Hemodynamic Indicators of Postthrombotic Sequelae

Norris, Caro

doi:10.1001/archsurg.1986.01400070031006

Cited by 11 publications

(5 citation statements)

References 4 publications

(1 reference statement)

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“…These data definitively demonstrate that in acute venous thrombosis the lymphatic system drain more interstitial fluid in order to reduce the local edema. The incidence of postthrombotic syndrome is nearly 35%-69% at three years after deep venous thrombosis and from 49% to 100% after five to ten years [28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Cariati¹

2012

TOCVJ

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Lymphatic and venous systems work together to drain interstitial fluid and blood respectively. Data on lymphatic function in chronic venous insufficiency and in chronic venous ulcerations are discordant. Modification of lymphatic function in acute venous thrombosis have been never described. The aim of this study is to report the modifications of the function of the lymphatic system in acute venous thrombosis, chronic venous ulceration and post-thrombotic syndrome. Material and Methods: Patients were studied with qualitative and semi-quantitative lymphoscintigraphy. The transport index (TI 60) have been calculated for each patients. Data obtained in group a (13 patients with acute venous thrombosis) (TI 60 = 398); group b (12 limbs of 6 controls) (TI 60 = 203); group c (10 limbs with chronic venous ulcerations) (TI 60 = 114); group d (6 limbs with post-thrombotic syndrome in absence of ulcerations) (TI 60 = 148) were compared with Kruscall-Wallis statistic and Mann-Whitney test. Results: The TI 60 is different in the four groups. Differences are significant between: group a (TI 60 = 398) and group b (TI 60 = 203); group b (TI 60 = 203) and group c (TI 60 = 114); group b (TI 60 = 203) and group d (TI 60 = 148). Discussion: The compensatory function of lymphatic system in acute venous thrombosis is definitively demonstrated. The lymphatic drainage of the limb affected by chronic venous ulceration is reduced. After the healing of the ulceration the lymphatic flow of the limbs affected by post-thrombotic syndrome improves but it remains under the levels of normal subjects.

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Section: Discussionmentioning

confidence: 99%

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Cariati¹

2012

TOCVJ

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“…All these changes in volume can be recorded by strain-gauge plethysmography, a reliable technique to record volume changes [ll, [17][18][19]. In addition, other newly developed plethysmographic techniques, such as air-plethysmography and photoplethysmography, have been used in the diagnosis of venous insufficiency [lo, 20-241.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Supine Venous Pump Function Test: A New Non-Invasive Tool in the Assessment of Deep Venous Insufficiency

Janssen¹,

Claassen²,

Asten

et al. 1996

Clinical Science

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1. A new non-invasive test was developed to assess calf muscle pump function: the supine venous pump function test. The technique uses strain-gauge plethysmography and is performed in the supine position. The method is superior to other non-invasive methods because basically the most essential haemodynamic parameter, venous pressure decrease, is used by properly converting venous volume measurements into venous pressure. The validity of this test was established by comparison with invasive venous pressure measurements and by determining the reproducibility. Additionally, normal values were determined. 2. In 28 extremities the supine venous pump function test was performed simultaneously with invasive venous pressure measurements. The reproducibility of the test was assessed in 10 randomly chosen volunteers. In 34 volunteers normal values were obtained and 26 patients with clinical venous insufficiency were examined. 3. Comparison of the two methods revealed a correlation coefficient of r = 0.98 (P < 0.001). A mean difference of 3.9%pf between both methods was found with limits of agreement of -6.3%pf to 14.1%pf. The coefficient of repeatability was 13%pf and the coefficient of variation was 9%. The normal range was found to be > 60%pf. The mean pump function in the patient group was 45%pf. 4. The limits of agreement are small enough to be confident that the supine venous pump function test can be used instead of invasive venous pressure measurements to assess calf muscle pump function in clinical practice. The reproducibility of the test is good.

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“…Except for Franzeck et al [2] and Eichlisberger et al [5] the other follow-up studies evaluated a short period (mean 0.5-7 years) [l, 3, 4, [6][7][8][9][10][11][12][13][14][15][16][17]. As it possibly takes a longer time to develop PTS after distal DVT, we investigated patients 7-13 (mean 10) years after a first period of DVT.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Haemodynamic Sequelae of Deep Venous Thrombosis: Retrospective Evaluation after 7–13 Years

et al. 1997

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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.

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Hemodynamic Indicators of Postthrombotic Sequelae

Cited by 11 publications

References 4 publications

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Validation of the Supine Venous Pump Function Test: A New Non-Invasive Tool in the Assessment of Deep Venous Insufficiency

Clinical and Haemodynamic Sequelae of Deep Venous Thrombosis: Retrospective Evaluation after 7–13 Years

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