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PubMed1990

[Parrot's method of angiostereometry in the evaluation of the status of chronic venous disease].

The authors present the results of capillary resistance measurements (CR) in three groups of examined subjects: with postthrombophlebitic syndrome, in patients with primary varicosis and in examined subjects which comprised the control group. We started from the fact that in more severe clinical conditions within venous insufficiency there also develop severe consequent conditions with the liberation of inflammatory reaction mediators in a greater extent than in the less severe cases and the assumption that in such patients CR is also lowered in the distant parts of the body. Angiostereometry by Parrot was the used technique. A total of 200 hundred persons was investigated. The examined subjects were divided into three groups. In group I there were 80 persons, all with the postthrombophlebitic syndrome which had the CR mean value of 15.26 cmHg (20.3 kPa). In group II there were 60 patients with primary varicosis, and the mean value of their CR was 17.7 cmHg (23.6 kPa). Group III had 60 examined subjects which comprised the control group, and their CR mean value was 19.90 cmHg (26.5 kPa). The difference was statistically significant. Capillary resistometry by Parrot is a very convenient method for the follow up and evaluation of clinical conditions of many diseases, as well as the follow up of therapy results. Due to all of its advantages it is superior to all stoppage methods such as Rumpel-Leed, for example.

Capillary Resistance↗
PubMedDate not supplied

Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium.

Fondaparinux, a selective inhibitor of activated factor X, has been shown to reduce further the risk of venous thromboembolism (VTE) in major orthopaedic surgery compared to the low molecular weight heparin enoxaparin, when both were applied for 7 days after surgery. To compare the expected costs and clinical outcomes of fondaparinux with enoxaparin applied for 7 days after surgery, we conducted a cost-consequence analysis in patients undergoing major orthopaedic surgery, i.e. total hip replacement, total knee replacement and hip fracture repair. Our decision model included endpoints relevant in routine clinical practice and the natural history of VTE over a long term period of 5 years. Costs for prevention, diagnosis and treatment of VTE and its complications were estimated from the Belgian health care payer perspective. Analyses were conducted for different time horizons and for the three indications, separately, and then combined. Overall, our results indicated that the initial investment in fondaparinux (cost per day: 10.39 euros versus 3.74 euros for enoxaparin) was soon compensated by savings due to avoided VTE events, with cost neutrality being achieved after 90 days and further savings being incurred over longer time periods mainly due to avoided post-thrombotic syndromes. These findings were most pronounced in patients undergoing hip fracture repair. Sensitivity analyses showed these findings to be robust for the three indications separately, and combined. We conclude that our analysis of health and economic consequences over a long term period, demonstrates the value for money of fondaparinux versus enoxaparin for the prevention of VTE events after total hip replacement, total knee replacement and hip fracture repair.

Anticoagulants↗
PubMed2004

[Disorders of rheologic properties of blood and their correction in postthrombophlebitic syndrome].

Pathogenetic mechanisms of disorders of rheologic properties of blood in postthrombophlebitic syndrome (PTPS) are analyzed. Thirty-six patients were examined and divided into 2 groups. In combined therapy of the study group (18 patients) pentoxyfillin tablets were included. In the control group derivatives of xantin were used. Good clinical effect of pentoxyfillin based on positive influence on rheologic properties of blood was demonstrated. In the study group significant reduction of edema was in 72,2% patients, of pains - in 83,3%. In the control group positive results were achieved only in 55,6% patients.

Adult↗
PubMedDate not supplied

[X-ray semeiotics of changes in the soft tissues and bones of the lower extremities in disorders of the venous outflow].

In order to improve radiodiagnosis of chronic and venous insufficiency of the lower limbs, the soft tissues and skeleton of the affected limbs were x-rayed in 120 patients with disturbed venous outflow (60 with varicosity and 60 with the post-thrombophlebitic syndrome - PTPS). The limb soft tissue changes in this disease were shown to be of one type and looked like the thickening of subcutaneous fat; obscure boundaries of the muscles with subcutaneous fat, the narrowing of intermuscular layers, the absence of differentiation of separate muscular groups, visible varices, calcifications of soft tissues and phleboliths. Bone changes appeared later than the clinical signs of disease and were as follows: regional and diffuse osteoporosis, various kinds of periostoses (scaled or partially assimilated linear, multilayer and pectiniform) and hyperostosis. Longitudinal platypodia and transverse foot flattening caused by dysfunction of the musculoligamentous apparatus and increasing venous congestion in the lower limbs were seen in most of the patients.

Humans↗
PubMed1989

Longitudinal and vertical ultrastructural lesion of crural muscle in post-thrombotic syndrome.

