[Post-thrombotic valvular lesions]

Area of Science:

• Vascular Surgery
• Venous Thromboembolism Research
• Diagnostic Imaging in Phlebology

Context:

• Deep vein thrombosis (DVT) can result in significant venous valve damage within months.
• Post-thrombotic valve destruction is diagnosed by venous reflux consequences.
• Current diagnostic methods like photoplethysmography and phlebography have limitations in sensitivity and specificity.

Purpose:

• To evaluate diagnostic methods for post-thrombotic venous valve destruction.
• To compare the impact of valve destruction versus non-repermeation on skin trophicity.
• To assess the efficacy and outcomes of surgical repair for severe cases.

Summary:

• Ultrasonography-Doppler is the preferred initial diagnostic tool for identifying, localizing, and quantifying venous reflux post-DVT.
• Dynamic popliteal phlebography in an upright position is considered a reference standard.
• Valve destruction leads to worse skin trophicity issues than non-repermeation, necessitating surgical consideration in young patients.

Impact:

• Ultrasonography-Doppler offers a reliable, accessible method for diagnosing venous reflux and guiding treatment decisions.
• Surgical interventions like transposition, transplantation, and valvuloplasty are options for severe cases unresponsive to medical treatment.
• Surgical repair success rates are around 50%, highlighting the complexity and challenges in managing post-thrombotic venous insufficiency.