RELATIONSHIP BETWEEN CHANGES IN THE DEEP VENOUS SYSTEM AND THE DEVELOPMENT OF THE POSTTHROMBOTIC-SYNDROME AFTER AN ACUTE EPISODE OF LOWER-LIMB DEEP-VEIN THROMBOSIS - A ONE-YEAR TO 6-YEAR FOLLOW-UP

Purpose: This study investigated changes in the deep venous system and the development of the postthrombotic syndrome (PTS) after an episode of acute deep vein thrombosis (DVT). Methods: Seventy-eight patients (41 male patients, 37 female patients) with acute DVT in 83 legs (31 r ight, 42 left, five bilateral) underwent annual follow-up examinations for 1 to 6 years (median, 3 years) for symptoms and signs of the PTS. A venous duplex scan was performed at each visit to detect obstructio n and reflux in the veins, both of which may contribute to the develop ment of the PTS. DVT was primary in 69 Limbs and recurrent in 14 limbs . Results: When last examined 49 limbs were free of symptoms, and 34 h ad the PTS (23 edema only, 11 hyperpigmentation). Only two patients ha d ulcers during the follow-up period; both patients had the ulcers in areas of hyperpigmentation in limbs with recurrent DVT. The extent of disease was similar in limbs with the PTS (79% multisegment, 18% singl e segment) and those without the PTS (69% multisegment, 12% single seg ment). In limbs with the PTS the deep veins were normal in only one (3 %), six (18%) showed reflux only, five (15%) obstruction only, and 22 had features of both obstruction and reflux (65%). In limbs without th e PTS the deep veins showed no abnormality in nine (18%), reflux only in 17 (35%), obstruction only in six (12%), and reflux with obstructio n in 17 (35%). In the 11 limbs with hyperpigmentation nine had obstruc tion and reflux noted, one had obstruction only, and one had reflux al one. Conclusions: After an episode of acute DVT 12% of the limbs retur ned to normal by duplex criteria. Although only 13% developed skin com plications, 41% had features of the PTS. Limbs with the PTS had more t han three times the odds of having combined reflux and obstruction tha n did limbs without the PTS (odds ratio = 3.5, 0.95 confidence interva ls = 1.4, 8.6). Continued study of these patients will determine the c ourse of those limbs with venous abnormalities that have not yet devel oped symptoms and signs of the PTS.