The vertical and longitudinal ultrastructural changes of the crural muscle (triceps surae) were studied in a selected patient material of 18 patients suffering from post-thrombotic syndrome. The transmission and scanning electron microscopic method helped in revealing that the damage had affected the contractile system, the mitochondria and the endoplasmic reticulum and in addition marked degenerative phenomena occurred. It was shown that vertically the impairments of the fine structure were localized in foci and involved the muscle layers to the same extent. Longitudinally--distally--the muscle changes displayed an increasingly aggravating diffuse appearance. Of the several factors responsible for the development of the pathological ultrastructural picture, tissue hypoxia and metabolic disorder, as well as a decreased microcirculation (hypoperfusion) and chronic inactivity are to be emphasized.

Adult↗
PubMed1997

[The use of color duplex scanning in the diagnosis of pathology of the venous system of the lower extremities].

During 1993-1996 period of time 175 patients with the lower extremities varication and post-thrombophlebitis syndrome (PTHPHS) were investigated using colour duplex scanning. Definite changes in the veins structure and spectral characteristics of blood flow in them corresponded to every PTHPHS stage. In an acute stage the lumen of the vessel is full of friable thrombotic masses, the blood from is absent. In 2-3 weeks the first recanalization signs appears showing the thrombus consolidation and residual blood flow. The recanalization process completes with the deep veins cusps destruction and retrograde blood escape occurrence, as a rule. The diagnosis criteria of each stage, the permissible limits of venous reflux, the hemodynamics peculiarities in combined affection of the deep veins various segments are substantiated.

Acute Disease↗
PubMed1994

[From thrombosis to post-thrombotic syndrome--plethysmography studies of venous function].

46 patients with deep vein thrombosis have been investigated by strain gauge plethysmography and by foot-volumetry in the acute state, after 4 weeks, and after every year up to 5 years. The primary therapy consisted in anticoagulation, compression-bandages and walking exercises. Venous drainage measured by venous occlusion plethysmography showed in average a normalisation after one year, while expelled volume as a parameter for the venous pumping function (assessed by foot-volumetry) remained in the pathological range. Since the clinical outcome--ulceration in 6.5%, lipodermatosclerosis in 15% and no major signs in 78%--does not correspond to these functional findings it is concluded that venous refluxes which are the main cause for the impeded pumping function lead to skin changes only in specially predisposed cases.

Adult↗
PubMed1990

Clinical study of late-stage postthrombotic lower extremities.

Through clinical and venographic study of 353 diseased limbs, the authors advocate a new classification for the postthrombotic syndrome of the deep veins of the lower extremity. The postthrombotic lower extremities may be divided into two types: (1) lesions of the whole lower extremity, consisting of the completely obstructed, partially recanalized, and completely recanalized types; (2) local lesions, such as segmental obstruction of the iliac, iliofemoral, superficial femoral, femoropopliteal veins, and the tibioperoneal venous trunk and the venous plexus in calf muscles. Each type has its characteristics related to the duration of symptoms and clinical features, and their management is not the same at all. The authors suggest that clinically this new classification may be of great help in estimating the status of the diseased limb and in selecting proper method of treatment.

Female↗
PubMed1988

[Popliteo-femoral venous reconstruction: indications and results].

In cases of a serious post-thrombotic syndrome in which conservative treatment has failed, the possibility of a venous femoralis bypass should be considered. Prerequisites for this procedure are an adaequate v. saphena magna and an open or recanalised v. poplitea at the confluens of the vv. tib. post. et vv. fib. This method was first described by May and Husni; we have modified it by replacing the original end-to-side anastomosis with a more effective end-to-end anastomosis and have added a subfascial av-fistula. Both procedures lower the ambulatory venous pressure. This operation has been performed 23 times; the paper presents the late results from 18 patients, 5 of whom underwent the operation over 8 years ago.

Arteriovenous Shunt, Surgical↗
PubMed1999

[Value of compression therapy in treatment of deep venous thrombosis].

Therapy in the acute phase of deep vein thrombosis aims to prevent the longitudinal growth of the thrombus as well as the life-threatening complication of pulmonary embolism. Compression therapy is part of all revascularisative and conservative treatment strategies, but hardly mentioned in most of the literature. Clinical efficacy of a sufficient compression therapy in patients with acute deep vein thrombosis is marked by a quick ease of subjective complaints as well as a reduction of the edema. The long-term risk of deep vein thrombosis, the postthrombotic syndrome, is avoidable by the use of compression therapy. Clinical studies about the effectiveness in relation to the length of the thrombus and the incidence of pulmonary embolism are missing as well as studies about the selection of the best compression material. Recently compression pressures were experimentally measured between long and short stretch bandages and the skin in order to select bandage material. It can be concluded that long stretch bandages can be used in the treatment of acute phlebothrombosis in mobile out-patients. Short stretch bandages should be used in immobile patients in order to avoid high pressures between the skin and the bandages. Compression stockings (Class III) represent an equivalent alternative to compression bandages after the resolution of edema.

