Prevention and treatment of the postthrombotic syndrome

Abstract

on behalf of writing group I of the Pacific Vascular Symposium 6, Ann Arbor, Mich TOPIC 1 Prevent recurrence of DVT Background. Recurrent ipsilateral deep venous thrombosis (DVT) is a primary and probably the most important etiologic factor in the development of the postthrombotic syndrome (PTS). 1,2Reducing the rate of recurrent DVT will thereby decrease the incidence of PTS. This can only be accomplished by modifying approaches to the current medical management of primary DVT. Furthermore, capitalizing on available strategies, such as patient and physician education, establishing hospital wide protocols for the prevention and treatment of DVT, and adherence to consensus guidelines, will help to optimize the treatment of DVT and thereby reduce the rate of recurrent DVT.The following issues are paramount to realizing a primary goal of recurrent DVT prevention (Table I): 1) identification of subgroups of patients who are at risk for recurrence, as DVT is heterogeneous with regard to anatomic extent, provoked by identified risk factors versus unprovoked, and cancer-versus non-cancer-related; 3,4 2) optimizing the initiation, duration, and type of anticoagulation for each patient, including maintaining appropriate intensity of oral anticoagulation; 5-7 3) provision of antithrombotic prophylaxis to high risk medical and surgical patients; 4,8,9 and 4) educating patients and front-line physicians regarding appropriate DVT management and risks of recurrent DVT. 10,11 Preventing recurrent DVT will also reduce the incidence of pulmonary embolism (PE) and PE-associated mortality. 12

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

“…The need for adopting evidence-based guidelines and reporting standards for venous diseases has long been recognized by international experts 15 and by leaders of the SVS 16 and AVF. [17][18][19][20] To define current guidelines, members of the Venous Guideline Committee reviewed the relevant literature, including previously published consensus documents and guidelines, [21][22][23][24][25][26][27][28][29][30][31] meta-analyses, [6][7][8][9][10][11][12][32][33][34][35][36][37][38][39][40][41][42] the AVF reports on the Venous Summit at the 2006 and 2009 Pacific Vascular Symposiums 13,[43][44][45][46] and considered the recommendations published in the third edition of the Handbook of Venous Disorders, Guidelines of the American Venous Forum. 47 The guidelines in this publication are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, as it was described by Guyatt et al (Table I).…”

Timing of Endovascular Interventions for Iliac Vein Compression Syndrome With Thrombus

“…The risk of PTS can be markedly reduced by preventing DVT and providing appropriate anticoagulation once it develops. 3 However, there has been no agreement on the treatment of IVCS with thrombus. We reviewed the data from cases of IVCS with thrombus with 5 years of follow-up treated at the Vascular Surgery Department at the First Affiliated Hospital of Wenzhou Medical University and discuss the timing and method of endovascular interventional treatments.…”

Practice patterns of adjunctive therapy for venous leg ulcers

“…Venous leg ulcers (VLU) are a large source of morbidity, create a large socioeconomic burden, and adversely impact quality of life. 1–3 Over 2.7 million Americans are affected by chronic venous insufficiency manifesting as leg edema, lipodermatosclerosis and VLU. 4 Many patients with VLU have superficial and deep venous reflux with the majority having primary venous disease.…”