Place de compression médicale après thrombose veineuse profonde iliofémorale by sfa

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									Place de compression médicale après thrombose veineuse profonde
iliofémorale

Eberhard Rabe1, Felizitas Pannier2
1
Department of Dermatology, University of Bonn, Germany
2
Department of Dermatology, University of Cologne, Germany

In current guidelines the use of elastic compression stocking after deep venous
thrombosis (DVT) for a minimum of 2 years is recommended (1). Two studies were
able to demonstrate that the rate of postthrombotic syndrome after proximal deep
vein thrombosis (DVT) can be reduced by 50% by wearing compression stockings
with 30-40 mm Hg for 2 years after DVT (Grade 1 A) (2, 3). A significant benefit of
early ambulation combined with compression, measured as mean score on Villalta
was found by Partsch at al (5,6).
The necessary duration of compression is under discussion. Only the study of
Aschwanden assessed whether prolonged duration of compression was superior to 6
months without showing a significant difference in the incidence of PTS (6).
Based on these observations ten Cate et al hypothesized that mainly initial
compression therapy is important for the prevention of PTS, treatment beyond 6
months is not inferior to prolonged compression and that the presence of venous
reflux in the absence of clinical signs is not a strong predictor for PTS. In a
prospective cohort of 125 consecutive patients with acute DVT the effectiveness of
individualized duration of ECS therapy based on complaints on the Villalta scale was
assessed. All patients had 6 months of initial therapy. Ten Cate found that 50% of
her patients did not need long-term ECS therapy, with an overall incidence of PTS of
21.1% (95% CI 13.5-28.7) (7).

1. Hirsh J, Guyatt G, Albers GW, Harrington R, Schünemann HJ, American College
of Chest Physician. Antithrombotic and thrombolytic therapy: American College of
Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest.
2008 Jun; 133(6 Suppl):110S-112S. Erratum in: Chest. 2008 Aug; 134(2):473.
2. Brandjes DP, Büller HR, Heijboer H, Huisman MV, de Rijk M, Jagt H, ten Cate JW.
Randomised trial of effect of compression stockings in patients with symptomatic
proximal-vein thrombosis.Lancet. 1997 Mar 15; 349(9054):759-62.
3. Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, Tormene D,
Mosena L, Pagnan A, Girolami A. Below-knee elastic compression stockings to
prevent the post-thrombotic syndrome:a randomized, controlled trial. Ann Intern Med.
2004 Aug 17; 141(4):249-56.
4. Partsch H, Blättler W. Compression and walking versus bed rest in the treatment
of proximal deep venous thrombosis with low molecular weight heparin. Journal of
Vascular Surgery 2000; 32(5):861–9.
5. Partsch H, Kaulich M, Mayer W. Immidiate mobilization in acute vein thrombosis
reduces post-thrombotic syndrome. Int. Angiol 2004; 23: 206-12.
6. Aschwanden M, Jeanneret C, Koller MT, Thalhammer C, Bucher HC, Jaeger KA.
Effect of prolonged treatment with compression stockings to prevent post-thrombotic
sequelae: a randomized controlled trial. J Vasc Surg. 2008; 47:1015-21
7. ten Cate-Hoek AJ, ten Cate H, Tordoir J, Hamulyák K, Prins MH. Individually
tailored duration of elastic compression therapy in relation to incidence of the post
thrombotic syndrome. J Vasc Surg. 2010;52:132-8
Les facteurs environnementaux et la maladie veineuse chronique

Eberhard Rabe1, Annette Ko1, Gabriele Berboth1, Felizitas Pannier2
1
Department of Dermatology, University of Bonn, Germany
2
Department of Dermatology, University of Cologne, Germany

OBJECTIVES: Chronic venous disorders are among the most common diseases in Germany. In the
Bonn Vein Study I (BVS I), conducted in 2000, 3072 participants of the general population of the city
of Bonn and two rural townships, aged 18-79 years were took part in this study (1350 men, 1722
women). Participants were selected via simple random sampling from the registries of residents. In
this follow-up study 6.6 years later, the same population was investigated again to. The aim was to
identify the incidence of newly developed chronic venous disorders and of progression of pre-
existing CVD.

METHODS: From May 2007 to September 2008, we contacted all participants of BVS I and invited
them for a reinvestigation. The participants answered a standardized questionnaire and were
examined by clinical means and by duplex ultrasound in the same way as in BVS I.

RESULTS: The response at follow-up after 6.6 years was 84.6%. We reinvestigated 1978 participants.
The prevalence for varicose veins rose from 22.7 to 25.1% and for CVI from 14.5 to 16%. The incidence
for new varicose veins was 13.7% and for new CVI 13.0% per 6.6 years increasing with age.
The main risk factors for VV are advanced age, female gender, pregnancies and positive family history.
Concerning CVI the main risk factors are age, arterial hypertension and obesity.


CONCLUSIONS: These results show a high incidence of app. 2% for varicose veins and for CVI per
year. Risk factors differ significantly between the two groups. Risk factors for VV like age, gender and
genetic predisposition can not be influenced whereas obesity and arterial hypertension, increasing
the risk for CVI can be treated as part of a prevention programme.

								
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