Early recanalization is important in preserving valve integrity for all but the posterior tibial segment. However, the small number of patients with reflux despite early lysis (< 1 month) or without reflux despite relatively late lysis (> 9 to 12 months) suggests that other factors may also contribute to the development of valvular incompetence. These factors may be particularly important in the posterior tibial vein, in which lysis time has little relationship to the ultimate development of reflux.
From December 1986 to December 1990, 268 patients with acute deep vein thrombosis were studied in our laboratory. From this group 107 patients (123 legs with deep vein thrombosis) were placed in our long-term follow-up program. The documentation of valvular reflux and its site was demonstrated by duplex scanning. The duplex studies were done at intervals of 1 and 7 days, 1 month, every 3 months for the first year, and then yearly thereafter. The mean follow-up time for these patients was 341 days. In addition, reflux was evaluated in 502 patients with negative duplex study results and no previous history of deep vein thrombosis or chronic venous insufficiency. In the patients with acute deep vein thrombosis, valvular incompetence was noted in 17 limbs (14%) at the time of the initial study. Reflux was absent in 106 limbs (86%). In this last group reflux developed in 17% of the limbs by day 7. By the end of the first month, 37% demonstrated reflux. By the end of the first year, more than two thirds of the involved limbs had developed valvular incompetence. The distribution of reflux at the end of the first year of follow-up was the following: (1) popliteal vein, 58%; (2) superficial femoral vein, 37%; (3) greater saphenous vein, 25%; and (4) posterior tibial vein, 18%. Reflux seems to be more frequent in the segments previously affected with deep vein thrombosis. Among cases where segments were initially affected with thrombi, after 1 year the incidence of reflux was 53%, 44%, 59%, and 33% for the common femoral vein, superficial femoral, popliteal vein, and posterior tibial vein, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
The location and extent of thrombosis in the deep venous system will determine immediate and long-term outcome. During the past 3 years, we have studied by duplex scanning 833 patients with suspected deep vein thrombosis. In this group, 209 patients (25%) had a positive study. The findings relative to location and extent of involvement are as follows. (1) The right leg was involved in 35% of patients, the left leg in 48%. Bilateral involvement was noted in 17%. (2) The veins most frequently affected by deep vein thrombosis were as follows: superficial femoral in 74%, popliteal in 73%, common femoral in 58%, posterior tibial in 40%, deep femoral in 29%, greater saphenous in 19%, and the inferior vena cava in 2%; multisegment involvement was common. (3) Total occlusion was present in 82% of the patients with deep vein thrombosis, and partial occlusion in 18%. (4) Isolated occlusion of single veins was uncommon. (5) The proximal (above-knee) area was involved in 95% of the cases with deep vein thrombosis, and the calf in 40% of the cases. Isolated calf deep vein thrombosis was found in 6% of the cases with right leg involvement and in 3% for the left. (6) Total leg involvement (iliocaval, femoropopliteal, and calf) occurred in 10% of the patients. Our data confirm the fallibility of the clinical diagnosis of deep vein thrombosis. The frequent involvement of both limbs stresses the importance of not examining just the symptomatic limb. Proximal venous thrombosis (popliteal to inferior vena cava) is much more common than isolated calf vein thrombosis as a cause for symptoms and the referral for study.
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