Search

Introduction Quality-of-life and severity scores are both popular measures in medicine. For deep venous obstruction, the VEINES-QOL/Sym and venous clinical severity score (VCSS) are widely used. Combining a patient-reported outcome with a clinical severity score should give a more sensitive outcome for treatment results. To establish and compare their suitability for deep venous disease, we compared the outcomes of both scores in a group of patients who were interventionally treated for deep venous disease. Methods The venous clinical severity scores and VEINES-QOL/Sym scores of a group of patients who had received interventional treatment for deep venous obstruction more than 12 months ago were compared at T0 and T12. Results Both the Spearman’s rho and Pearson’s r show a very weak, negative correlation (statistically significant ( p ≤ 0.05)), between the venous clinical severity score and VEINES-QOL at T12 and between the venous clinical severity score and the VEINES-SYM at both T0 and T12. T0 VCSS-VSYM: rho = −0.219 ( p = 0.052), r = −0.236 ( p = 0.037), T12 VCSS-VQOL: rho = −0.459 ( p = 0.007), r = −0.379 ( p = 0.030), T12 VCSS-VSYM: rho = −0.463 ( p = 0.007), r = −0.432 ( p = 0.012). This negative correlation was not statistically ( p ≥ 0.05) confirmed for T0 VCSS-VSYM. Conclusion The physician-scored venous clinical severity score of patients treated for deep venous obstruction does not correlate well with their self-reported quality-of-life and symptom scores.

Deep venous obstruction is relatively common in patients with chronic venous disease and is caused by either post-thrombotic vein damage, extraluminal vein compression or a combination of both. With increasing in‐depth knowledge of the pathophysiological mechanisms, we know that venous outflow of the leg is compromised, and venous hypertension can occur. This thesis evaluates the outcomes of patients treated in the Maastricht University Medical Center and Klinikum Aachen over the past decade. We then identified variables that could influence and improve outcomes, specifically improve stent patency. This thesis investigates both the technical and clinical optimization methods and focuses on pre‐operative patient selection.

Background Iliofemoral venous obstruction, caused by post-thrombotic disease, can be treated by percutaneous angioplasty and additional stenting with good results. However, no hemodynamic parameter determining the need for treatment has been defined. This article describes the preliminary results of a study investigating the pressure changes occurring in post-thrombotic deep venous obstruction. Methodology Four patients with post-thrombotic deep venous obstruction of the iliofemoral tract were identified. Intravenous pressure was pre-operatively measured in the common femoral vein and in a dorsal foot vein bilaterally. During these pressure measurements patients were asked to walk on a treadmill with a speed of 3.2 km/h and a zero per cent slope, with the slope increasing two per cent every two minutes. Results Four patients (two male, two female) with age varying from 23 to 40 were identified. In two patients, disease extended below the femoral confluence. Pressure in the dorsal foot vein was not notably different between the affected and the control side. Pressure in the common femoral vein was markedly higher in post-thrombotic limbs compared to the control limb, with ambulatory pressure increasing more in post-thrombotic limbs. Conclusions These preliminary results are highly illustrative for the hemodynamic effect of iliofemoral deep venous obstruction due to post-thrombotic disease, even though sample size is admittedly limited. Furthermore, these results suggest that pressure measurements of the common femoral vein, and not the dorsal foot vein, might be able to identify a significant outflow obstruction due to post-thrombotic disease, though further inclusion of patients is necessary.