Secondary chronic venous disorders

Mark H. Meissner, Bo Eklof, Phillip Coleridge Smith, Michael C. Dalsing, Ralph G. DePalma, Peter Gloviczki, Gregory (Greg) Moneta, Peter Neglén, Thomas O' Donnell, Hugo Partsch, Seshadri Raju

    Research output: Contribution to journalArticle

    97 Citations (Scopus)

    Abstract

    Secondary chronic venous disorders (CVD) usually follow an episode of acute deep venous thrombosis (DVT). Most occluded venous segments recanalize over the first 6 to 12 months after an episode of acute DVT, leading to chronic luminal changes and a combination of partial obstruction and reflux. Such morphological changes produce venous hypertension with the highest levels of ambulatory venous pressure occurring in patients with combined outflow obstruction and distal reflux. The clinical manifestations of secondary CVD, including pain, venous claudication, edema, skin changes, and ulceration are commonly referred to as the post-thrombotic syndrome. Such sequelae are best avoided by early and aggressive treatment of proximal DVT. The diagnostic evaluation of secondary CVD is similar to primary CVD and is based upon duplex ultrasound. However, the definition of hemodynamically significant venous stenosis remains obscure and there are no reliable tests to confirm the presence of such lesions. Diagnosis depends more on anatomic rather than hemodynamic criteria, and IVUS is superior to venography in estimating the morphological degree and extent of iliac vein stenosis. The fundamental role of compression in the treatment of CVD is well recognized. Compliance with compression is essential to heal ulcers and minimize recurrence. The efficacy of various adjuncts to ulcer treatment, including complex wound dressings and medications have been variable. Although superficial venous surgery has not been demonstrated to improve ulcer healing rates, it does decrease ulcer recurrence. Deep venous valve reconstruction is performed in only a few specialized centers, and the results are better for primary than for secondary CVD. Treatment of incompetent perforating veins remains controversial. Although artificial venous valves are promising, most early experimental models have failed. With respect to venous obstruction, iliocaval angioplasty and stenting has emerged as the primary treatment for proximal iliofemoral venous obstruction with surgical bypass assuming a secondary role.

    Original languageEnglish (US)
    JournalJournal of Vascular Surgery
    Volume46
    Issue number6 SUPPL.
    DOIs
    StatePublished - Dec 2007

    Fingerprint

    Ulcer
    Venous Valves
    Venous Thrombosis
    Pathologic Constriction
    Iliac Vein
    Therapeutics
    Recurrence
    Somatoform Disorders
    Venous Pressure
    Phlebography
    Bandages
    Angioplasty
    Veins
    Edema
    Theoretical Models
    Hemodynamics
    Hypertension
    Skin
    Wounds and Injuries

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Meissner, M. H., Eklof, B., Smith, P. C., Dalsing, M. C., DePalma, R. G., Gloviczki, P., ... Raju, S. (2007). Secondary chronic venous disorders. Journal of Vascular Surgery, 46(6 SUPPL.). https://doi.org/10.1016/j.jvs.2007.08.048

    Secondary chronic venous disorders. / Meissner, Mark H.; Eklof, Bo; Smith, Phillip Coleridge; Dalsing, Michael C.; DePalma, Ralph G.; Gloviczki, Peter; Moneta, Gregory (Greg); Neglén, Peter; O' Donnell, Thomas; Partsch, Hugo; Raju, Seshadri.

    In: Journal of Vascular Surgery, Vol. 46, No. 6 SUPPL., 12.2007.

    Research output: Contribution to journalArticle

    Meissner, MH, Eklof, B, Smith, PC, Dalsing, MC, DePalma, RG, Gloviczki, P, Moneta, GG, Neglén, P, O' Donnell, T, Partsch, H & Raju, S 2007, 'Secondary chronic venous disorders', Journal of Vascular Surgery, vol. 46, no. 6 SUPPL.. https://doi.org/10.1016/j.jvs.2007.08.048
    Meissner MH, Eklof B, Smith PC, Dalsing MC, DePalma RG, Gloviczki P et al. Secondary chronic venous disorders. Journal of Vascular Surgery. 2007 Dec;46(6 SUPPL.). https://doi.org/10.1016/j.jvs.2007.08.048
    Meissner, Mark H. ; Eklof, Bo ; Smith, Phillip Coleridge ; Dalsing, Michael C. ; DePalma, Ralph G. ; Gloviczki, Peter ; Moneta, Gregory (Greg) ; Neglén, Peter ; O' Donnell, Thomas ; Partsch, Hugo ; Raju, Seshadri. / Secondary chronic venous disorders. In: Journal of Vascular Surgery. 2007 ; Vol. 46, No. 6 SUPPL.
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