Symptomatic venous hypertension because of occult iliofemoral deep vein thrombosis: a report of two cases

Bautista, Ernesto García; Martinez, Jeffrey M.; Gagne, Paul J.

doi:10.1016/s0967-2109(98)00085-4

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Isolated cases have been presented by others. 24,25,32,49 Venous claudication and its severity among patients with a confirmed prior I-F DVT were evaluated in the current study using a standardized treadmill exercise challenge, similar to that used for the investigation of peripheral vascular disease. Seventeen of these patients (43.6%, 17 of 39) were found to suffer from venous claudication.…”

Section: Discussionmentioning

confidence: 99%

Venous claudication in iliofemoral thrombosis: Long-term effects on venous hemodynamics, clinical status, and quality of life

Delis¹,

Bountouroglou²,

Mansfield³

2004

Journal of Vascular Surgery

149

234

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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 Ͻ 1.0 postexercise) or unrelated causes and those thrombectomized 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/h, 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 Ͻ 0.001) and 27% (P Ͼ 0.2), respectively; 43.6% (17 of 39; 95% CI, 27-60%) of patients developed venous claudication ipsilateral to I-F DVT (ICD: 130 m, range 105-268 m), compelling 15.4% (6 of 39; 95% CI, 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 Ͻ 0.001), abnormally higher VFI (3.8 mL/s, range 2.5-5.7 mL/s; P Ͻ 0.001), and RVF (45%, range 32.5-51.5%; P ϭ 0.006), and clinical impairment in CEAP and VCSS systems (P Ͻ 0.0001). Patients with I-F DVT had impaired physical functioning (P ϭ 0.02) and role (P ϭ 0.033), general health (P ϭ 0.001), social function (P ϭ 0.047), and mental health (P ϭ 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.

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Section: Discussionmentioning

confidence: 99%

Venous claudication in iliofemoral thrombosis: Long-term effects on venous hemodynamics, clinical status, and quality of life

Delis¹,

Bountouroglou²,

Mansfield³

2004

Journal of Vascular Surgery

149

234

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“…Clinically, chronic venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction, which are accompanied by varicosities, edemas, pigmentation, and so on, induce venous hypertension (1,23,36,39,52). These diseases are clinically rather common and, therefore, venous hypertension should occur frequently.…”

Section: Discussionmentioning

confidence: 99%

“…When compared at the same pressures, the external diameter was larger and the wall distensibility was smaller in the tilt animals than in the age-matched, nontilt animals, although there was no difference in the wall thickness between them. Clinically, chronic venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction, which are accompanied by varicosities, edemas, pigmentation, and so on, induce venous hypertension (1,23,36,39,52). Appling an indirect method to the patients having such chronic venous insufficiency as a combination of reflux and obstruction, Neglen and Raju (35) observed that the femoral and the popliteal veins, which were most likely exposed to high blood pressure, were less compliant than those in normal, healthy patients.…”

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confidence: 99%

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Hayashi

Mori

Miyazaki

2003

American Journal of Physiology-Heart and Circulatory Physiology

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response of femoral vein to chronic elevation of blood pressure in rabbits. Am J Physiol Heart Circ Physiol 284: H511-H518, 2003. First published September 26, 2002 10.1152/ajpheart.00620.2002-Venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction induce venous hypertension. To know the effects of the hypertension on venous mechanics, blood pressure in the left femoral vein in the rabbit was chronically elevated by the constriction of the left external iliac vein. Wall dimensions and biomechanical properties of the femoral vein were studied in vitro at 1, 2, or 4 wk after surgery. Blood pressure measured immediately before the animal was killed was significantly higher in the left femoral vein than in the sham-operated, contralateral vein. Wall thickness was increased by blood pressure elevation even at 1 wk, which restored circumferential wall stress to a control level. The stress was kept at normal up to 4 wk. Vascular tone and vascular contractility were increased by the elevation of blood pressure; however, wall elasticity and compliance were kept at a normal level. These results are very similar to those observed in hypertensive arteries, indicating that not only arteries but veins optimally operate against blood pressure elevation.hypertrophy; remodeling; wall stress MANY EXPERIMENTAL STUDIES and clinical observations have shown that arteries change their dimensions and properties in response to the chronic elevation of blood pressure (10,14,16,17,19,41). One of the specific biomechanical phenomena appearing in response to arterial hypertension is wall thickening, which restores wall hoop stress to a normal, control level. In addition, vascular tone is increased, although arterial elasticity at in vivo working pressure changes to an optimal level. For example, Matsumoto and Hayashi (26,27) demonstrated in the rat with induced Goldblatt hypertension that the aortic hoop stress at in vivo systolic pressure, which should have been high soon after the induction of hypertension, was rapidly (within 2 wk) restored to a physiologically normal level because of wall hypertrophy and remained at the normal level thereafter. On one hand, the elastic modulus of the wall, which was also high soon after the induction of hypertension, became normal after a relatively long period of time, i.e., at 16 wk. In addition, Fridez et al. (8,9) have shown that normal vascular tone related to the smooth muscle cell, which is the sensing and effecting element of the adaptation process, was increased during the early phase of arterial adaptation to hypertension.As far as we know only Monos et al. (30,32) directly studied the biomechanical effects of the chronic elevation of blood pressure in the vein, and much less is known about the remodeling of the venous wall compared with arteries. They chronically increased blood pressure in the vein of the lower extremity by exposing rats to head-up tilt for 2 wk, and they studied the pressure-diameter relations and wall thickness of the saphenous vein excised from t...

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“…Response of venous wall to blood pressure change Chronic venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction, which are accompanied by varicosities, edemas, pigmentation etc., induce venous hypertension (for example, Bautista et al (1998)). Appling an indirect method to the patients having such chronic venous insufficiency as a combination of reflux and obstruction, Neglen and Raju (1995) observed that the femoral and the popliteal veins, which were most likely exposed to high BP, were less compliant than those in normal, healthy patients.…”

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confidence: 99%

Adaptation and remodeling of vascular wall; biomechanical response to hypertension

Hayashi

Naiki

2009

Journal of the Mechanical Behavior of Biomedical Materials

136

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Symptomatic venous hypertension because of occult iliofemoral deep vein thrombosis: a report of two cases

Cited by 5 publications

References 15 publications

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

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Adaptation and remodeling of vascular wall; biomechanical response to hypertension

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