Clinical Significance of the Soleal Vein and Related Drainage Veins, in Calf Vein Thrombosis in Autopsy Cases with Massive Pulmonary Thromboembolism

Abstract

Objective: To clarify the histopathological characteristics of deep vein thrombosis (DVT) resulting in lethal pulmonary thromboembolism (PE). Subjects and Methods:We investigated 100 autopsy cases of PE from limb DVT. The distribution and chronology of DVT in each deep venous segment were examined. Venous segments were classified into three groups: iliofemoral vein, popliteal vein and calf vein (CV). The CV was subdivided into two subgroups, drainage veins of the soleal vein (SV) and non drainage veins of SV. Results: Eighty-nine patients had bilateral limb DVTs. CV was involved in all limbs with DVT with isolated calf DVTs were seen in 47% of patients. Fresh and organized thrombi were detected in 84% of patients. SV showed the highest incidence of DVTs in eight venous segments. The incidence of DVT gradually decreased according to the drainage route of the central SV. Proximal tips of fresh thrombi were mainly located in the popliteal vein and tibioperoneal trunk, occurring in these locations in 63% of limbs. Conclusions: SV is considered to be the primary site of DVT; the DVT then propagated to proximal veins through the drainage veins. Lethal thromboemboli would occur at proximal veins as a result of proximal propagation from calf DVTs.Keywords: pulmonary thromboembolism, deep vein thrombosis, soleal vein, calf vein, autopsy thromboembolism (VTE). Among these consequences, massive PE is one of the most serious outcomes with a high mortality rate. 1,2) In the majority of PE cases, the embolic source is considered to be the deep veins of the lower extremitiesy. 3-6) However, the detailed incidence and distribution of leg DVT in cases of massive PE are unclear because most acute massive PE patients die suddenly without definitive diagnosis or leg examinations during their lifetime.Autopsy investigations of leg DVT in patients with massive PE have been performed previously. 4-9) However, most previous reports focused on proximal limb DVTs, which are considered to have a direct relationship to massive PE. 8,9) Calf DVT has not been adequately studied using autopsy material. However, clinical investigations have shed new light on calf DVT as a possible embolic source leading to PE. [10][11][12][13][14][15] We have previously studied medicolegal autopsy cases of patients who died of massive PE using histopathological methods. 1,2,16,17) Among them, we reported a high frequency of DVT in calf veins, especially in the soleal vein and related drainage veins. 16) However, we could not perform statistical analysis on the distribution and chronology of DVT in each deep venous segment in our previous study. Moreover, the location of residual fresh thrombi in the limbs, which would be useful information in the clinical setting was not considered in our previous study. Therefore, we increased the number of the cases to 100 from 60 cases in the present study and performed detailed statistical analysis.The present study was carried out to clarify the histopathological characteristics of limb DVT resulting in lethal massive PE....

The utility of on‐site ultrasound screening in population at high risk for deep venous thrombosis in temporary housing after the great East Japan Earthquake

“…However, we still emphasized distal imaging because lethal thromboemboli may occur in proximal veins as a result of proximal propagation from calf DVT. 46 In addition, isolated distal DVT was significantly more often associated with 47 However, no differences were observed in recent surgery or hospital admission between the DVTpositive and -negative groups in our study. Overdiagnosis may also be considered, but each ultrasonographic examination positive for DVT was confirmed by at least one other investigator, including at least one physician.…”

“…Therefore, the high prevalence of DVT may have resulted from the different types of imaging methods used when compared with the prevalence detected by proximal imaging. However, we still emphasized distal imaging because lethal thromboemboli may occur in proximal veins as a result of proximal propagation from calf DVT . In addition, isolated distal DVT was significantly more often associated with transient risk factors (recent surgery, recent plaster immobilization, and recent travel), whereas proximal DVT was significantly more often associated with chronic health states (active cancer, congestive heart failure, or respiratory insufficiency, and age of >75 years) .…”

Anatomy of Extramuscular Soleus Veins: Clinical Impact

“…Kageyama et al [28] and Ro and Kageyama [29] reported that the soleal vein contains over 10 multibranched veins in each leg and they are roughly subclassified into three groups: (1) centralis, (2) medialis, and (3) lateralis.…”

Association of Coagulation Factors VIII/XI/XIII Polymorphisms With Coagulation Factor Activities and Deep Vein Thrombosis After Artificial Joints Replacement

“…5 The current studies found that venous wall injury, blood stagnation, and hypercoagulable state are the main risk factors of DVT. [6][7][8] Evidence supported that coagulation factors contribute to wound repair after tissue injury and wound injuries, and the activation of coagulation system may be an important role in DVT occurrence. 9 In recent years, the association of gene polymorphisms and DVT formation has been increasing recognized as an attracting topic.…”