Chapter Eleven
Venous Disease Coalition
Chronic Venous Insufficiency
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Post-Thrombotic Venous
Reflux Disease
Seen in 20-50% of patients after DVT1
Normal Vein
Dilated Vein
1. Deep vein valves become
damaged by DVT
resulting in venous valve
failure
Heart
2. Reflux or backward flow
in the deep veins occurs
Foot
Valve
Open
Valve Closed
Leaky
Valve
3. Pooling of blood causes
increased pressure in
leg veins, edema,
hyperpigmentation
Reproduced with permission of VNUS Medical Technologies, CA
1. Antithrombotic and Thrombolytic Therapy 8th edition, ACCP Guidelines
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Chronic Venous Disease
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Telangiectases
C1
Pigmentation
C4
Varicose veins
C2
Active Ulceration
C6
Bergan – NEJM 2006;355:488
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Post-Thrombotic Syndrome
• Prospective study of 355 patients with DVT
• All patients advised to wear 40 mmHg stockings
Years since
DVT
Cumulative
Incidence of PTS
1
2
5
8
17 %
23 %
28 %
29 %
 PTS - recurrent, ipsilateral DVT
NOT - extent of DVT
Prandoni - Ann Intern Med (1996)
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Prevention and Management of
Post-Thrombotic Syndrome
• Prevent recurrent DVT with anticoagulation
• Encourage the obsessive use of good quality compression
stockings = ESSENTIAL
• Encourage regular exercise
• Encourage normal body weight
• Avoid local trauma to the legs
• Aggressive management of stasis dermatitis
• Urgent expert treatment of early ulcers
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Venous Disease Coalition
www.vasculardisease.org/venousdiseasecoalition/
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