Venous claudication in iliofemoral thrombosis - Long-term effects on venous hemodynamics, clinical status, and quality of life
Venous claudication in iliofemoral thrombosis - Long-term effects on venous hemodynamics, clinical status, and quality of life
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DOI：
10.1097/01.sla.0000103067.10695.74
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发表时间：
2004-01-01
影响因子：
9
通讯作者：
Mansfield, AO
中科院分区：
文献类型：
--
作者：
Delis, KT;Bountouroglou, D;Mansfield, AO
目的：评估髂股血栓形成(I-F-DVT)对步行能力、静脉血流动力学状态、CEAP分级、静脉临床严重程度和生活质量的长期影响，并确定静脉跛行的发生率。材料和方法：对1990年以来在我所就诊的所有既往I-F-DVT患者进行随访。排除因动脉疾病(运动后ABI<；1.0)或无相关原因导致的行走障碍和血栓溶解的患者；纳入39例患者(年龄22-83岁，中位年龄46岁)。中位随访期为5年(1~23年)。检查包括CEAP和静脉临床严重程度评分(VCSS)系统的分类，空气容积描记(流出分数[OF]，静脉充盈指数[VFI]，残余容量分数[RVF])和静脉双功，跑步机(3.5公里/b，10%)以确定初始(ICD)和绝对(ACD)跛行距离，以及生活质量评估(SF-36)。对照组为单侧I-F-DVT患者健侧肢体(37/39)。结果：I-F-DVT患肢81%有浅、深反流，19%有浅表返流，对照侧分别为29.7%(P<；0.001)和27%(P>；0.2)，43.6%(17/39；95%CI，27~60%)发生同侧静脉跛行。NG 15.4%(6/39；95%氯，3.5~27%)用于停止跑台(ACD：241m，范围137-298m)。有I-F-DVT史的患肢VFI降低37%(32.2-43%，P<；0.001)，VFI异常升高(3.8mL/S，2.5-5.7mL/S；P<；0.001)，RVF降低(45%，32.5-51.5%，P=0.006)，临床功能受损。I-F-DVT患者的躯体功能(P=0.02)、角色(P=0.033)、一般健康(P=0.001)、社会功能(P=0.047)和心理健康(P=0.043)均受损。既往的I-F-DVT导致流出功能障碍、大的残余静脉容量和返流，导致明显的临床和生活质量的损害。标准化的挑战使那些有临床相关损害的人能够被区别对待。
Objective: We evaluated the long-term impact of iliofemoral thrombosis (I-F-DVT) on walking capacity, venous hemodynamic status, CEAP class, venous clinical severity, and quality of life, and determined the prevalence of venous claudication.Materials and Methods: All patients with prior I-F-DVT, assessed at our institution since 1990, were called for follow-up. Those with walking impairment due to arterial disease (ABI < 1.0 postexercise) or unrelated causes and those thrombectornized or thrombolyzed were excluded; 39 patients (22-83 years, median 46 years) were included. Median follow-up was 5 years (range 1-23 years). Investigation included classification in CEAP and Venous Clinical Severity Scoring (VCSS) systems, air-plethysmography (outflow fraction [OF], venous filling index [VFI], residual volume fraction [RVF]) and venous duplex, treadmill (3.5 km/b, 10%) to determine initial (ICD) and absolute (ACD) claudication distances, and quality of life assessment (SF-36). Nonaffected limbs of patients with unilateral I-F-DVT (37 of 39) comprised the control group. Data are presented as median and interquartile range.Results: A total of 81% of limbs with I-F-DVT had superficial and deep reflux and 19% superficial reflux; reflux in control limbs was 29.7% (P < 0.001) and 27% (P > 0.2), respectively; 43.6% (17 of 39; 95% CI, 27-60%) of patients developed venous claudication ipsilateral to I-FDVT (ICD: 130 m, range 105-268 m), compelli. ng 15.4% (6 of 39; 95% Cl, 3.5-27%) to discontinue treadmill (ACD: 241 m, range 137-298 m). Limbs with prior I-F-DVT had a lower OF (37%, range 32.2-43%; P < 0.001), abnormally higher VFI (3,8 mL/s, range 2.5-5.7 mL/s; P < 0.001), and RVF (45%, range 32.5-51.5%; P = 0.006), and clinical impairment in CEAP and VCSS systems (P < 0.0001). Patients with I-F-DVT had impaired physical functioning (P = 0.02) and role (P = 0.033), general health (P = 0.001), social function (P = 0.047), and mental health (P = 0.043).Conclusions: A total of 43.6% of those with prior I-F-DVT developed venous claudication compelling interruption of walking in 15.4%. Prior I-F-DVT caused outflow impairment and a large residual venous volume and reflux, resulting in marked clinical and quality of life compromise. Standardized challenge enabled discrimination of those with clinically relevant impairment.