Prospective 12-Year Follow-up Study of Clinical and Hemodynamic Sequelae After Deep Vein Thrombosis in Low-Risk Patients (Zürich Study)

Uk, Franzeck; Schalch, I.; Jäger, K; Schneider, Ernst; Grimm, J; Bollinger, A

doi:10.1161/01.cir.93.1.74

Cited by 153 publications

(108 citation statements)

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“…Table 4 shows the duplex-derived venous reflux parameters in the FV at two-and six-year follow-up points between groups I and II. There were similar tendencies in venous reflux Lipodermatosclerosis or atropic blanche 7 C 5 Healed venous ulcer 9 C 6 Active venous ulcer 2 parameters between the early and late phases after DVT. There were no significant differences in the RT between the groups (P ¼ 0.814 and 0.209, respectively).…”

Section: Resultsmentioning

confidence: 86%

High peak reflux velocity in the proximal deep veins is a strong predictor of advanced post‐thrombotic sequelae

Yamaki

Nozaki

Sakurai

et al. 2007

Journal of Thrombosis and Haemostasis

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Summary. Background: The presence of reflux in the femoral vein (FV) and popliteal vein (POPV) after acute deep vein thrombosis (DVT) is considered to contribute to the development of advanced post-thrombotic syndrome (PTS). However, a quantification of reflux has yet to be determined. The purpose of study was to determine the indicative parameters reflecting the progression of PTS. Methods: Venous abnormalities were evaluated in 131 limbs out of 130 patients who completed a sixyear follow-up after an acute DVT. Clinical manifestations were categorized according to the clinical, etiologic, anatomic, and pathophysiologic (CEAP) classification, and the patients were divided into two groups at a six-year follow-up point: group I, C 0-3 E s ,A s,d,p ,P r,o , early chronic venous insufficiency (CVI); group II, C 4-6 E s ,A s,d,p ,P r,o , advanced CVI. Venous segments were examined whether they were occluded or recanalized. The reflux parameters assessed were the diameter (cm), the reflux time (RT; s), the peak reflux velocity (PRV; cm s )1 ), and total refluxed volume, and these parameters were assessed especially in the FV and POPV at the two-year (early phase) and subsequent six-year (late phase) follow-up points after DVT. Results: There were 98 limbs in group I and 33 in group II. The frequency of venous reflux was significantly higher in group II (<0.0001). In contrast, the proportion of occlusion did not differ between the groups (P ¼ 0.138). The proportions of FV and POPV incompetence were significantly higher in group II (P < 0.0001 and P < 0.0001, respectively). In these veins, the RT did not improve the discrimination power between the two groups. In contrast, the PRV had significant discrimination power in these veins at both the two-and six-year follow-up points. In the superficial venous system, there were no significant differences in any of the determined parameters between the groups. In group II, 19 patients (58%), who had early symptoms of CVI at the two-year follow-up point, subsequently developed advanced symptoms of PTS. After calculating a suitable cutoff point using receiver operating characteristic curves analysis at the two-year follow-up point, multivariable analysis showed that a PRV of >25.4 cm s )1 in the POPV was the strongest independent predictor of advanced CVI [odds ratio (OR) 60.32; 95% confidence interval (95CI) 43.1-1238.97, P < 0.0001]. Similarly, in the FV, a PRV of >24.5 cm s )1 was found to be a strong predictor of advanced CVI (OR 25.77, 95CI 10.56-331.12, P < 0.0001). Conclusions: These findings suggest that the presence of a high PRV in the proximal deep veins is an independent predictor of advanced symptoms of PTS.

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Section: Resultsmentioning

confidence: 86%

High peak reflux velocity in the proximal deep veins is a strong predictor of advanced post‐thrombotic sequelae

Yamaki

Nozaki

Sakurai

et al. 2007

Journal of Thrombosis and Haemostasis

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“…[20][21][22][23] Trophic skin changes tend to occur between 2 and 4 years after the diagnosis of DVT, with no further changes between 5 and 12 years. 21 In general, the absolute risk of trophic skin changes appears to be greatest with proximal thrombosis, as compared with distal thrombosis, and with deep, or deep and superficial thrombosis, as compared with superficial thrombosis. 20,22,[24][25][26][27][28] These studies have also correlated the severity of skin changes to the number of thrombosed venous segments, and the degree of venous reflux.…”

