TY - JOUR
T1 - Update on diagnosis and treatment strategies in patients with post-thrombotic syndrome due to chronic venous obstruction and role of endovenous recanalization
AU - Schleimer, K.
AU - Barbati, M.E.
AU - Grommes, J.
AU - Hoeft, K.
AU - Toonder, I.M.
AU - Wittens, C.H.A.
AU - Jalaie, H.
N1 - Funding Information:
Author conflict of interest: C.H.A.W. has consultancy agreements with Angiocare, BioMedical, Medi, OptiMed, Vascular Insights, and IQ Brand Group; he has received research funds from BTG, EKOS, Vascular Insights, Volcano/Philips, Cook, AB Medica, Angiocare, Bayer, Medtronic, OptiMed, BD Bard, Veniti, and Boston Scientific. H.J. reports personal fees from OptiMed, BD Bard, Medtronic, Bentley, BTG, and Cook; he has received research funds from OptiMed, BD Bard, Medtronic, and AB Medica. Author conflict of interest: C.H.A.W. has consultancy agreements with Angiocare, BioMedical, Medi, OptiMed, Vascular Insights, and IQ Brand Group; he has received research funds from BTG, EKOS, Vascular Insights, Volcano / Philips, Cook, AB Medica, Angiocare, Bayer, Medtronic, OptiMed, BD Bard, Veniti, and Boston Scientific. H.J. reports personal fees from OptiMed, BD Bard, Medtronic, Bentley, BTG, and Cook; he has received research funds from OptiMed, BD Bard, Medtronic, and AB Medica. The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Funding Information:
Author conflict of interest: C.H.A.W. has consultancy agreements with Angiocare, BioMedical, Medi, OptiMed, Vascular Insights, and IQ Brand Group; he has received research funds from BTG, EKOS, Vascular Insights, Volcano/Philips, Cook, AB Medica, Angiocare, Bayer, Medtronic, OptiMed, BD Bard, Veniti, and Boston Scientific. H.J. reports personal fees from OptiMed, BD Bard, Medtronic, Bentley, BTG, and Cook; he has received research funds from OptiMed, BD Bard, Medtronic, and AB Medica. Author conflict of interest: C.H.A.W. has consultancy agreements with Angiocare, BioMedical, Medi, OptiMed, Vascular Insights, and IQ Brand Group; he has received research funds from BTG, EKOS, Vascular Insights, Volcano/ Philips, Cook, AB Medica, Angiocare, Bayer, Medtronic, OptiMed, BD Bard, Veniti, and Boston Scientific. H.J. reports personal fees from OptiMed, BD Bard, Medtronic, Bentley, BTG, and Cook; he has received research funds from OptiMed, BD Bard, Medtronic, and AB Medica. The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Publisher Copyright:
© 2019 Society for Vascular Surgery
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Objective: After a first episode of lower extremity deep venous thrombosis, post-thrombotic syndrome (PTS) develops in 20% to 50% of patients despite adequate anticoagulation. Symptoms of PTS can vary from leg swelling to venous ulceration with disabling venous claudication. It significantly affects the patient's quality of life and has considerable socioeconomic consequences. This review gives an update on diagnosis and current treatment strategies in patients with PTS due to chronic venous obstruction, in particular regarding the role of endovenous procedures.Methods: This review article is based on a selective literature search in PubMed and the Cochrane Library. The terms "postthrombotic syndrome," "post-thrombotic syndrome," "chronic venous obstruction," "venous outflow obstruction," and "venous stent" were used as keywords. Selected publications addressed the diagnosis of and therapy for PTS. Acute deep venous thrombosis, thrombolysis, case reports, complications as a result of caval vein filters, animal experiments, PTS of the upper extremity, and PTS in children were excluded.Results: In addition to conservative treatment of PTS, the following invasive procedures are also available: open surgical reconstructions, hybrid procedures, and endovenous recanalization of the occluded iliocaval venous tract with stent angioplasty. Since introduction of dedicated venous stents in 2012, technical success, patency rates, and improvement in quality of life have been at least as good as results of open surgical reconstruction if not better.Conclusions: First-line treatment should be conservative therapy. In case of therapy-resistant PTS with poor quality of life, the possibility of an invasive treatment should be evaluated. All invasive procedures are recommended with low levels of evidence. Therefore, deciding on an invasive treatment and type of procedure should be made individually. Because PTS is rarely a threat to life or limb, a minimally invasive treatment is preferred. Therefore, endovenous recanalization appears to be appropriate as the therapy of choice. In patients with involvement of the femoral confluence, endophlebectomy of the common femoral vein in addition to venous recanalization is inevitable to ensure an adequate inflow into the recanalized venous tract. It also secures a sufficient drainage of blood from the peripheral venous system. Because this hybrid procedure is burdened with a significantly higher risk of complications, strict criteria must be fulfilled to legitimize the indication for this procedure. For the best possible results to be achieved, the following perioperative and postoperative management must be considered: therapeutic anticoagulation, early mobilization, compression therapy, and systematic follow-up with duplex ultrasound.
