Vascular 19

Abstract

Aims: We evaluated long‐term impact of iliofemoral thrombosis (IFDVT) on walking capacity, venous haemodynamics, CEAP class, venous‐clinical‐severity score (VCSS) and quality of life (SF‐36), and determined prevalence of venous claudication. Methods: All patients with prior IFDVT at our institution since 1990 were followed up. Excluded were those with walking impairment due to arterial (ABI < 1.0 post‐exercise) or unrelated causes, and those thrombectomized or thrombolyzed. Thirty‐nine patients (22–83 years) were included. Median follow‐up was 5 years (range: 1–23). Investigation included CEAP and VCSS stratification, air‐plethysmography (outflow fraction: OF; venous‐filling index: VFI; residual‐volume fraction: RVF), duplex, treadmill (3.5 km h−1, 10 per cent) to determine initial (ICD) and absolute (ACD) claudication distances, and SF‐36 assessment. Non‐affected limbs of patients with unilateral IFDVT (37/39) comprised the control group; data presented as median and interquartile range. Results: A total of 75.6 per cent of limbs with IFDVT had superficial and deep reflux and 26.3 per cent superficial reflux; reflux in control limbs was 13.5 and 19 per cent, respectively (P < 0.01); 43.6 per cent (17/39) (95 per cent CI: 27–60 per cent) of patients developed venous claudication ipsilateral to IFDVT (ICD: 130 (105–268) m), compelling 15.4 per cent (6/39) (95 per cent CI: 3.5–27 per cent) to discontinue treadmill (ACD: 241 (137–298) m). Limbs with prior IFDVT had a lower OF (37 (32.2–43) per cent; P < 0.001), abnormally higher VFI (3.8 (2.5–5.7) mL s−1; P < 0.001) and RVF (45 (32.5–51.5) per cent; P = 0.006), and clinical impairment in CEAP and VCSS (P < 0.0001). Patients with IFDVT had impaired physical functioning and role (P < 0.034), general health (P < 0.001), social function (P = 0.047) and mental health (P = 0.043). Conclusions: Of those with prior IFDVT 43.6 per cent developed venous claudication, compelling interruption of walking in 15.4 per cent; prior IFDVT caused outflow impairment, and large residual‐venous volume and reflux, resulting in marked clinical and quality‐of‐life compromise. Standardized challenge enabled discrimination of those with clinically relevant impairment.