This Article Full Text (PDF) A correction has been published References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Web of Science (1) Citing Articles via Scopus Google Scholar Articles by Ashrani, A. A Articles by Heit, J. A PubMed PubMed Citation Articles by Ashrani, A. A Articles by Heit, J. A Social Bookmarking                         What's this?

Risk factors and underlying mechanisms for venous stasis syndrome: a population-based case–control study

Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinicashrani.aneel{at}mayo.edu

Marc D Silverstein

Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic

Brian D Lahr

Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic

Tanya M Petterson

Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic

Kent R Bailey

Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic

L Joseph Melton, III

Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic

John A Heit

Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic

Abstract

Venous stasis syndrome may complicate deep vein thrombosis (DVT; i.e. post-phlebitic syndrome), but, in most cases, venous stasis syndrome is not post-phlebitic. The objective of this study was to determine the risk factors (including prior DVT) for venous stasis syndrome, and to assess venous outflow obstruction and venous valvular incompetence as possible mechanisms for venous stasis syndrome. This was a case–control study nested within a population-based inception cohort. The study population consisted of 232 Olmsted County, MN residents with a first lifetime venous thromboembolism (VTE) and 133 residents without VTE. Measurements included a questionnaire and physical examination for venous stasis syndrome; strain gauge outflow plethysmography, venous continuous wave Doppler ultrasonography and passive venous drainage and refill testing for venous outflow obstruction and venous valvular incompetence. Altogether, 161 (44%), 43 (12%), and 136 (38%) subjects respectively, had venous stasis syndrome, venous outflow obstruction and venous valvular incompetence. Independent risk factors for venous stasis syndrome included increasing patient age and body mass index (BMI), prior DVT, longer time interval since DVT, and varicose veins. Both venous outflow obstruction (p = 0.003) and venous valvular incompetence (p < 0.0001) were strongly associated with venous stasis syndrome. Increasing age and prior DVT were significantly associated with venous outflow obstruction, while prior DVT, varicose veins and venous stasis syndrome diagnosed prior to the incident DVT were significantly associated with venous valvular incompetence. The risks of venous outflow obstruction, venous valvular incompetence and venous stasis syndrome were higher with left leg DVT. In conclusion, increasing patient age and BMI, prior DVT (particularly left leg DVT), longer time interval since DVT and varicose veins are independent risk factors for venous stasis syndrome. Venous stasis syndrome related to DVT is due to venous outflow obstruction and venous valvular incompetence, while venous stasis syndrome related to older age and to varicose veins is due to venous outflow obstruction and to venous valvular incompetence, respectively.

Key Words: deep vein thrombosis • epidemiology • post thrombotic syndrome • risk factors • venous stasis syndrome • venous thromboembolism

Vascular Medicine, Vol. 14, No. 4, 339-349 (2009)
DOI: 10.1177/1358863X09104222


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?