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Purpose: Venous hemodynamics were evaluated in relation to the postthrombotic syndrome (PTS) 7 to 13 years after deep venous thrombosis (DVT). Methods: The presence of flow, reflux, and compressibility of 1394 vein segments in 82 patients was assessed by means of duplex scanning. The venous outflow resistance was measured by means of strain-gauge plethysmography. The venous hemodynamics were related to the clinical severity of the PTS, characterized by the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification. Results: In patients with severe clinical symptoms of PTS, the prevalence of reflux was significantly higher. There was no relationship between the severity of the PTS and the noncompressibility or the combination of reflux and noncompressibility or an increased venous resistance. By means of multiple regression analysis with the variables of age, gender, reflux, and venous resistance, age and reflux were shown to be the main contributors to the severity of PTS. Significantly more patients (64%) with severe signs of PTS had a combination of deep and superficial reflux. In each of the traceable vein segments, the mean of the CEAP classification was calculated for the vein segments with and without reflux. In the proximal superficial femoral vein (P < .001), distal superficial femoral vein (P < .05), and popliteal vein (P < .05), a significantly higher mean CEAP classification was found in the veins with reflux, whereas in the distal, long, and short saphenous veins, no such relationship was found. Conclusion: Most patients with severe PTS had a combination of deep and superficial reflux. Reflux in the deep proximal veins contributes significantly to the PTS. (J Vasc Surg 1999;29:1071-6.)

Purpose:The use of duplex ultrasound scanning to evaluate the hemodynamic outcome of deep venous thrombosis 7 to 13 years after the original diagnosis. Methods: Duplex ultrasound was used to re-examine 1212 segments of vein from 72 patients (49 men, 23 women) with deep venous thrombosis previously diagnosed by means of phlebography to detect reflux and obstruction and evaluate flow; 611 segments were initially thrombosed and 601 segments were open. To define reflux, reversed flow in 31 healthy persons was measured. Results: In a review of all veins of the 72 patients, 8 patients (11%) had completely normal duplex results in all veins, 33 (46%) had reflux, 6 (8%) had at least one noncompressible vein segment, and 25 (35%) had a combination of both. In the proximal vein segments without initial thrombosis a higher percentage was normal (73%) than in segments with initial thrombosis (46%). There was a significantly higher frequency of reflux (46%, p = 0.05) and noncompressibility (12%, p < 0.01) in initially thrombosed proximal vein segments than in vein segments without initial thrombosis (reflux 25%, noncompressibility 3%). Distal to the knee 125 (17%) of 720 vein segments were not traceable. Significantly more initially thrombosed vein segments were not traceable (p < 0.01). In distal vein segments there was no significant difference in reflux (7% versus 5%) and noncompressibility (10% versus 5%) between vein segments with and without initial thrombosis. Flow was present in 99% of the 611 previously thrombosed proximal and distal segments. Conclusions: Most patients with deep venous thrombosis still had venous abnormalities 7 to 13 years after the initial diagnosis. The most common abnormality was reflux. Significantly more abnormalities were found in initially thrombosed segments. The abnormalities were found in the proximal vein segments and in the distal vein segments, although less frequently in the latter. (J Vasc Surg 1998;27:472-8.)

The limited capacity of the heart to survive ischaemia presents a recognized problem during open-heart surgery. In order to provide a baseline for the study of cardioprotection we subjected a series of isolated rat hearts to periods of ischaemia of increasing duration, and sought correlations between phosphate metabolite levels as measured by31P NMR and post-ischaemic recovery of external work output. A strong linear correlation was found between the fraction of ATP measured after reperfusion expressed as a ratio RATP, to the pre-ischaemic level, and the fractional recovery of external work output, RW: Rw=1.06 (SE 0.27) RATP+0.01 (SE 0.21) (Spearman rank correlation coefficient 0.72, two-tailedPvalue 0.006).