Management of Post Thrombotic Limb
Ramez Onsy Kamel;
Abstract
Post-thrombotic syndrome is a chronic disease following DVT, with significant impacts on patient quality of life and health-care burden, typical symptoms include pain, heaviness, swelling, and cramping of the leg, which are generally worsened by standing and exercising. Venous ulceration occurs in advanced cases, causing additional pain and disability and increasing the cost of treatment.
Venous hypertension caused by a persistent venous obstruction, valve incompetence, or a combination of the two is considered to be the major cause of PTS.
As with many diseases, prevention is key, and the most effective mode to decrease PTS is to prevent DVT. When DVT occurs, it should be rapidly treated with modern therapies in order to restore venous flow and preserve valve function.
Iliofemoral DVT represents the most extensive form of venous thrombosis, patients with iliofemoral DVT treated with anticoagulation alone suffer severe post thrombotic morbidity, nearly all will have deterioration of the quality of life.
Catheter-directed thrombolysis is now the most common form of intervention for extensive iliofemoral DVT with success exceeding 90%, CDT improved the clinically relevant long-term outcome after iliofemoral DVT by reducing PTS compared with conventional treatment with anticoagulation and elastic compression stockings alone.
The typical post-thrombotic iliofemoral lesion often involves both common and external iliac veins with irregular stenosis or occlusions, and axial, transpelvic, and ascending lumbar collaterals are present.
Iliac vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open veno-venous bypass procedures for iliac vein stenoses and chronic total occlusions, the current technique of venous stenting is carried out in an outpatient setting, and has excellent long - term patency, low morbidity, and excellent clinical outcome, iliocaval venous stenting alone is sufficient to control symptoms in the majority of patients with combined outflow obstruction and deep reflux.
With rapidly evolving stent technology, most CTO(complete total occlusion) lesions of the iliac veins, even those involving the inferior vena cava, can now corrected by recanalization procedures.
Venous hypertension caused by a persistent venous obstruction, valve incompetence, or a combination of the two is considered to be the major cause of PTS.
As with many diseases, prevention is key, and the most effective mode to decrease PTS is to prevent DVT. When DVT occurs, it should be rapidly treated with modern therapies in order to restore venous flow and preserve valve function.
Iliofemoral DVT represents the most extensive form of venous thrombosis, patients with iliofemoral DVT treated with anticoagulation alone suffer severe post thrombotic morbidity, nearly all will have deterioration of the quality of life.
Catheter-directed thrombolysis is now the most common form of intervention for extensive iliofemoral DVT with success exceeding 90%, CDT improved the clinically relevant long-term outcome after iliofemoral DVT by reducing PTS compared with conventional treatment with anticoagulation and elastic compression stockings alone.
The typical post-thrombotic iliofemoral lesion often involves both common and external iliac veins with irregular stenosis or occlusions, and axial, transpelvic, and ascending lumbar collaterals are present.
Iliac vein stenting technology is rapidly emerging as a minimally invasive alternative to traditional open veno-venous bypass procedures for iliac vein stenoses and chronic total occlusions, the current technique of venous stenting is carried out in an outpatient setting, and has excellent long - term patency, low morbidity, and excellent clinical outcome, iliocaval venous stenting alone is sufficient to control symptoms in the majority of patients with combined outflow obstruction and deep reflux.
With rapidly evolving stent technology, most CTO(complete total occlusion) lesions of the iliac veins, even those involving the inferior vena cava, can now corrected by recanalization procedures.
Other data
| Title | Management of Post Thrombotic Limb | Other Titles | علاج متلازمة ما بعد جلطة الساق الوريدية العميقة | Authors | Ramez Onsy Kamel | Issue Date | 2016 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G13077.pdf | 158.86 kB | Adobe PDF | View/Open |
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