The postthrombotic syndrome in relation to venous hemodynamics, as measured by means of duplex scanning and strain-gauge plethysmography

Haenen, J.H.; Janssen, Mirian C. H.; Langen, H. van; Asten, W.N.J.C. van; Wollersheim, Hub; Hof, M.A. van ’t; Skotnicki, S.H.; Thien, Th.

doi:10.1016/s0741-5214(99)70248-x

Cited by 69 publications

(66 citation statements)

References 23 publications

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“…30 Iliofemoral patency was noted in 65.9% of patients randomized to CDT compared with 47.4% of those who received conventional anticoagulant therapy, 30 but the prevalence of valvular reflux was similar in the 2 groups. 31 In contrast, Haenen et al 32 reported a significant positive correlation between increasing severity of PTS and prevalence of reflux in the proximal femoral vein (P<0.001), distal femoral vein (P<0.05), and popliteal vein (P<0.05). These investigators also noted that venous obstruction alone or in combination with reflux had no relation to the presence of severe PTS.…”

Section: Clinical Manifestations and Pathophysiology Characteristic Smentioning

confidence: 91%

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

Kahn¹,

Comerota²,

Cushman³

et al. 2014

Circulation

485

410

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Section: Clinical Manifestations and Pathophysiology Characteristic Smentioning

confidence: 91%

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

Kahn¹,

Comerota²,

Cushman³

et al. 2014

Circulation

485

410

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“…In patients with deep vein reflux, the highest prevalence of valve incompetence was found in the FV and POPV [18]. Haenen et al [19] also demonstrated that advanced CVI was found in the FV and POPV with reflux, and reflux in the proximal deep veins significantly contributed to the development of PTS. These reports suggest that residual abnormalities in the proximal deep veins play a major role in the development of late PTS.…”

Section: Discussionmentioning

confidence: 96%

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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“…However, the proportion of patients with persistent venous occlusion was reported to be the same in patients with CEAP scores of C0-3 and C4-6. Haenen et al 8 showed reflux in the proximal deep veins to be associat ed with worse CEAP scores, but no such relation was shown for reflux in the superficial veins and distal deep veins and no relation was observed between vein noncompressibility or the combi nation of reflux and noncompressibility and PTS. In a second study, the same group showed super ficial venous reflux to be the most important risk factor for the onset of PTS symptoms, and 64% of patients with severe PTS were shown to have a combination of superficial and deep reflux.…”

Section: Tablementioning

confidence: 97%

“…[8][9][10] This review focuses on the diagnosis and risk determinants of PTS after DVT in adult patients.…”

Section: -4mentioning

confidence: 99%

How to predict and diagnose postthrombotic syndrome

Rabinovich¹,

Kahn²

2014

Polish Archives of Internal Medicine

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The postthrombotic syndrome in relation to venous hemodynamics, as measured by means of duplex scanning and strain-gauge plethysmography

Abstract: Most patients with severe PTS had a combination of deep and superficial reflux. Reflux in the deep proximal veins contributes significantly to the PTS.

Cited by 69 publications

References 23 publications

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

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

How to predict and diagnose postthrombotic syndrome

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