Chapter ElevenVenous Disease Coalition

Chronic Venous Insufficiency

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Post-Thrombotic VenousReflux Disease

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Seen in 20-50% of patients after DVT1

1. Deep vein valves become damaged by DVT resulting in venous valve failure

2. Reflux or backward flow in the deep veins occurs

3. Pooling of blood causes increased pressure in leg veins, edema, hyperpigmentation

Dilated VeinHeart

FootValve Open Valve

Closed

Leaky Valve

Normal Vein

Reproduced with permission of VNUS Medical Technologies, CA1. Antithrombotic and Thrombolytic Therapy 8th edition, ACCP Guidelines

Chronic Venous Disease

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TelangiectasesC1

Varicose veinsC2

PigmentationC4

Active UlcerationC6

Bergan – NEJM 2006;355:488

Post-Thrombotic Syndrome

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• Prospective study of 355 patients with DVT• All patients advised to wear 40 mmHg stockings

PTS - recurrent, ipsilateral DVT NOT - extent of DVT

Prandoni - Ann Intern Med (1996)

Years since Cumulative DVT Incidence of PTS

1 17 % 2 23 % 5 28 % 8 29 %

Prevention and Management ofPost-Thrombotic Syndrome

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• Prevent recurrent DVT with anticoagulation

• Encourage the obsessive use of good quality compression stockings = ESSENTIAL

• Encourage regular exercise

• Encourage normal body weight

• Avoid local trauma to the legs

• Aggressive management of stasis dermatitis

• Urgent expert treatment of early ulcers

Venous Disease Coalition

www.vasculardisease.org/venousdiseasecoalition/

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