Acute Disease↗
PubMed1998

Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy.

The anatomical and functional status of the epifascial and subfascial lymphatic compartments was analyzed using two compartment lymphoscintigraphy in five groups of patients (total 55) with various forms of edema of the lower extremities. Digital whole body scintigraphy enabled semiquantitative estimation of radiotracer transport with comparison of lymphatic drainage between those individuals without (normal) and those with leg edema by calculating the uptake of the radiopharmaceutical transported to regional lymph nodes. A visual assessment of the lymphatic drainage pathways of the legs was also performed. In patients with cyclic idiopathic edema, an accelerated rate of lymphatic transport was detected (high lymph volume overload or dynamic insufficiency). In those with venous (phlebo) edemas, high volume lymphatic overload (dynamic insufficiency) of the epifascial compartment was scintigraphically detected by increased tracer uptake in regional nodes. In patients with deep femoral venous occlusion (post-thrombotic syndrome). subfascial lymphatic transport was uniformly markedly reduced (safety valve lymphatic insufficiency). On the other hand, in the epifascial compartment, lymph transport was accelerated. In those patients with recurrent or extensive skin ulceration, lymph transport was reduced. Patients with lipedema (obesity) scintigraphically showed no alteration in lymphatic transport. This study demonstrates that lymphatic drainage is notably affected (except in obesity termed lipedema) in various edemas of the leg. Lymphatic drainage varied depending on the specific compartment and the pathophysiologic mechanism accounting for the edema. Two compartment lymphoscintigraphy is a valuable diagnostic tool for accurate assessment of leg edema of known and unknown origin.

Adult↗
PubMed1997

[Vascular sports in ambulatory therapy of venous circulatory disorders of the legs. Diagnostic, therapeutic and prognostic aspects].

In 33 patients with chronic venous incompetence (CVI) caused by primary varicoses or postthrombotic syndrome stage I-III (according to Widmer) the therapeutic benefit of 6 months of medically supervised physical exercise training was documented. During the training penud there was an improvement in subjective complains such as pain and tendency for edema in the legs. Mobility in the upper ankle joint was improved asuss as venous drainage function. Clinical benefit was achieved in the reduction of ulcer size; 7 of the 10 ulcers completely healed. Medically supervised physical exercise training and optimized compression therapy are basic therapeutic approaches in conservative treatment in chronic venous insufficiency. Costs are covered by the patient's health insurance company in Germany, as long as the exercise training is medically supervised.

Adult↗
PubMed1996

The role of the leech in medical therapeutics.

Leeching is considered by many to be a discredited medical relic of the past. This view is not justified, since leeches still play an important part in modern medicine, as in microsurgery and in the treatment of patients with post-phlebitic syndrome. Hirudin, the potent thrombin inhibitor of leech saliva, has been cloned and is used in the treatment of cardiological and hematological disorders. In our search for other antihemostatic factors in Hirudo medicinalis saliva, we found inhibitors of platelet aggregation induced by thrombin, collagen, adenosine 5'-diphosphate, epinephrine, platelet-activating factor and arachidonic acid. We purified apyrase (adenosine 5'-triphosphate diphosphohydrolase), which is a non-specific inhibitor of platelet aggregation by virtue of its action on adenosine 5'-diphosphate. We isolated and characterized the platelet-activating factor antagonist and also identified and recovered an inhibitor of coagulation factor Xa from leech saliva. This report summarizes our findings and those of other investigators, as well as the experience of one of us (A.E.) in leech therapy.

Animals↗
PubMed2003

A cross-sectional study evaluating post-thrombotic syndrome in children.

BACKGROUND: Post-thrombotic syndrome (PTS) in adults, characterized by swelling, skin pigmentation, pain, and ulceration of the limb, is secondary to deep vein thrombosis (DVT). In contrast to the extensive documentation on PTS in adults, little is known about the risk of PTS in children. OBJECTIVE: To determine the incidence, clinical characteristics, and predictors of PTS in children. METHODS: A cross-sectional study in 153 nonselected children with objectively confirmed DVT. All children were assessed for PTS using a standardized score. As per the PTS score, severity was classified as: absent, mild, moderate, or severe. RESULTS: Post-thrombotic syndrome was present in 96/153 children (63%), in which 80 (83%) were mild and 16 (17%) were moderate. Swelling was the most frequently recorded subjective symptom (43%) while increased limb circumference (71%) and presence of collateral circulation (53%) were the most frequently recorded objective symptoms. Risk factors for development of PTS were: lack of resolution of the DVT by radiographic assessment (OR 3.96, 95% CI 1.68-9.30), number of vessels involved in the initial DVT (OR 2.05, 95% CI 1.52-2.77), and length of follow-up (OR 1.22, 95% CI 1.08-1.39). CONCLUSIONS: These findings demonstrate that PTS is a clinically significant disease in children with previous DVT.

