Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
J Thromb Haemost. 2016 Jun;14(6):1163-70. doi: 10.1111/jth.13333. Epub 2016 May 31.
Essentials Little is known about the hemodynamic consequences of deep venous obstructive disease. We investigated pressure changes in 22 patients with unilateral postthrombotic obstruction. Common femoral vein pressure significantly increased after walking, compared to control limbs. Common femoral vein hypertension could explain the debilitating effect of venous claudication. Click to hear Dr Ten Cate's perspective on postthrombotic syndrome
Background Little is known about the hemodynamic consequences of deep venous obstructive disease. Objectives The aim of this study was to investigate the hemodynamic effect of postthrombotic obstruction of the iliofemoral veins and to determine what pressure parameters differentiate best between limbs with post-thrombotic obstructive disease of the iliofemoral veins and those without obstruction. Methods Twenty-two participants with unilateral obstruction of the iliac and common femoral veins underwent a standardized treadmill test with simultaneous bilateral invasive pressure measurements in the common femoral vein and dorsal foot vein. Results Mean age was 42.8 ± 11.9 years and 86.4% of participants were female. Postthrombotic limbs showed a mean common femoral vein (CFV) pressure increase of 28.1 ± 21.0 mmHg after walking, compared with 2.1 ± 6.2 mmHg in control limbs (26.0 mmHg difference; 95% confidence interval [CI], 17.1-34.9). Less difference was observed in the dorsal foot vein (net drop of 36.8 ± 22.7 mmHg in affected limbs vs. 48.7 ± 23.1 mmHg in non-affected limbs, 11.9 mmHg difference; 95% CI, -1.3 to 25.0). Change in CFV pressure after walking yielded the best discrimination between affected and non-affected limbs (area under the receiver operated characteristic curve of 0.94 [95% CI, 0.85-1.00], compared with 0.57 [95% CI, 0.37-0.76] in the dorsal foot vein, P < 0.001). Conclusions Common femoral vein pressure significantly increases during ambulation in patients with iliofemoral postthrombotic obstruction, which could explain the debilitating effects of venous claudication. This is an indication that patients with an iliofemoral obstruction may benefit from further treatment that resolves the deep vein obstruction.
本研究旨在探讨髂股静脉血栓后阻塞的血液动力学效应，并确定哪些压力参数能最好地区分髂股静脉血栓后阻塞性疾病肢体与无阻塞性疾病肢体。
22 名单侧髂股静脉阻塞患者接受了标准化跑步机测试，并同时进行双侧股总静脉和足背静脉的侵入性压力测量。
平均年龄为 42.8±11.9 岁，86.4%的参与者为女性。与健侧相比，血栓后肢体在行走后股总静脉（CFV）压力平均增加 28.1±21.0mmHg，而健侧增加 2.1±6.2mmHg（26.0mmHg 差异；95%置信区间[CI]，17.1-34.9）。在足背静脉中观察到的差异较小（患侧净下降 36.8±22.7mmHg，非患侧净下降 48.7±23.1mmHg，11.9mmHg 差异；95%CI，-1.3 至 25.0）。行走后 CFV 压力的变化对区分患侧和非患侧肢体的效果最好（接受者操作特征曲线下面积为 0.94[95%CI，0.85-1.00]，而足背静脉为 0.57[95%CI，0.37-0.76]，P<0.001）。
在髂股静脉血栓后阻塞的患者中，股总静脉压力在行走时显著增加，这可能解释了静脉跛行的衰弱效应。这表明髂股静脉阻塞的患者可能受益于进一步治疗，以解决深静脉阻塞。
