Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life.
OBJECTIVE
We evaluated the long-term impact of iliofemoral thrombosis (I-FDVT) on walking capacity, venous hemodynamic status, CEAP class, venous clinical severity, and quality of life, and determined the prevalence of venous claudication.


METHODS
All patients with prior I-FDVT, assessed at our institution since 1990, were called for follow-up. Those with walking impairment due to arterial disease (ABI < 1.0 postexercise) or unrelated causes and those thrombectomized or thrombolyzed were excluded; 39 patients (22-83 years, median 46 years) were included. Median follow-up was 5 years (range 1-23 years). Investigation included classification in CEAP and Venous Clinical Severity Scoring (VCSS) systems, air-plethysmography (outflow fraction [OF], venous filling index [VFI], residual volume fraction [RVF]) and venous duplex, treadmill (3.5 km/h, 10%) to determine initial (ICD) and absolute (ACD) claudication distances, and quality of life assessment (SF-36). Nonaffected limbs of patients with unilateral I-FDVT (37 of 39) comprised the control group. Data are presented as median and interquartile range.


RESULTS
A total of 81% of limbs with I-FDVT had superficial and deep reflux and 19% superficial reflux; reflux in control limbs was 29.7% (P < 0.001) and 27% (P > 0.2), respectively; 43.6% (17 of 39; 95% CI, 27-60%) of patients developed venous claudication ipsilateral to I-FDVT (ICD: 130 m, range 105-268 m), compelling 15.4% (6 of 39; 95% CI, 3.5-27%) to discontinue treadmill (ACD: 241 m, range 137-298 m). Limbs with prior I-FDVT had a lower OF (37%, range 32.2-43%; P < 0.001), abnormally higher VFI (3.8 mL/s, range 2.5-5.7 mL/s; P < 0.001), and RVF (45%, range 32.5-51.5%; P = 0.006), and clinical impairment in CEAP and VCSS systems (P < 0.0001). Patients with I-FDVT had impaired physical functioning (P = 0.02) and role (P = 0.033), general health (P = 0.001), social function (P = 0.047), and mental health (P = 0.043).


CONCLUSIONS
A total of 43.6% of those with prior I-FDVT developed venous claudication compelling interruption of walking in 15.4%. Prior I-FDVT caused outflow impairment and a large residual venous volume and reflux, resulting in marked clinical and quality of life compromise. Standardized challenge enabled discrimination of those with clinically relevant impairment.
Delis
Konstantinos T
KT
St Mary's Hospital, Imperial College, Academic Vascular Surgery, London, UK. k.delis@ic.ac.uk
Bountouroglou
Dimitris
D
Mansfield
Averil O
AO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D005080:Exercise Test; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D007383:Intermittent Claudication / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010991:Plethysmography / Q000379:methods; D011336:Probability; D011788:Quality of Life; D011859:Radiography; D012494:Sampling Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000379:methods*; D013924:Thrombophlebitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013995:Time
D000925:Anticoagulants