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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