Kolbach D N, Neumann H A M, Prins M H
Department of Epidemiology, University Maastricht, Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2005 Oct;30(4):404-14. doi: 10.1016/j.ejvs.2005.06.006.
Accepted diagnostic criteria exist for the diagnosis of deep vein thrombosis (DVT). However, no uniform definition for the diagnosis and treatment of the post-thrombotic syndrome (PTS) exists. We examined the various definitions of PTS that are used and their relationships with invasive venous pressure measurement.
Patients who had previously suffered a documented DVT underwent clinical evaluation of both lower limbs in which we used five clinical definitions to grade PTS. We included the definition of Widmer, the CEAP classification, the venous clinical severity score (also without compression therapy), and the definitions according to Prandoni and Brandjes in the evaluation. We compared all the clinical scoring systems with invasive ambulatory venous pressure measurement.
In total 124 patients were enrolled in whom both legs were evaluated. Thirteen patients had previously suffered bilateral DVT and nine patients had had an ipsilateral recurrent DVT. In the limbs with DVT, 10 (7%) to 29 (21%) were defined as severe PTS, compared to 0-4 (4%) in the control legs. Mild-to-moderate PTS in the DVT legs ranged from 23 to 49%, compared to 13-34% in the control legs. Overall the presence of any PTS in the DVT legs varied from 30% (VCS without compression) to 66% (Brandjes). The scoring systems of Brandjes and VCS showed a tendency towards more legs to be defined as severe PTS. Absolute frequencies of PTS in DVT legs were highest for the classifications according to Widmer, Prandoni and Brandjes. Differences in proportions of any PTS calculated between DVT and control legs varied from 18 to 39%, while odds ratios varied between 2.2 and 5.2 for the different definitions. The CEAP classification and definition of Brandjes show a moderate relation to Widmer, kappa=0.53 and 0.52, respectively. The VCS shows in all comparisons a poor correlation (kappa 0.22-0.41). Prandoni has a moderate correlation with most definitions (kappa 0.40-0.44).
All clinical definitions of PTS were highly associated with the reference standard of ambulatory venous pressure, with higher AVPs observed in the more severely affected groups. The ability of the scoring systems to discriminate between DVT and control legs as well as the observed prevalence of PTS differed substantially. In part this is due to the considerable overlap in AVP in the different clinical groups, reflecting the fact that our reference standard has substantial deficiencies. No clear advantage was found in any one system of classification over the rest.
深静脉血栓形成（DVT）的诊断有公认的诊断标准。然而，对于血栓形成后综合征（PTS）的诊断和治疗尚无统一的定义。我们研究了所使用的PTS的各种定义及其与有创静脉压力测量的关系。
对既往有DVT记录的患者进行双下肢临床评估，我们使用五种临床定义对PTS进行分级。评估中包括维德默（Widmer）的定义、CEAP分类、静脉临床严重程度评分（也不包括压迫治疗）以及普兰多尼（Prandoni）和布兰德耶斯（Brandjes）的定义。我们将所有临床评分系统与有创动态静脉压力测量进行比较。
共纳入124例患者并对其双下肢进行评估。13例患者既往有双侧DVT，9例有同侧复发性DVT。在有DVT的肢体中，10例（7%）至29例（21%）被定义为重度PTS，而对照侧下肢为0 - 4例（4%）。DVT侧下肢轻度至中度PTS的比例为23%至49%，而对照侧下肢为13% - 34%。总体而言，DVT侧下肢存在任何PTS的比例在30%（无压迫的VCS）至66%（布兰德耶斯定义）之间。布兰德耶斯和VCS的评分系统显示有更多肢体被定义为重度PTS的趋势。根据维德默、普兰多尼和布兰德耶斯的分类，DVT侧下肢PTS的绝对频率最高。DVT侧下肢与对照侧下肢计算出的任何PTS比例差异在18%至39%之间，而不同定义的优势比在2.2至5.2之间。CEAP分类和布兰德耶斯的定义与维德默的定义呈中度相关，kappa值分别为0.53和0.52。在所有比较中，VCS显示出较差的相关性（kappa值为0.22 - 0.41）。普兰多尼与大多数定义呈中度相关（kappa值为0.40 - 0.44）。
PTS的所有临床定义均与动态静脉压力的参考标准高度相关，在受影响更严重的组中观察到更高的平均静脉压（AVP）。评分系统区分DVT侧下肢与对照侧下肢的能力以及观察到的PTS患病率有很大差异。部分原因是不同临床组的AVP有相当大的重叠，这反映出我们的参考标准存在重大缺陷。没有发现任何一种分类系统相对于其他系统有明显优势。
