Factors predicting development of post-thrombotic syndrome in patients with a first episode of deep vein thrombosis: preliminary report.
OBJECTIVE
To investigate the indicative parameters reflecting the progression of post-thrombotic syndrome (PTS) in patients with a first episode of deep vein thrombosis (DVT).


METHODS
The patients' initial risk factors were assessed at presentation. Venous occlusion, and reflux and reflux parameters were evaluated at 6 months using venous duplex scanning. Near-infrared spectroscopy (NIRS) was also used to measure calf muscle deoxygenated haemoglobin levels at 6 months. Clinical manifestations were categorised using the clinical, etiologic, anatomic and pathophysiologic (CEAP) classification for chronic venous insufficiency (CVI), and the patients were divided into those having no PTS (C(0-3S),E(s),A(s,d,p),P(r,o)) and those having PTS (C(4-6S),E(s),A(s,d,p),P(r,o)).


RESULTS
Of the 121 patients evaluated, 25 (21%) developed PTS with a mean follow-up period of 66 months. At initial presentation, ilio-femoral DVT (odds ratio (OR) 3.4, 95% confidence interval (CI) 1.4-8.6) was associated with development of PTS. At 6 months, venous occlusion combined with reflux (OR 4.4, 95% CI 2.9-20.7), peak reflux velocity >29.7 cm s(-1) (OR 13.7, 95% CI 4.1-45.7) and mean reflux velocity >8.6 cm s(-1) (OR 4.4, 95% CI 1.5-12.9) in the popliteal vein detected by duplex scanning were strong predictors of PTS. NIRS-derived retention index >3.5 was the strongest predictor of PTS at 6 months (OR 67.4, 95% CI 14.3-318.1).


CONCLUSIONS
Ilio-femoral DVT is associated with the development of PTS at initial presentation. By contrast, occlusion and reflux, high reflux velocity in the popliteal vein and increased NIRS-derived retention index are important time-course predictors of PTS progression.
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. yamaki@prs.twmu.ac.jp
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T
Yamaki
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A
Hamahata
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K
Soejima
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Kono
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M
Nozaki
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H
Sakurai
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D054070:Postthrombotic Syndrome / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared; D018616:Ultrasonography, Doppler, Duplex; D014690:Venous Pressure / Q000502:physiology; D020246:Venous Thrombosis / Q000503:physiopathology*