Hemodynamic changes in iliofemoral disease.
BACKGROUND
Iliofemoral venous obstruction, caused by post-thrombotic disease, can be treated by percutaneous angioplasty and additional stenting with good results. However, no hemodynamic parameter determining the need for treatment has been defined. This article describes the preliminary results of a study investigating the pressure changes occurring in post-thrombotic deep venous obstruction.


METHODS
Four patients with post-thrombotic deep venous obstruction of the iliofemoral tract were identified. Intravenous pressure was pre-operatively measured in the common femoral vein and in a dorsal foot vein bilaterally. During these pressure measurements patients were asked to walk on a treadmill with a speed of 3.2 km/h and a zero per cent slope, with the slope increasing two per cent every two minutes.


RESULTS
Four patients (two male, two female) with age varying from 23 to 40 were identified. In two patients, disease extended below the femoral confluence. Pressure in the dorsal foot vein was not notably different between the affected and the control side. Pressure in the common femoral vein was markedly higher in post-thrombotic limbs compared to the control limb, with ambulatory pressure increasing more in post-thrombotic limbs.


CONCLUSIONS
These preliminary results are highly illustrative for the hemodynamic effect of iliofemoral deep venous obstruction due to post-thrombotic disease, even though sample size is admittedly limited. Furthermore, these results suggest that pressure measurements of the common femoral vein, and not the dorsal foot vein, might be able to identify a significant outflow obstruction due to post-thrombotic disease, though further inclusion of patients is necessary.
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM, School for Cardiovascular Diseases, Maastricht, The Netherlands ralph.kurstjens@gmail.com.
Rlm
R
Kurstjens
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM, School for Cardiovascular Diseases, Maastricht, The Netherlands.
Maf
M
de Wolf
Department of radiology, Maastricht University Medical Centre, Maastricht, The Netherlands Department of vascular surgery, University Hospital Aachen, Aachen, Germany.
R
R
de Graaf
Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands CARIM, School for Cardiovascular Diseases, Maastricht, The Netherlands Department of vascular surgery, University Hospital Aachen, Aachen, Germany.
Cha
C
Wittens
Deep venous obstruction; common femoral vein; dorsal foot vein; hemodynamic changes; intravenous pressure; post-thrombotic syndrome; stenting; treadmill; venous claudication