I thought this was a puzzler. After an upper extremity deep venous thrombosis, which would be a clot in the arm veins that may or may not recanalize into a working vein, patients sometimes have what's called post-thrombotic syndrome. I checked Wikipedia for what that is and http://en.wikipedia.org/wiki/Post-thrombotic_syndrome it's "the signs and symptoms that may occur as long-term complications of deep vein thrombosis (DVT)." This includes pain, heaviness, swelling, varicose veins, itching, discoloration, and ulceration.Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis
Michael Czihal1
Simone Paul1
Antje Rademacher1
Christoph Bernau2
Ulrich Hoffmann1
1Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Germany
2Department of Medical Informatics, Biometry and Epidemiology, Munich University Hospital, Germany
Michael Czihal, Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Pettenkoferstrasse 8a, D-80336 Munich, Germany. Email: michael.czihal@med.uni-muenchen.de
Abstract
Objectives To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis.
Methods Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman’s correlation analysis.
Results Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68).
Conclusions Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities.
What's odd is that, according to this research, this syndrome is not associated with venous hemodynamics or residual morphological abnormalities after the deep vein thrombosis of the arm. What does that mean? It means that one person can have a damaged vein in the arm and not display post-thrombotic syndrome, and another person can have a vein that doesn't look as bad as the first person's but can have a slew of those post-thrombotic syndrome symptoms.
What does that mean in relation to CCSVI syndrome? I take it that we need to consider that it cannot be predicted by looking at the vein abnormalities and deranged hemodynamics how severe the CCSVI syndrome will be or if it is present. One person might have biltateral jugular abnormalities and be ok, and another might have a unilateral jugular valve abnormality and have a slew of CCSVI syndrome symptoms. Just as the hemodynamics and morphological abnormalities in post-DVT patients do not predict who will have post-thrombotic syndrome, the same hemodynamics and morphological abnormalities of the jugulars might not predict who will have CCSVI syndrome. But no one questions the existence of post-thrombotic syndrome in the arm despite the difficulty in explaining why one person with the same hemodynamics has it and another person with the same hemodynamics does not.
Please let me know if I explained myself coherently, and whether or not the reasoning is solid! This was a confusing one to type out.