Evolution of deep venous thrombosis: a 2-year follow-up using duplex ultrasound scan and strain-gauge plethysmography

J H Haenen, H Wollersheim, M C Janssen, M A Van 't Hof, P M Steijlen, H van Langen, S H Skotnicki, T Thien
Journal of Vascular Surgery 2001, 34 (4): 649-55

OBJECTIVE: The development of the post-thrombotic syndrome (PTS) and recurrence of deep venous thrombosis (DVT) are not yet fully understood. The aim of the study was to identify factors that lead to the long-term complications of DVT.

METHODS: In a 2-year prospective follow-up study, duplex scanning and strain-gauge plethysmography were used to evaluate DVT in relation to the development of long-term complications. Each of the 12 segments examined was assigned as a thrombosis score (TS). A total TS was calculated for each leg. Patent segments were assigned a TS = 0, noncompressible vein segments with flow TS = 1 and noncompressible vein segments without flow TS = 2. The degree of resolution of DVT and the incidence, timing, and outcome of further thrombotic events were measured during 24 months of follow-up.

RESULTS: The study involved 86 legs with DVT. The 2-year follow-up was completed for 70 legs. Within 3 months, only 1% of the originally occluded proximal deep vein segments were still occluded. Between all time intervals, from month 12 to month 24, for example, thrombus regression continued in 36% of the legs and thrombus propagation continued in 27%. Multiple regression analysis revealed that an increase in age (P = .008) and proximal location of the original DVT (P = .05) was significantly related to thrombus propagation. Multiple regression analysis showed that the risk factors for clinical signs of PTS were a high venous outflow resistance after 1-month and 12-month follow-ups (P <or= .002) and a high thrombosis score in the proximal veins after 3 months (P = .008).

CONCLUSIONS: In the follow-up of older patients and patients with proximal DVT, evolution was shown to be an unstable process with continuing propagation for 2 years. The risk factors for the development of PTS were a slow decrease in venous outflow resistance or a high thrombosis score of the proximal veins after 3 months.

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