[Post-thrombotic valvular lesions].

A patent lumen after deep vein thrombosis can be achieved but at the cost of valve destruction which occurs in 50 to 75% of the cases within 6 to 12 months after the thrombotic event. The diagnosis of post-thrombotic valve destruction is made on the basis of direct consequences of venous back flow. Photoplethysmographic measurement of venous filling pressure while walking or after a Valsava manoeuvre lacks specificity and is insufficiently sensitive, especially in case of minimal back flow. Retrograde femoral phlebography can miss distal back flow if the femoral valves functions correctly. Dynamic popliteal phlebography in the upright position could be the reference examination. Ultrasonography-Doppler is however widely used as the first intention investigation providing a positive diagnosis, recognizing the localization and quantifying the back flow. The patient is placed in the upright position and reflux is checked after standardized distal compression. The ultrasonographic aspect (fibrosis, thick wall, tributary vessels) gives further arguments for differential diagnosis. The consequences of valve destruction on skin trophicity appear to be worse than non-repermeation after a thrombotic event. Surgical repair (transposition, transplantation, valvuloplasty) should be proposed for young patients with severe trophicity disorders which resist well-conducted medical treatment. The rate of failure is approximately 50% i.e. higher than for primary valve destruction.