title: Intravenous pressure changes in patients with postthrombotic deep venous obstruction: results using a treadmill stress test.
abstract: Essentials Little is known about the hemodynamic consequences of deep venous obstructive disease. We investigated pressure changes in 22 patients with unilateral postthrombotic obstruction. Common femoral vein pressure significantly increased after walking, compared to control limbs. Common femoral vein hypertension could explain the debilitating effect of venous claudication. Click to hear Dr Ten Cate's perspective on postthrombotic syndrome
  
  
  
  Background Little is known about the hemodynamic consequences of deep venous obstructive disease. Objectives The aim of this study was to investigate the hemodynamic effect of postthrombotic obstruction of the iliofemoral veins and to determine what pressure parameters differentiate best between limbs with post-thrombotic obstructive disease of the iliofemoral veins and those without obstruction. Methods Twenty-two participants with unilateral obstruction of the iliac and common femoral veins underwent a standardized treadmill test with simultaneous bilateral invasive pressure measurements in the common femoral vein and dorsal foot vein. Results Mean age was 42.8 ± 11.9 years and 86.4% of participants were female. Postthrombotic limbs showed a mean common femoral vein (CFV) pressure increase of 28.1 ± 21.0 mmHg after walking, compared with 2.1 ± 6.2 mmHg in control limbs (26.0 mmHg difference; 95% confidence interval [CI], 17.1-34.9). Less difference was observed in the dorsal foot vein (net drop of 36.8 ± 22.7 mmHg in affected limbs vs. 48.7 ± 23.1 mmHg in non-affected limbs, 11.9 mmHg difference; 95% CI, -1.3 to 25.0). Change in CFV pressure after walking yielded the best discrimination between affected and non-affected limbs (area under the receiver operated characteristic curve of 0.94 [95% CI, 0.85-1.00], compared with 0.57 [95% CI, 0.37-0.76] in the dorsal foot vein, P < 0.001). Conclusions Common femoral vein pressure significantly increases during ambulation in patients with iliofemoral postthrombotic obstruction, which could explain the debilitating effects of venous claudication. This is an indication that patients with an iliofemoral obstruction may benefit from further treatment that resolves the deep vein obstruction.
  
  
  
  https://clinicaltrials.gov/show/NCT01846780.
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
authors.forename: R L M
authors.identifier: 0000-0003-1742-964X
authors.initials: RL
authors.lastname: Kurstjens
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
authors.forename: M A F
authors.initials: MA
authors.lastname: de Wolf
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Konijn
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Toonder
authors.affiliation: Department of Epidemiology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: Department of Radiology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.|Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
authors.forename: C H A
authors.initials: CH
authors.lastname: Wittens
mesh_terms: D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D005080:Exercise Test; D005260:Female; D005268:Femoral Vein / Q000473:pathology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007084:Iliac Vein / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D010865:Pilot Projects; D054070:Postthrombotic Syndrome / Q000503:physiopathology*; D012372:ROC Curve; D015607:Stents; D014652:Vascular Diseases; D014689:Venous Insufficiency
keywords: hemodynamics; postthrombotic syndrome; pressure; thrombosis; veins