Is venous reflux a common disease in post-thrombotic patients with unilateral deep vein thrombosis episode?

Objectives: To investigate reflux development and changes in resting venous diameters in the DVT and the non-DVT lower limbs.

Methods: Twenty subjects (40 limbs) with acute unilateral proximal DVT diagnosed by ultrasound, who were treated with low-molecular-weight-heparin (LMWH), followed by at least three months of oral warfarin therapy, were enrolled in the study. The limbs were classified according to CEAP (clinical, aetiologic, anatomic, pathophysiology) clinical classification on a scale of 0-6. Duplex ultrasound (DUS) was employed to assess DVT resolution, vein diameter and venous reflux in both limbs at intervals of zero, three, six and 12 months. Venous reflux was defined as a valve closure time more than 1 s.

Results: There were 13 men and seven women, average age was 40.8 years and average body mass index 27.7 kg/m2. In the DVT limbs at three, six and 12 months, deep veins were non-occluded in 40%, 60% and 85%, respectively. By 12 months, 16 (80%) had developed venous reflux, mostly in the femoral (FV) and popliteal veins (PV); eight limbs (40%) were in clinical classes 4-6. In the contralateral 20 non-DVT limbs, four limbs developed borderline reflux at the sapheno-femoral junction (SFJ) after six months and mean diameters of SFJ, FV and PV increased significantly.

Conclusions: Venous reflux is highly likely to occur in DVT limbs within a year follow-up period. Venous dilatation can occur in the contralateral unaffected lower limb, consistent with a systemic effect. Our results are suggestive and further studies are needed.