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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
The predictive value of haemodynamic parameters for outcome of deep venous reconstructions in patients with chronic
Rlm Kurstjens1,2, Maf de Wolf1,2, J Kleijnen3
11 Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Insights
Predicting the success of deep venous obstruction treatments like stenting or bypass surgery using hemodynamic parameters is challenging. Current data quality is poor, with reduced femoral inflow showing some predictive value for stent issues.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Medical Prognostics
Background:
- Deep venous obstruction, both non-thrombotic and post-thrombotic, poses significant clinical challenges.
- Stenting and bypass surgery are treatment options, but predicting their success remains difficult.
- Hemodynamic parameters are potential predictors of treatment outcomes in these conditions.
Purpose of the Study:
- To evaluate the predictive value of hemodynamic parameters for the success of stenting or bypass surgery in deep venous obstruction.
- To assess the reliability of existing hemodynamic measurements in guiding treatment decisions.
- To identify key hemodynamic factors that correlate with positive or negative treatment outcomes.
Main Methods:
- A systematic literature search was conducted on EMBASE, MEDLINE, and trial registries up to February 5, 2016.
- Studies included stenting or bypass surgery for non-thrombotic or post-thrombotic deep venous obstruction with available hemodynamic data and prognostic analysis.
- Data extraction and risk of bias assessment were performed independently by two authors using the Quality in Prognosis Studies tool.
Main Results:
- Four studies were included (2 stenting, 2 bypass surgery).
- Plethysmography showed variable results and was not deemed valuable for predicting outcomes.
- Reduced femoral inflow was a predictor for stent stenosis or occlusion, though confounding factors were present.
Conclusions:
- Evidence on hemodynamic parameters predicting treatment success in deep venous obstructive disease is scarce and of low quality.
- Plethysmography is unlikely to predict the outcome of stenting or bypass surgery in post-thrombotic disease.
- Reduced common femoral vein inflow may predict in-stent stenosis/occlusion, warranting further research into new predictive hemodynamic techniques.
Abstract:
Objective The aim of this study was to investigate the predictive value of haemodynamic parameters on success of stenting or bypass surgery in patients with non-thrombotic or post-thrombotic deep venous obstruction. Methods EMBASE, MEDLINE and trial registries were searched up to 5 February 2016. Studies needed to investigate stenting or bypass surgery in patients with post-thrombotic obstruction or stenting for non-thrombotic iliac vein compression. Haemodynamic data needed to be available with prognostic analysis for success of treatment. Two authors, independently, selected studies and extracted data with risk bias assessment using the Quality in Prognosis Studies tool. Results Two studies using stenting and two using bypass surgery were included. Three investigated plethysmography, though results varied and confounding was not properly taken into account. Dorsal foot vein pressure and venous refill times appeared to be of influence in one study, though confounding by deep vein incompetence was likely. Another investigated femoral-central pressure gradients without finding statistical significance, though sample size was small without details on statistical methodology. Reduced femoral inflow was found to be a predictor for stent stenosis or occlusion in one study, though patients also received additional surgery to improve stent inflow. Data on prediction of haemodynamic parameters for stenting of non-thrombotic iliac vein compression were not available. Conclusions Data on the predictive value of haemodynamic parameters for success of treatment in deep venous obstructive disease are scant and of poor quality. Plethysmography does not seem to be of value in predicting outcome of stenting or bypass surgery in post-thrombotic disease. The relevance of pressure-related parameters is unclear. Reduced flow into the common femoral vein seems to be predictive for in-stent stenosis or occlusion. Further research into the predictive effect of haemodynamic parameters is warranted and the possibility of developing new techniques that evaluate various haemodynamic aspects should be explored.
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