AB - Objective: After a first episode of lower extremity deep venous thrombosis, post-thrombotic syndrome (PTS) develops in 20% to 50% of patients despite adequate anticoagulation. Symptoms of PTS can vary from leg swelling to venous ulceration with disabling venous claudication. It significantly affects the patient's quality of life and has considerable socioeconomic consequences. This review gives an update on diagnosis and current treatment strategies in patients with PTS due to chronic venous obstruction, in particular regarding the role of endovenous procedures.Methods: This review article is based on a selective literature search in PubMed and the Cochrane Library. The terms "postthrombotic syndrome," "post-thrombotic syndrome," "chronic venous obstruction," "venous outflow obstruction," and "venous stent" were used as keywords. Selected publications addressed the diagnosis of and therapy for PTS. Acute deep venous thrombosis, thrombolysis, case reports, complications as a result of caval vein filters, animal experiments, PTS of the upper extremity, and PTS in children were excluded.Results: In addition to conservative treatment of PTS, the following invasive procedures are also available: open surgical reconstructions, hybrid procedures, and endovenous recanalization of the occluded iliocaval venous tract with stent angioplasty. Since introduction of dedicated venous stents in 2012, technical success, patency rates, and improvement in quality of life have been at least as good as results of open surgical reconstruction if not better.Conclusions: First-line treatment should be conservative therapy. In case of therapy-resistant PTS with poor quality of life, the possibility of an invasive treatment should be evaluated. All invasive procedures are recommended with low levels of evidence. Therefore, deciding on an invasive treatment and type of procedure should be made individually. Because PTS is rarely a threat to life or limb, a minimally invasive treatment is preferred. Therefore, endovenous recanalization appears to be appropriate as the therapy of choice. In patients with involvement of the femoral confluence, endophlebectomy of the common femoral vein in addition to venous recanalization is inevitable to ensure an adequate inflow into the recanalized venous tract. It also secures a sufficient drainage of blood from the peripheral venous system. Because this hybrid procedure is burdened with a significantly higher risk of complications, strict criteria must be fulfilled to legitimize the indication for this procedure. For the best possible results to be achieved, the following perioperative and postoperative management must be considered: therapeutic anticoagulation, early mobilization, compression therapy, and systematic follow-up with duplex ultrasound.
KW - chronic venous obstruction
KW - clinical-experience
KW - common femoral vein
KW - disease
KW - editors choice
KW - endovenectomy
KW - endovenous recanalization
KW - post-thrombotic syndrome
KW - practice guidelines
KW - predictors
KW - prevention
KW - reconstruction
KW - stent
KW - stent angioplasty
KW - venous stents
KW - PRACTICE GUIDELINES
KW - Chronic venous obstruction
KW - RECONSTRUCTION
KW - Venous stents
KW - CLINICAL-EXPERIENCE
KW - Endovenous recanalization
KW - Stent angioplasty
KW - ENDOVENECTOMY
KW - COMMON FEMORAL VEIN
KW - PREDICTORS
KW - Post-thrombotic syndrome
KW - PREVENTION
KW - EDITORS CHOICE
KW - STENT
KW - DISEASE
U2 - 10.1016/j.jvsv.2019.01.062
DO - 10.1016/j.jvsv.2019.01.062
M3 - (Systematic) Review article
SN - 2213-333X
VL - 7
SP - 592
EP - 600
JO - Journal of Vascular Surgery: Venous and Lymphatic Disorders
JF - Journal of Vascular Surgery: Venous and Lymphatic Disorders
IS - 4
ER -