Venous Claudication in Iliofemoral Thrombosis

Long-term Effects on Venous Hemodynamics, Clinical Status, and Quality of Life

Abstract

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 < 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 < 0.001) and 27% (P > 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 < 0.001), abnormally higher VFI (3.8 mL/s, range 2.5–5.7 mL/s; P < 0.001), and RVF (45%, range 32.5–51.5%; P = 0.006), and clinical impairment in CEAP and VCSS systems (P < 0.0001). Patients with I-F_DVT had impaired physical functioning (P = 0.02) and role (P = 0.033), general health (P = 0.001), social function (P = 0.047), and mental health (P = 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.

In Brief

We evaluated the long-term impact of iliofemoral thrombosis (I-F DVT) on walking capacity, venous hemodynamic status, CEAP class, venous clinical severity score, and quality of life. Based on stringent exclusion criteria to eliminate walking impairment due to other causes, we found that 43.6% of those with prior I-F DVT develop venous claudication (ICD: 130 m, range 105–268 m), compelling interruption of walking in 15.4% (ACD: 241 m, range 137–298 m). Limbs with prior I-F DVT have a lower outflow fraction, higher reflux, and residual venous volumes (all P ≤ 0.006), resulting in marked clinical impairment in CEAP and VCSS systems (P < 0.0001), significantly compromising subjects’ perception of their physical functioning and role, general health, social function, and mental health.