Determinants of chronic venous disease after acute deep venous thrombosis
Determinants of chronic venous disease after acute deep venous thrombosis
复制标题
DOI：
10.1016/s0741-5214(98)70057-6
复制
发表时间：
1998-11-01
影响因子：
4.3
通讯作者：
Strandness, DE
中科院分区：
文献类型：
--
作者：
Meissner, MH;Caps, MT;Strandness, DE
目的：本研究的目的是评估急性深静脉血栓形成（DVT）的表现特征、血栓的后续自然史以及根据血管外科学会和国际心血管外科学会北美分会静脉疾病报告标准定义的最终结局之间的关系。方法：对急性DVT患者进行一系列临床和超声检查。根据报告标准对7个静脉节段内的血栓范围进行回顾性评分（评分范围为0 - 3分），节段反流评分为存在（1分）或不存在（0分）。初始和最终的血栓评分，再通率和再血栓形成，总反流分数，然后从这些分级量表和相关的最终慢性静脉疾病（CVD）classification.Results：68例急性DVT在73肢随访18至110个月（平均55 +/- 26个月）。在随访期结束时，20个肢体（27%）无症状（0级），13个肢体（18%）疼痛或浅静脉突出（1级），25个肢体（34%）出现水肿（3级），13个肢体（18%）出现色素沉着过度（4级），2个肢体（3%）出现溃疡（5级）。在单变量分析中，CVD分类与反流评分相关（P = 0.003），但与初始或最终血栓评分或再通率或再血栓形成率无关。在一个多变量模型中，只有胫骨血栓评分是CVD分类的重要预测因子（R-2 = 0.06）。结果是更好地预测（R-2 = .29）与模型，其中包括变量定义在后续-最终反流评分，最终腘评分，再通率。结论：急性DVT后，CVD的严重程度预测能力目前是有限的，虽然自然历史出现更重要的事件比呈现的功能。反流的程度、持续性腘动脉阻塞的存在和再通率与最终的CVD分类相关，但其他决定因素仍有待确定。
Purpose: The purpose of this investigation was to evaluate the relationship between the presenting features of an acute deep venous thrombosis (DVT), the subsequent natural history of the thrombus, and the ultimate outcome as defined according to the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery reporting standards in venous disease.Methods: Patients with an acute DVT were followed with serial clinical and ultrasound examinations. Thrombus extent within 7 venous segments was scored retrospectively according to the reporting standards (scores ranged from 0 to 3), and segmental reflux was scored as present (1) or not present (0). The initial and final thrombus scores, the rates of recanalization and rethrombosis, and the total reflux scores were then calculated from these grading scales and related to ultimate chronic venous disease (CVD) classification.Results: Sixty-eight patients with an acute DVT in 73 limbs were followed for 18 to 110 months (mean, 55 +/- 26 months). At the completion of the follow-up period, 20 extremities (27%) were asymptomatic (class 0), 13 (18%) had pain or prominent superficial veins (class 1), 25 (34%) had manifested edema (dass 3), 13 (18%) had developed hyperpigmentation (class 4), and 2 (3%) had developed ulceration (class 5). In a univariate analysis, CVD classification was correlated with the reflux score (P = .003) but not with the initial or final thrombus score or with the rate of recanalization or rethrombosis. In a multivariate model of features documented at presentation, only the tibial thrombosis score was a significant predictor of CVD classification (R-2 = .06). Outcome was better predicted (R-2 = .29) with a model that included variables defined during follow-up-the final reflux score, the final popliteal score, and the rate of recanalization.Conclusion: The ability to predict the severity of CVD after an acute DVT is currently limited, although the natural history appears more important than the presenting features of the event. The extent of reflux, the presence of persistent popliteal obstruction, and the rate of recanalization are related to ultimate CVD classification, but other determinants remain to be identified.