Kennisvragen

Tijdens de ontwikkeling van de modules is gebleken dat er binnen een aantal modules nog te weinig bewijs is voor de onderbouwing van de aanbeveling en dus kennisvragen bestaan. (Vervolg)onderzoek is wenselijk om in de toekomst een duidelijker antwoord te kunnen geven op vragen uit de praktijk.

Achtergrond

Post-thrombotic syndrome (PTS) is a chronic complication due to deep vein thrombosis seen in 40-60% of patients (Prandoni, 2015). Current guidelines (ESVS 2022, CIRSE 2014) recommend endovascular recanalization and stent placement for patients with clinically relevant post-thrombotic iliocaval obstruction. The success of this treatment is highly dependent on the involvement of inflow blood vessels, as well as other factors such as extensiveness of the defects and adequate stent start and landing zone. Pre-interventional imaging is therefore crucial to determine the presence and extensiveness of post-thrombotic abnormalities, allowing the need for as well as the success of endovascular intervention to be determined and optimized, respectively. Duplex ultrasound is widely used for this purpose as a first-line imaging modality, sometimes in combination with cross-sectional imaging such as CTV or MRV. Data on the diagnostic accuracy of these different pre-interventional imaging techniques is limited and with this, the value on predicting the development of post-thrombotic syndrome, or the effect of any endovascular treatment, is unclear. In this module, we provide a recommendation on which modality is most appropriate as an initial pre-interventional imaging technique in patients with (suspected) PTS.

Voorstel onderzoeksvraag

Wat is de waarde van pre-interventionele cross-sectionele beeldvorming voor het voorspellen van een succesvolle interventie bij patiënten met (verdenking op) post-trombotisch syndroom (PTS)?