ABSTRACT
No prospective study of the long-term sequelae of more than 10 years after acute deep vein thrombosis exists so far. Therefore, 28 patients with DVT were included in a prospective study to evaluate the natural history of postthrombotic syndrome. Clinical and hemodynamic examinations were performed at the time of admission; after 3, 6 and 12 months; after the 2nd, 3rd, 4th, 5th; and finally after the 12th year. All patients received unfractionated heparin initially and oral anticoagulants subsequently. After 12 years, 64% of the patients exhibited normal findings. Mild skin changes were found in 28%, marked trophic changes in 5%, and only 1 venous ulcer occurred. Regular use of compression stockings was reported by 54% of the patients with multilevel disease. Although mean maximum venous outflow was significantly reduced from the acute event to 2 years later (p < 0.003) compared with the contralateral leg, a significant (p < 0.05) improvement was observed 6 months later. Recanalization of calf vein thrombosis was detected by Doppler sonography after 3 months. 64% of the multilevel thromboses were recanalized completely or in part after 1 year; in 69%, valvular incompetence was found. In conclusion, in contrast to earlier reports, this prospective study up to 12 years after DVT demonstrates a low incidence of PTS by administration of initially unfractionated heparin, oral anticoagulation and compression therapy. However, the adverse clinical event rate (mortality 14%) and recurrency rate of 24% show that the prognosis after DVT does not appear favorable even in low-risk patients.
Subject(s)
Hemodynamics/physiology , Postphlebitic Syndrome/diagnosis , Thrombophlebitis/diagnosis , Adult , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Bandages , Blood Flow Velocity/drug effects , Blood Flow Velocity/physiology , Combined Modality Therapy , Female , Follow-Up Studies , Hemodynamics/drug effects , Heparin/administration & dosage , Heparin/adverse effects , Humans , Leg/blood supply , Male , Middle Aged , Postphlebitic Syndrome/mortality , Postphlebitic Syndrome/therapy , Prospective Studies , Recurrence , Survival Analysis , Switzerland , Thrombophlebitis/mortality , Thrombophlebitis/therapy , Treatment Outcome , Ultrasonography, DopplerABSTRACT
Avascular necrosis of the hip is a serious clinical problem encountered by primary care physicians. It requires early detection for proper management and treatment. The clinician should be aware of the imaging modalities available for evaluation of patients with suspected avascular necrosis. Traditional studies include plain-film radiography, computed tomography, and planar bone scintigraphy. Magnetic resonance imaging and single-photon emission computed tomography bone scanning have been developed to such an extent that they are now the most sensitive indicators of early avascular necrosis. The authors review currently available imaging modalities and provide a practical approach to the assessment of patients with suspected avascular necrosis of the hip.
