Performance of two clinical scales to assess quality of life in patients with post-thrombotic syndrome

Assessment of venous disease with different venous disease specific scales in Behçet's disease patients with deep vein thrombosis

Objectives: Post-thrombotic syndrome (PTS) is a frequent and important consequence of deep vein thrombosis (DVT) for Behcet`s disease (BD) patients. Although various clinical scales are used to diagnose PTS, Villalta scale was accepted as the standard tool to diagnose and grade the severity of PTS. Poor quality of life (Qol) in the general population was defined for patients with PTS, however, studies in BD patients with PTS is limited. Our aim was to compare the performance of different scales to assess venous disease in BD patients with a history of DVT and to assess the relationship with quality of life.Methods: Patients with BD (n = 194, M/F:157/37, age:39.1 ± 9.5 years) with a DVT history were investigated. Villalta, VCSS,CEAP scale and SF 36,Veines scales were used to assess venous disease and QoL respectively.Results: Among BD patients, 120 (61.9 %) patients were classified as having PTS by Villalta and of patients 18% had severe PTS. Half of patients with CEAP score <4 were classified as having PTS. Also, 42% of patients with CEAP>4 and almost two third of VCSS classified severe CVD patients was grouped in severe PTS by Villalta scale. VCSS and Villalta classified PTS patients had decreased disease specific and general Qol scores compared to the patients without PTS. Also, severe PTS group (by VCSS) had decreased veines QoL scores and PCS compared to mild/moderate group.Conclusion: BD patients with DVT have a high risk of PTS. Our results show that both Villalta scale and VCSS should be used to assess venous disease BD patients with DVT. However, VCSS classified severity of PTS can show better correlation with venous disease -specific QoL.

Delphi Consensus on Reporting Standards in Clinical Studies for Endovascular Treatment of Acute Iliofemoral Venous Thrombosis and Chronic Iliofemoral Venous Obstruction

Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics specific to evaluating percutaneous venous thrombectomy and stent placement. Using modified Delphi techniques for consensus achievement, a panel of physician experts in vascular disease voted on the statements and succeeded in reaching the predefined threshold of >80% consensus (agreement or strong agreement) on all 30 statements. It is hoped that the guidance from these statements will improve standardization, objectivity, and patient-centered relevance in the reporting of clinical outcomes of endovascular interventions for acute iliofemoral deep venous thrombosis and chronic iliofemoral venous obstruction in clinical studies and thereby enhance venous patient care.

Systematic review of exercise therapy in the management of post-thrombotic syndrome

OBJECTIVES

Exercise improves haemodynamic parameters in patients with chronic venous disease. There is a paucity of evidence on its effect in post-thrombotic syndrome (PTS). The aim of this systematic review is to assess the impact of exercise in PTS.

METHODS

Adhering to PRISMA guidelines and following PROSPERO registration (CRD42021220924), MEDLINE, Cochrane Library, EMBASE database, and trial registries were searched on 19th May 2022.

RESULTS

One article met the inclusion criteria and a narrative synthesis was carried out. The included randomised controlled trial reported a between-group mean difference of 4.6 points (p = .027) in the VEINES-QOL score and -2.0 points (p = .14) in the Villalta score, in favour of exercise therapy. The statistical significance threshold was not reached.

CONCLUSION

Data on exercise in PTS remains sparse but exercise appears to be a safe intervention. In the context of this literature, a potential future trial and outcome reporting measures are suggested.

Determinants of Quality of Life in Patients with Post-Thrombotic Syndrome

OBJECTIVES

Chronic post-thrombotic syndrome (PTS) may develop in up to 50% of patients after deep vein thrombosis (DVT) and may reduce patients' quality of life (QoL). We aimed to evaluate the association of PTS severity with QoL in patients with proximal DVT submitted to medical treatment and also to identify modifiable and non-modifiable risk factors related to PTS.

METHODS

Patients with iliac or femoropopliteal DVT observed in Vascular Surgery consultation in our institution from 1 year period with unilateral DVT were selected. Patients with total vein recanalization were excluded. Villalta scale was applied to assess PTS degree and VEINES-QoL/Sym questionnaire was used as a disease-specific QoL measure. Correlation between PTS degree and VEINES-QoL/Sym score and predictors of PTS were determined.

RESULTS

56 patients accepted to enter the study. From those, 66.1% were female, 64.3% (n=36) had iliac and 35.7% (n=20) femoropopliteal DVT. PTS was present in 52.8% of iliac and 65.0% of femoropopliteal DVT patients observed in consultation (P=0.413). There was a significant correlation with PTS degree and both VEINES-QoL and VEINES-Sym scores (P<0.001). Major depression (OR=5.63, P=0.045) and regular wear of compressing stockings (OR=4.69, P=0.041) were the only independent factors associated with PTS. Patients with depression had lower QoL scores, while patients with PTS who wear compression stockings had similar QoL scores compared to patients without PTS. Ultrasound alterations (OR=3.28, P=0.174), age, gender, iliac DVT, multiple DVT and time after DVT (P>0.2) were not associated with PTS syndrome.

CONCLUSIONS

VEINES-QoL/Sym had moderate inverse correlation with PTS degree. Depression was associated with both PTS and lower QoL scores. Patients with PTS criteria compliant to wearing compressing stockings had similar QoL scores to patients without PTS.

Effect of trimodal pre-rehabilitation on the rehabilitation of patients with gastrointestinal tumors in the perioperative period

OBJECTIVE

To explore the effects of trimodal pre-rehabilitation on the rehabilitation of patients with gastrointestinal tumors in the perioperative period.

METHODS

Clinical data of 878 patients with gastrointestinal tumors undergoing surgical treatment in our hospital were analyzed in this retrospective study. They were divided into a control group and an observation group. The patients in the control group received only routine preoperative education and guidance before operation, while those in the observation group received preoperative trimodal pre-rehabilitation. The nutritional status, sleep quality, psychological status, and physical function of two groups were compared 1 day before operation and at discharge. The postoperative complications, length of hospital stays, and hospitalization expenses were compared. The patients were followed up for three months after discharge from the hospital, and the quality of life between groups was compared.

RESULTS

The nutritional status of two groups 1 day before operation and at discharge was improved compared with that at admission (all P<0.001). The nutritional status in the observation group was better than that in the control group 1 day before operation. The scores of sleep quality, psychological status, and physical function of the observation group were higher than those in the control group 1 day before surgery and at discharge (all P<0.001). The observation group had shorter hospital stays and lower hospitalization expenses than the control group (all P<0.001). The 3-month follow-up after discharge showed that the observation group had higher quality of life than the control group (all P<0.05).

CONCLUSION

Trimodal pre-rehabilitation can improve the preoperative nutritional status, sleep quality, psychological state, and physical function of patients with gastrointestinal tumors during the perioperative period. Besides, it can shorten the hospital stays, reduce the total hospitalization expenses, and improve the quality of life of patients after discharge. It is worthy of clinical promotion.