Influencing factors for lower extremity postthrombotic syndrome in patients with acute iliofemoral vein thrombosis
Sun Yafeng1, Qiu Peng2, Huang Jiaqi2
1Department of Chinese Medicine Surgery, the First People's Hospital of Shangqiu City, Shangqiu 476100, China; 2Department of Vascular Surgery, the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China;
Abstract：Objective To explore the predictive model of postthrombotic syndrome (PTS) in patients with iliofemoral vein thrombosis. Methods Retrospective study. The clinical data of 233 patients with acute iliofemoral vein thrombosis admitted to the Department of Vascular Surgery, the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine, from January 2017 to June 2018 were included. Of the patients, 135 were males and 98 were females with ages of 17–85 (58.69 ± 15.73) years old, and 200 received intracavitary treatment. By using simplified random grouping in accordance with the ratio of 7∶3, the patients were divided into 163 cases in the modeling group and 70 cases in the verification group. The observation indicators were as follows: (1) the occurrence of PTS in patients during follow-up; (2) risk factors affecting the occurrence of PTS; (3) a PTS risk prediction model. Results (1) All patients were followed up for 12–18 months. PTS occurred in 81 cases (34.80%) out of 233 patients. Among the cases of PTS, 61 (30.50%) occurred in 200 patients who received intracavitary thrombectomy, and 20 (60.60%) occurred in patients who did not undergo surgical treatment. A statistical difference was found between the two groups (χ2 = 11.32, P = 0.010). No statistically significant differences in age, gender, body mass index (BMI), deep vein thrombosis (DVT) risk factors, number of symptoms and signs, comorbidity, history of DVT, thrombectomy, PTS, and other metrics were found between the modeling group and the validation group (all P values > 0.05). (2) Univariate and multivariate analyses showed that male sex (X1), BMI (Χ2), history of subacute and chronic DVT (X3), history of varicose veins (X4), number of symptoms and signs (X5), and intracavitary thrombosis evacuation treatment (X6) were risk factors for PTS in patients with acute iliofemoral vein DVT (odds ratio = 2.46, 1.14, 3.44, 4.33, 1.28, and 0.24; 95% confidence intervals of 1.06–5.67, 1.04–1.25, 1.38–8.59, 1.71–10.97, 1.01–1.62, and 0.08–0.69, all P values < 0.05). (2) The PTS prediction model established on the basis of binary logistic regression analysis was logit(P)=-5.075+0.899X1+0.134Χ2+1.235X3+1.465X4+0.248X5-1.443X6. The area under the receiver operating characteristic curve was 0.81, and sensitivity and specificity were 0.90 and 0.65. respectively. Conclusion Male sex, BMI, history of subacute and chronic DVT, history of varicosity, number of symptoms and signs, and endoscopic thrombus removal are risk factors for PTS in patients with acute iliofemoral vein thrombosis. A prediction model for the PTS risk of patients with acute iliofemoral vein thrombosis is established and could enable personalized PTS risk assessment for patients with DVT to improve the guidance of clinical treatment.
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2022, Vol. 27 
