CLINICAL AND HEMODYNAMIC SEQUELAE OF DEEP VENOUS THROMBOSIS - RETROSPECTIVE EVALUATION AFTER 7-13 YEARS

1. In contrast to the extensive documentation on diagnosis and treatme nt of deep venous thrombosis (DVT), information about long-term compli cations, like the post-thrombotic syndrome (PTS), is scarce, Most stud ies report on clinical examination only, whereas adequate haemodynamic investigation is lacking, Therefore 81 patients with venographically confirmed lower extremity DVT were clinically and haemodynamically ree xamined 7-13 years after DVT (mean 10 years) to assess PTS, Interest w as focused on the relation between clinical and haemodynamic PTS and t he relation between location of the initial DVT and incidence of PTS. 2, Clinical signs and symptoms of PTS were classified according to the latest consensus of the international consensus committee on chronic venous disease, Non-invasive venous vascular laboratory tests were per formed to assess the venous outflow resistance and calf muscle pump fu nction (CMP), CMP was determined by the supine venous pump function te st (SVPT). 3. Clinically only 20 of 81 patients (25%) were asymptomati c, 34 (42%) had mild PTS (class 1-3), 25 (31%) moderate PTS (class 4) and 2 (2%) severe PTS (class 5-6); 57% had an abnormal CMP, Both the s everity of clinical symptoms and the haemodynamic abnormalities were r elated to the location of the initial thrombus, Of the patients with d istal DVT 11% developed moderate clinical PTS and 39% developed an abn ormal CMP, CMP and difference in CMP between post-thrombotic and non-t hrombotic leg were significantly related to the different classes of P TS. 4. This study indicates that 7-13 years after DVT 31% of the patie nts had moderate and 2% had severe clinical PTS, while 57% of the pati ents had abnormal haemodynamic findings (both related to the initial s ite of the thrombosis), Secondly, it reveals that the risk of PTS afte r distal DVT is not negligible, which causes concern about not diagnos ing and treating patients with distal DVT. Thirdly, we have demonstrat ed that a functional test, such as the SVPT, is a sensitive test to as sess post-thrombotic damage, Therefore its use as a screening tool aft er a period of DVT should be investigated to select patients at risk o f PTS.