An objective assessment of the physiologic changes in the postthrombotic syndrome
L. A. Killewich, R. Martin, M. Cramer, K. W. Beach and D. E. Strandness Jr
To determine what physiologic changes might contribute to the development
of the postthrombotic syndrome, venous outflow, venous refilling time, and
valvular competence were assessed in 32 patients (39 limbs) with documented
deep venous thrombosis. The follow-up ranged from nine to 144 months (mean,
41 months) after the acute deep venous thrombosis. Pain was noted by 49% of
the patients, but more objective end points occurred less frequently
(edema, 21%; pigmentation, 26%; ulceration, 3%). Venous outflow was lower
in the affected limbs but was not a good indicator of those patients with
or without symptoms. Venous refilling time after calf compression was
markedly reduced in limbs with incompetent valves (mean +/- SD, 8.4 +/- 3.8
s v 25.3 +/- 12.1 s), as well as in those with edema, pigmentation, and
ulceration. It appears that most of the sequelae of the postthrombotic
syndrome can be attributed to the loss of valvular function.
