Venographic Studies on the Role of Valve Pockets in Thrombogenesis with Clinical Comments

Abstract

In postmortem exploration of the veins of the lower limbs for studies of the frequency and significance of thromboembolism intraosseous venography with injection of contrast medium into the calcaneus was performed followed by complete dissection of the leg veins. A good agreement was found between venographic results and dissection findings. Out of the 596 legs examined, deep venous thrombosis was found in 229 (38%). In 32 of the lower limbs (5.4%) a definite localization and adherence of thrombi to valve pockets was noted. Altogether, 37 such thrombi were encountered. In addition 9 small thrombi of early type were found floating freely in the venous lumen just above a pocket. Microscopically the thrombi showed the greatest degree of organization at the bottom of the valve pocket speaking for this localization as the origin of formation. This is in accordance with the fact that stasis of blood would be most pronounced at the bottom of valve pockets as shown by retention of contrast medium in pockets in clinical venography. In a clinical series of venographies performed after hip surgery several thrombi located to valve pockets were found. Some of these thrombi had proximally free floating tails forming a potential menace of fatal pulmonary embolism.