were scanned by duplex. To determine the reproducibility the intra-observer variability was measured in 11 healthy individuals (187 vein segments) and the inter-observer variability in 15 healthy individuals (255 vein segments) and 13 patients (169 vein segments) previously diagnosed with deep venous thrombosis. Of the 714 normal vein segments, 708 (99%) were traceable, including the crural veins. Of the traceable vein segments, 675 (95%) were compressible and in 696 (98%) flow was present. Of the 42 common femoral vein segments, in 25 (60%) the reflux duration exceeded 1.0 s, but in the other proximal vein segments the reflux duration was less than 1.0 s (95% confidence interval 3.0-10.0). With the exception of the distal long saphenous vein, in the distal vein segments the reflux duration was less than 0.5 s (95% confidence interval 3.5-8.2). The coefficient of variation of the diameter measurements ranged from 14 to 50% and that of the reflux measurements from 28 to 60%. The kappa-coefficient of the inter-observer variability in the classification of compressibility measurements in the patients was 0. 77 and that of the reflux measurements was 0.86. This study shows that almost all veins were compressible in healthy individuals, except the distal femoral veins. In healthy individuals the duration of reflux of the proximal veins was less than 1.0 s and in the distal veins it was less than 0.5 s. The inter-observer variability of the reflux and compressibility measurements in the patients was good.
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