The natural history of calf vein thrombosis: Lysis of thrombi and development of reflux

Masuda, Elna M.; Kessler, Darcy M.; Kistner, Robert L.; Eklöf, Bo; Sato, Dean T.

doi:10.1016/s0741-5214(98)70201-0

Cited by 124 publications

(103 citation statements)

References 16 publications

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“…11,27) Previous investigations have indicated that isolated calf DVTs have better prognosis, with a relatively lower incidence of complications of proximal propagation (3%-32% of cases 10,[13][14][15]24,27,28,29) ) and PE (2%-21% of cases 10,11,[13][14][15]30) ). However, an epidemiological study revealed that the prognosis of patients with bilateral distal DVT is as poor as that of patients with bilateral proximal DVT in terms of mortality and the recurrence rate of DVT.…”

Section: Discussionmentioning

confidence: 99%

“…9, No. 1; 2016; pp [15][16][17][18][19][20][21] Online December 11, 2015 ©2016 Annals of Vascular Diseases doi:10.3400/avd.oa. who had pre-fatal examinations or any treatment for VTE were excluded from this study.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

Kageyama

2016

Annals of Vascular Diseases

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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....

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Kageyama

2016

Annals of Vascular Diseases

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“…The clinical significance of isolated calf vein thrombosis, particularly with respect to development of postthrombotic syndrome, remains controversial, opinions ranging from few adverse sequelae, such as mild to moderate venous valvular insufficiency mostly in segments not involved with the calf thrombosis [39,40], to more severe problems with PE, persistent symptoms and development of valvular incompetence in approximately one quarter of the patients [41].…”

Section: Calf-vein Thrombosismentioning

confidence: 99%

Ultrasound of limb veins

Mantoni

2001

Eur Radiol

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“…But even in nonpregnant women, proximal propagation of deep vein thrombosis from the calves into the popliteal or thigh veins can vary and can be less than 5%. 7 The natural course of distal or proximal deep vein thrombosis in pregnancy is even less known.…”

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confidence: 99%

Is deep vein thrombosis different during pregnancy?

Kaaja¹

2010

Canadian Medical Association Journal

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The natural history of calf vein thrombosis: Lysis of thrombi and development of reflux

Cited by 124 publications

References 16 publications

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

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

Ultrasound of limb veins

Is deep vein thrombosis different during pregnancy?

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