This week, I am very grateful to Mr Christopher Lattimer for writing about his reflections on the first day of the Spring Meeting of the Venous Forum at the Royal Society of Medicine. This meeting is the largest conference in the United Kingdom dedicated exclusively to the diagnosis and treatment of vein conditions. Chris completed his specialist vascular training at St Thomas’ Hospital and King’s College London. He is an expert in vein disease and has carried out important research on venous haemodynamics (how blood flows in veins). He is based at Ealing and Northwick Park Hospitals.
“I have just returned from day 1 of the Spring Meeting of the Venous Forum at the Royal Society of Medicine and I thought you may be interested in hearing some of the content of the invited lecture by Professor Cees Wittens from Maastricht University in the Netherlands. He spoke about the assessment and treatment of deep venous disease where he emphasized the importance of non-occlusive obstruction as a cause of venous claudication. I was particularly interested in his haemodynamic studies. He used an example at rest where the calibre of the femoral vein was shown to be the same in a normal subject as in a patient with venous claudication. After heavy exercise on a treadmill, the calibre of the femoral vein in the control subject increased substantially to accommodate the increase in venous drainage. However, the size of the vein in the patient with venous claudication remained the same. It failed to distend because of fibrotic scarring. Direct venous pressure measurements in this patient demonstrated a gradual increase in pressure. At 60 mmHg the symptoms of venous claudication appeared and at 80 mmHg the patient had to stop because of pain. His conclusion was that assessments of venous outflow obstruction should be performed after challenge tests like exercise. It is only in such situations that abnormal haemodynamic patho-physiology can be unmasked.
Cees went on to explain his experience of catheter directed thombolysis post ilio-femoral DVT, and subsequent stenting of residual stenoses. He recommended that many more patients should be treated this way, including those with DVT secondary to malignancy. His rationale was that this would significantly improve the quality of life in these patients in their remaining 3 months. Professor Bruce Braithwaite pointed out in his presentation that NICE guidelines stated that patients had to have a life expectancy of least 1 year before CDT and stenting should be considered. However, he admitted that these were only guidelines and not tramlines. Professor Gerard Stansby stated a word of caution that thrombolysis in malignant conditions carries a significant risk of haemorrhage into metastases and should be considered very carefully in these patients.”
FRCS MS PhD
Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College, London
24th April 2014