Outcome after bilateral deep vein thrombosis.

Background: The aim of our study was to assess how often deep vein thrombosis (DVT) occurs bilaterally and if this has an impact on the recurrence rate of thromboembolic disease and on the occurrence of malignant tumors. Additionally, the occurrence of pulmonary embolism and mortality of patients was assessed. Patients and methods: For this observational study, we retrospectively screened all patient's records for DVT, investigated between 2000 and 2017. 2409 patients with the diagnosis of DVT were found. The patients aged between 18 and 89 years old in 2017, received a follow-up questionnaire, asking for thromboembolic recurrence, malignant tumors and pulmonary embolism. 755 patients were included in the follow-up cohort (604 with unilateral, 151 with bilateral DVT). We performed nonparametric tests to assess two group analysis. Results: Bilateral DVT occurred in 19% of the patients in this cohort. Patients with bilateral DVT develop significantly more often cancer, either at the time of diagnosis or in the follow up, compared to patients with unilateral DVT (22.5% vs. 15.4%, p=0.036). They also endure significantly more often pulmonary embolism simultaneously (33.8% vs. 20.8%, p<0.001). Patients with bilateral DVT were significantly older (median 69 years) than patients with unilateral DVT (median 63 years, p<0.001). In addition, patients with bilateral DVT show a higher mortality (9.1% vs. 5.2%, p=0.002), a higher recurrence rate could not be observed. Conclusions: Bilateral DVT is more common than published so far. Patients with bilateral DVT suffer more often from malignant tumors, and are more often diagnosed with pulmonary embolism. The patients with bilateral DVT are older and have a higher mortality. Further investigations should address the issue of recurrent thromboembolic disease in a prospective cohort study.

Comparison of the standardized Valsalva manoeuvre versus the cuff deflation method to elicit venous reflux.

Background: Two standardized methods to detect venous reflux, the Valsalva manoeuvre (VM) and the cuff deflation method (CM) are compared. Patients and methods: We included 72 patients with varicose veins (VV) and 106 patients with deep vein thrombosis (DVT). The proximal leg veins were examined. A survey was sent to the members of the Union of Vascular Societies to assess, which methods are used in the clinical practice. Results: In the VV-group the correlation coefficient (VM vs CM) for the reflux time (RT) amounted to 0.44 (p<0.0001) for the common femoral vein (CFV) and 0.4 for the femoral vein (FV) (p=0.0003). The sensitivity of the two tests in the VV group amounted to 87.5% for both methods in the CFV (p=0.4). The sensitivity for the FV amounted to 87.5% for the VM and 71.4% for the CM (p=0.4). In the DVT - group the correlation coefficient (VM vs CM) for RT amounted to 0.62 for the CFV (p<0.0001) and 0.77 for the FV (p<0.0001), as well as to 0.6 for the great saphenous vein (GSV) (p<0.0001). The sensitivity of the two tests amounted to 50.0% for the VM and 42.9% for the CM in the CFV (p=0.5). The sensitivity, if reflux was measured in the FV, amounted to 42.9% for the VM and 50.0% for the CM (p=0.5). 87.3% of the doctors who answered the survey use a non-standardized reflux measurement method. Conclusions: Both methods of reflux measurement (VM, CM) are comparable. Further studies have to address the issue, whether non standardized methods are as accurate as the standardized manoeuvres.

[The Postthrombotic Syndrome]. / Das postthrombotische Syndrom.

The Postthrombotic Syndrome Abstract. The postthrombotic syndrome is defined by clinical signs (objectively assessed findings) and complaints that occur after a deep vein thrombosis. The most commonly used score is the Villalta score, but the most easily applicable is the Ginsberg score (pain, swelling > 1 month). Unfortunately, the current scores are not specific in this respect and are used differently in the different studies. The natural course of deep vein thrombosis during anticoagulation and the occurrence of a postthrombotic syndrome are important predictors of the long-term outcome. Four large controlled studies examined the effect of compression stockings on the development of a postthrombotic syndrome, they are summarized and discussed in this paper. Whether compression stocking do or do not prevent a postthrombotoc syndrome is questioned. Duplex sonographic findings such as residual thrombusload and postthrombotic venous reflux are unfortunately not predictive for the development of a postthrombotic syndrome, as shown in a prospective study.

[Duplexsonography investigation in patients with venous ulcer]. / Grundelemente der sonographischen Venenabklärung beim offenen Bein.

Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended.