Copyright
©The Author(s) 2015.
World J Crit Care Med. Feb 4, 2015; 4(1): 29-39
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.29
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.29
Table 1 Scoring system according to Brandjes for mild-to moderate and severe postthrombotic syndrome[24]
Subjective criteria | |||
Symptoms | Score | Signs | Score |
For mild-to-moderate PTS: score > 3 of subjective and objective criteria | |||
Spontaneous pain in calf | 1 | Calf circumference ↑ by 1 cm | 1 |
Spontaneous pain in thigh | 1 | Ankle circumference ↑ by 1 cm | 1 |
Calf pain on standing/ walking | 1 | Pigmentation | 1 |
Thigh pain on standing/ walking | 1 | Venectasia | 1 |
Edema of foot/calf | 1 | Newly formed varicosis | 1 |
Heaviness of foot/leg | 1 | Phlebitis | 1 |
For severe PTS score > 4 of symptoms and signs | |||
Spontaneous pain | 1 | Calf circumference ↑ by 1 cm | 1 |
Pain on standing/walking Edema calf | 1 | Pigmentation, discolouration, and venectasia | 1 |
Impaiment of daily activities | 4 | Healed or active ulcer | 1 |
Subjective symptoms | Objective signs |
Heaviness | Pretibial oedema |
Pain | Induration of the skin |
Cramps | Hyperpigmentation |
Pruritus | New venous ectasia |
Paraesthesia | Redness |
Pain during calf compression | |
Ulceration of the skin (= severe) | |
Each sign or symptom is graded with a score as 0, 1, 2, or 3 | |
0 = absent, 1 = mild, 2 = moderate or interference with daily life and work, 3 = severe or invalidating | |
The presence or absence of leg ulcer has to be noted | |
Definition of post-thrombotic syndrome according to Prandoni(Vilalta) | |
Absent | Score < 4 |
Mild-to-moderate | core between 5 and 14 at 2 consecutive visits |
Severe | score > 15 at 2 consecutive occasions or ulcer at 1 occasion |
Table 3 Clinical-etiology-anatomic-pathophysiologic classification for severity of chronic venous insufficiency[26]
Classification | Symptom |
C0 (C = Clinical) | No visible varicose veins |
C1 | Spider or reticular veins |
C2 | Varicose veins |
C3 | Oedema |
C4a | Pigmentetion or eczema |
C4b | Lipodermatosclerosis or atrophie blanche |
C5 | Skin changes with healed ulceration |
C6 | Skin changes with active ulceration |
S | Symptomatic, including aches, pain, tightness, skin irritation, heaviness, muscle cramps, and other complaints attributable to venous dysfunction |
A | Asymptomatic |
Clinical symptoms | Post-DVT |
E = Etiology | Deep, perforator, or superficial vein, alone or in combination |
A = Anatomic distribution | Reflux or obstruction, alone or in combination |
P = Pathophysiologic dysfunction |
Table 4 Widmer classification for assessment of chronic venous insufficiency[27]
Classification | Symptom |
I | Corona phlebotatica paraplantaris (ankle flare), subclinical mild oedema |
II | Hyperpigmentation, lipo- and dermatosclerosis, atrophie blanche (white skin atrophy), oedema, eczema |
III | Healed or active ulcer |
Table 5 Venous clinical severity score system of PTS or chronic venous insufficiency[28]
Attribute | Absent= 0 | Mild= 1 | Moderate= 2 | Severe= 3 |
Pain | None | Occasional, not restricting activity or requiring analgesics | Daily, moderate activity limitation, occasional analgesics | Daily, severe limiting activities or requiring regular use of analgesics |
Varicose veins | None | Few, scattered: branch varicous veins | Multiple: GS varicose veins confined to calf or thigh | Extensive: thigh and calf or GS and LS distribution |
Venous oedema | None | Evening ankle oedema only | Afternoon oedema, above ankle | Morning oedema above ankle and requiring activity change, elevation |
Skin pigmentation | Non or focal, low intensity | Diffuse, but limited in area and old (brown) | Diffuse over most of gaiter distribution (lower 1/3) or recent pigmentation (purple) | Wider distribution (above lower 1/3) and recent pigmentation |
Inflammation | None | Mild cellulitis, limited to marginal area around ulcer | Moderate cellulitis, involves most of gaiter area (lower 1/3) | Entire lower third of leg or more |
No. of active ulcers | 0 | 1 | > 2 | > 2 |
Active ulceration, duration | None | < 3 mo | > 3 mo, < 1 yr | Not healed > 1 yr |
Active ulcer, size | None | < 2 cm diameter | 2 to 6 cm diameter | > 6 cm diameter |
Compressive therapy | Not used or not compliant | Intermittent use of stockings | Wears stockings most days | Full compliance: stockings + elevation |
Objective score | |
Complete recanalization at 3 mo and no reflux | 0 |
Incomplete recanalization at 3 mo | 2 |
Complete recanalization after 6 mo and reflux | 1 |
Incomplete recanalization after 6 mo and reflux | 2 |
Obstruction after 1 year without or with reflux | 3 |
Normal D-dimer after discontinuation of anticoagulant therapy | 0 |
Increased D-dimer after discontinuation of anticoagulant thereapy | 3 |
Clinical score | |
Brandjes Prandoni score for PTS: Absent | 0 |
Mild | 1 |
Moderate | 2 |
Total Rotterdam score 12 | |
Score | Therapeutic implication |
Score 0 at 6 mo | No MECS and no ACT |
Score 1 to 4 at 6 mo | MECS and discontinuation ACT |
Score > 4 and normal D-dimer | MECS randomization ACT vs no ACT |
Score > 4 and abnormal D-dimer | MECS and continuation of ACT according to the PROLONG |
Plus Study | |
Designed by Michiels |
- Citation: Michiels JJ, Michiels JM, Moossdorff W, Lao M, Maasland H, Palareti G. Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014. World J Crit Care Med 2015; 4(1): 29-39
- URL: https://www.wjgnet.com/2220-3141/full/v4/i1/29.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v4.i1.29