Kovač Ana, Janić Miodrag, Nuredini Dašmir, Kozak Matija
Department of Cardiology, University Medical Centre Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Slovenia.
Vasa. 2019 Aug;48(5):393-398. doi: 10.1024/0301-1526/a000776. Epub 2019 Mar 8.
The mechanism for post-thrombotic syndrome (PTS), the most important long-term sequelae of deep venous thrombosis, is not entirely known. It is probably caused by venous hypertension due to venous insufficiency and venous obstruction. Venous hypertension could also be a consequence of the May-Thurner syndrome (MTS), i.e. the obstruction of the common iliac vein. The aim of the present study was to explore if women with untreated MTS and a history of proximal DVT develop PTS more frequently. A cohort of 68 female patients with a history of proximal left-sided DVT in the past were evaluated. According to Villalta score, they were segregated in two groups - with and without PTS (Villalta score ≥ 5 or < 5 points, respectively). For the diagnosis of MTS, magnetic resonance venography was performed. Out of 68 patients, 25 developed PTS (36.8 %). Recurrent DVT, older age, pre-existent chronic venous insufficiency, and shorter compression stockings wearing time were statistically related to PTS. Deep and superficial valve incompetence was also significantly related to PTS, while incomplete thrombus removal showed only a trend towards PTS development. On the other hand, MTS turned out not to be linked to PTS. Our study suggests that women with MTS might not develop PTS more often, which puts aggressive treatment of MTS under question. More clinical trials are warranted to further examine this yet not fully explained field.
血栓形成后综合征（PTS）是深静脉血栓形成最重要的长期后遗症，其发病机制尚不完全清楚。它可能是由静脉功能不全和静脉阻塞导致的静脉高压引起的。静脉高压也可能是梅-图二氏综合征（MTS）的结果，即髂总静脉阻塞。本研究的目的是探讨未经治疗的MTS且有近端深静脉血栓形成病史的女性是否更易发生PTS。对一组68例有既往近端左侧深静脉血栓形成病史的女性患者进行了评估。根据维拉尔特评分，她们被分为两组——有和没有PTS（维拉尔特评分分别≥5分或<5分）。为诊断MTS，进行了磁共振静脉造影。68例患者中，25例发生了PTS（36.8%）。复发性深静脉血栓形成、年龄较大、既往存在慢性静脉功能不全以及穿弹力袜时间较短与PTS在统计学上相关。深静脉和浅静脉瓣膜功能不全也与PTS显著相关，而血栓清除不完全仅显示出有发生PTS的趋势。另一方面，结果表明MTS与PTS无关。我们的研究表明，患有MTS的女性可能不会更频繁地发生PTS，这使得对MTS进行积极治疗受到质疑。需要更多的临床试验来进一步研究这个尚未完全阐明的领域。
