The value of outcome measures after endovenous iliofemoral thrombolysis in the big trials

• Main Author: Niels Bækgaard
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Vascular Investigation and Therapy
• Subjects: endovenous thrombolysis; euro quality of life-five dimensions; iliofemoral deep-vein thrombosis; patency; quality-of-life scores; venous clinical severity score; villalta scale
• Online Access: http://www.vitonline.org/article.asp?issn=2589-9686;year=2020;volume=3;issue=3;spage=82;epage=87;aulast=Bækgaard
• ISSN: 2589-9686; 2589-9481

Different outcome measures have been used in the last 10–15 years with the publications of some major randomized controlled trials which compared different methods of catheter-directed thrombolysis with anticoagulation in patients with iliofemoral deep-vein thrombosis (DVT). This review addresses the Villalta scale, the Venous Clinical Severity Score, Euro Quality of Life (QOL)-Five Dimensions, the 36-Item Short-Form Health Survey (SF-36), and VEnous INsufficiency Epidemiological and Economic Study on QOL (VEINES-QOL)/symptoms questionnaire as tools for assessing the postthrombotic syndrome (PTS). Patency has also been a part of the results in some trials, although it may be considered as a pseudo end point by some. The newly revised Clinical-Etiologic-Anatomic-Pathophysiologic classification is mentioned as well. It appears that none of the available outcome measures can answer all the questions. The Villalta scale is still the most used outcome measure for PTS after endovenous thrombolysis of iliofemoral DVT. It can be supplemented with the VSCC to differentiate the more severe cases. The generic part of QOL score seems to be useless in assessing changes in PTS, whereas the VEINES scores are useful. More attention should, however, be addressed to report on patency. The better the patency, the better the outcome in PTS. The reason for high rates of PTS can in many cases be the result of poor patency at baseline due to inadequate technical results. Future focus should be on improved patient selection and optimization of treatment strategies.