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Underlying factors influencing the development of the post-thrombotic limb
A M O'Shaughnessy1, D E Fitzgerald
1Vascular Medicine Unit, James Connolly Memorial Hospital, Dublin, Ireland. defvmu@iol.ie
Insights
Underlying venous disease in the opposite limb predicts worse outcomes after deep vein thrombosis (DVT). Contralateral venous dysfunction indicates ipsilateral disease severity, influenced by initial risk factors.
Area of Science:
- Vascular Medicine
- Venous Thromboembolism Research
- Clinical Outcomes Assessment
Background:
- Deep vein thrombosis (DVT) can lead to chronic venous disease.
- The impact of contralateral venous health on ipsilateral DVT outcomes is not fully understood.
Purpose of the Study:
- To investigate if underlying venous disease in the contralateral limb correlates with more severe long-term clinical outcomes in the ipsilateral limb post-DVT.
- To identify other factors influencing long-term DVT outcomes.
Main Methods:
- Acute DVT diagnosed via duplex ultrasound.
- Follow-up included clinical exams and bilateral duplex reflux studies for up to 3 years.
- Patients grouped by history of contralateral DVT; outcomes assessed using CEAP classification.
Main Results:
- Sixty-three patients followed for a mean of 3 years.
- Significant symptom incidence in both ipsilateral and contralateral limbs.
- Contralateral venous dysfunction severity correlated with ipsilateral disease severity and nonreversible risk factors.
Conclusions:
- A significant proportion of DVT patients have pre-existing contralateral venous disease.
- Ipsilateral post-thrombotic limb development is more likely with primary venous reflux.
- Contralateral venous dysfunction level predicts ipsilateral disease severity; initial risk factors are influential.
Purpose:
This study was designed to determine whether patients having underlying venous disease in their contralateral limbs indicates a more severe long-term clinical outcome in the ipsilateral limb after a deep vein thrombosis (DVT) and to determine what other factors may influence the long-term outcome.
Methods:
An acute DVT was initially diagnosed by means of duplex ultrasound scanning. Follow-up clinical examinations and bilateral duplex reflux studies were performed for a mean period as long as 3 years. The patients were divided into two groups: group I, those with no history of a contralateral DVT, and group II, those with a history of a contralateral DVT. The patients were classified at their final examination according to the Clinical, Etiology, Anatomic, Pathophysiologic (CEAP) classification, and the ipsilateral and contralateral limbs were compared. Predisposing factors were compared with the final clinical outcome.
Results:
Sixty-three patients were monitored in a mean follow-up period of 3 years. There was a significant difference in the incidence of symptoms between the ipsilateral limbs (P <.01) and the contralateral limbs (P <.001) for both groups. There was no significant difference between the incidence of superficial reflux between the ipsilateral and contralateral limbs, but the deep venous system and perforator veins were involved more often in the ipsilateral limbs. In group I, only six patients (10%) had no evidence of venous dysfunction (CEAP = 0) in their ipsilateral or contralateral limbs at the time of the final examination, and all patients had reversible risk factors. Of patients who had a mild clinical outcome (CEAP score, 1 to 3), 64% had a healthy contralateral limb, and the remaining 36% had mild to moderate disease. Eighty percent of patients with the most severe clinical outcome (CEAP > 3) had mild to moderate venous disease in their contralateral limb and had nonreversible risk factors.
Conclusion:
There are a significant number of patients with an acute DVT who had an underlying venous disease in the uninvolved contralateral limb. An ipsilateral post-thrombotic limb is more likely to develop in patients with primary venous reflux after an acute DVT. The level of venous dysfunction in the contralateral limb is an indication of the severity of disease developing in the ipsilateral limb. The initial risk factors of the patients have an influence on the final clinical outcome.