Adolescent↗
PubMed1997

[Post-phlebothrombotic venous insufficiency of the lower limbs. Echo-guided targetted surgery].

The post-phlebothrombotic syndrome surgery has always had a limited space within the limits of the venous lower limbs surgery. This, either for the distrust of surgeon to operate a limb with deep thrombotic phenomenon, or because the range of possible operations is rather limited and constituted by very cruent and devasting operations. The introduction of very accurate method in the preoperative diagnostic, as the echo-color-Doppler, enables an accurate mapping of the new venous post-phlebothrombotic situation and a careful haemodynamic study of the deep or superficial venous circle. Hence, the surgeon has a new and significant chance to perform a minimal surgery generally directed to the ligation of the perforans veins that has become incontinent after the phlebothrombotic insult. In this way, the wide and devasting dissection can be avoided as previous Linton-type interventions.

Humans↗
PubMed2005

Origin and natural history of deep vein thrombosis of the legs.

Deep vein thrombosis (DVT) is a disorder frequently affecting the deep veins of the lower limbs; its onset is induced by known risk factors. The main complications of DVT are pulmonary embolism and postthrombotic syndrome (PST). Clinical pulmonary embolism occurs in a high proportion of cases of untreated proximal DVT and is associated with a mortality rate of 11-23% if not treated. PST, however, is a cause of increased morbidity and disability. The natural history of DVT is a dynamic process, with both thrombolysis and thrombus extension occurring after an episode of DVT. With the introduction of duplex scanning, several clinical studies have investigated and tried to clarify the natural history of DVT, the rate of recanalization of the thrombus, and the presence of reflux and its relation to lysis of the thrombus. These and other debated issues associated with PST are reviewed here. Knowledge of the evolution of these processes could result in better understanding of PST and be applied for improvement of medical and surgical management of venous thrombosis and its complications.

Combined Modality Therapy↗
PubMed1997

[Ultrasound angiography in diagnosis of deep venous thrombosis and post-thrombotic syndrome. A prospective comparative study].

PURPOSE: Aim of the present study was to establish the value of ultrasound angiography compared with colour duplex sonography and phlebography in the diagnosis of deep venous thrombosis of the leg and insufficiency of the perforating vein. METHOD: Sixty-two patients with deep venous thrombosis of the leg and 30 patients with post-thrombotic syndrome and perforating vein insufficiency underwent diagnostic examination by colour duplex sonography, ultrasound angiography and phlebography. Endoscopic varicose surgery was taken as the gold standard for diagnosis of perforating vein insufficiency. RESULTS: In the diagnosis of deep venous thrombosis, the specificity of colour duplex sonography was 92% in the thigh, 100% in the popliteal area and 89% in the lower leg. Colour angiography showed higher specificity. 95%, in the lower leg. In a diagnosis of perforating vein insufficiency, accuracy specificity of the three procedures was 60% for colour duplex sonography, 47% for phlebography and 80% for ultrasound angiography. CONCLUSIONS: The diagnosis of venous thromboses in the lower leg can be further improved by means of ultrasound angiography. Ultrasound angiography is the best method for demonstrating insufficiency of the perforating vein.

Adult↗
PubMedDate not supplied

Long term results of vein valve transplants placed in the popliteal vein for intractable post-phlebitic venous ulcers and pre-ulcer skin changes.

Most patients with chronic venous ulceration or severe pre-ulcer damaged skin have incompetent popliteal valves and a high ambulant venous pressure (AVP). Competency can be restored by a vein valve transplant taken from the arm and placed in the popliteal fossa, with subjective and objective improvement. In this study 23 patients with post-phlebitic syndromes received 25 vein valve grafts as part of management. Seventeen patients had large recurrent ulcers after unsuccessful venous surgery: 6 patients had extensive pre-ulcer skin damage. Fifteen of 17 patients healed their ulcers, and all 6 patients with skin damage showed rapid improvement with relief of symptoms. Falls in the AVP, ranging from 10 to 40 mmHg occurred in 19 patients. All vein valve transplants were patent, after 18 months, but 5 grafted valves have evidence of venous reflux. These results suggest a functioning valve replacement in the popliteal fossa may lower the AVP sufficiently to heal intractable venous ulcers or severely damaged skin. Vein valve transplants function well long term, and the falls in the AVP are usually maintained. The popliteal fossa may be the ideal site since a component popliteal valve has been shown to limit adverse post-phlebitic changes.

Arm↗