Section: Epidemiology and Natural Historymentioning

confidence: 99%

Chronic Venous Insufficiency and Venous Ulceration

Alguire

Mathes

1997

J Gen Intern Med

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OBJECTIVE:To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI).DATA SOURCES: English-language articles identified through a MEDLINE search using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION:Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION:Data were manually extracted from selected studies and reviews; emphasis was placed on information relevant to the general internist. pproximately 5 million people in the United States exhibit some evidence of chronic venous insufficiency (CVI) and between 400,000 and 500,000 of these individuals have or will develop a venous leg ulcer. 1-3 The signs of CVI include engorgement of the cutaneous veins and dependent edema in mildly affected patients to pigmentation, dermatitis, and ulceration in the more severe cases. Although most patients are asymptomatic, others have leg heaviness and aching or recurrent and recalcitrant leg ulcers punctuated by bouts of cellulitis. These more severe cases are associated with recurrent hospitalization, high health-care costs, and disability. 4,5 Venous insufficiency with trophic skin changes or ulceration is a frustrating problem, which many physicians approach with a sense of ennui. This may be due to the chronic and remitting nature of the problem, the need for lifestyle modification, inconvenient therapies, and contradictory information regarding medical and surgical management. Nevertheless, CVI, including ulceration, is a manageable problem. The purpose of this review is to present the normal anatomy and physiology of the venous circulation and to summarize the epidemiology, pathophysiology, and treatment of CVI. DATA SYNTHESIS: METHODSA MEDLINE search for relevant English-language articles published between 1966 and 1996 was completed using the following MeSH terms: venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt). When selecting articles on treatment, randomized, controlled trials were reviewed whenever possible. Emphasis was placed on reviewing articles with clinical relevance for internal medicine physicians. ANATOMY AND NORMAL PHYSIOLOGYVenous blood from the skin and subcutaneous fat is collected in a system of superficial venules and veins that drain toward the deep venous system underneath the fascia via three major pathways: (1) through the long or short saphenous veins, which join the deep system at the saphenofemoral and saphenopopliteal junctions; (2) through the perforating veins originating from the long or short saphenous veins or their branches; or (3) directly into the deep venous system or bypass the deep system entirely and enter the pelvis. 6 Deep veins are categorized as either intramuscular or intermuscular; o...

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“…Furthermore, pulmonary thromboembolism is the most common cause of mortality in non-surgical urology (1), also constituting a significant risk factor for postoperative morbidity (13). Consequently, the prevention of thromboembolism represents an important strategic objective for the reduction of postoperative mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…In almost all cases, heparin administration was postoperatively prolonged for 3 or 4 weeks, in accordance with the ACCP guidelines, since this leads to a reduction in the rate of venous thromboembolism without significantly affecting the occurrence of complications (13).…”

Section: Re-intervention --------------------------------------------mentioning

confidence: 99%

Association between postoperative thromboembolism prophylaxis and complications following urological surgery

Cerruto

D’Elia

Piccoli

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Thromboembolism represents the most significant complication and cause of non-surgical mortality in major urological surgery. The aim of the present study was to assess the association between the type of pharmacological thromboembolism prophylaxis and the postoperative complication rate in a cohort of patients undergoing major urological surgery. All consecutive patients treated with major urological surgery between December 2011 and March 2013 were evaluated. For each patient, clinical and demographic data, as well as information on the post-surgical complications and the type of pharmacological thromboembolism prophylaxis, were collected. In total, 453 patients (mean age, 63.36±12.05 years) were recruited (43.5% for prostate surgery, 33.1% for renal surgery, 12.1% for bladder surgery and 11.3% for other surgery). Postoperative blood transfusions were required in 50 cases (11.0%). A total of 32 patients (7.1%) underwent re-intervention due to the occurrence of grade ≥3 complications, with a readmission rate of 2.0%. According to the Clavien-Dindo Classification, the complications were grade 1 in 36.0% of the cases, grade 2 in 19.4%, grade 3 in 6.0%, grade 4 in 2.0% and grade 5 (mortality) in 0.7%. Only 1 case of deep venous thrombosis not associated with pulmonary thromboembolism was observed. Univariate analyses showed a significant negative association (higher risk of complications) between the use of >4,000 IU enoxaparin as the thromboembolism prophylaxis and postoperative blood transfusion rate (P= 0.045), re-intervention rate (P=0.001) and the occurrence of grade ≥3 complications (P<0.001). Multivariate analysis confirmed the significant association between the use of >4,000 IU enoxaparin and both re-intervention rate (P=0.013) and occurrence of grade ≥3 complications (P=0.002). High doses of enoxaparin (>4,000 IU) may lead to an increased risk of re-intervention and severe postoperative complications following major urological surgery. Randomised, controlled trials comparing the effect of different types of pharmacological thromboembolism prophylaxis on postoperative complications following major urological surgery are required.

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Prospective 12-Year Follow-up Study of Clinical and Hemodynamic Sequelae After Deep Vein Thrombosis in Low-Risk Patients (Zürich Study)

Cited by 153 publications

References 20 publications

High peak reflux velocity in the proximal deep veins is a strong predictor of advanced post‐thrombotic sequelae

High peak reflux velocity in the proximal deep veins is a strong predictor of advanced post‐thrombotic sequelae

Chronic Venous Insufficiency and Venous Ulceration

Association between postoperative thromboembolism prophylaxis and complications following urological surgery

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