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

E. M. Masuda, D. M. Kessler, R. L. Kistner, B. Eklof, D. T. Sato, R. DePalma, R. L. Kistner, S. Salles-Cunha, Gregory (Greg) Moneta, K. McIntyre

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Purpose: Although the fact is well accepted that deep venous thrombosis (DVT) of the iliac, femoral, and popliteal veins can lead to the post- thrombotic (postphlebitic) syndrome, the significance of isolated calf DVT on the development of late venous sequelae and physiologic calf dysfunction is unknown. The purpose of this study was to review the outcome of 58 limbs with isolated calf DVT and report the clinical, physiologic, and imaging results up to 6 years after the onset of DVT. Methods: The study consisted of 58 limbs of 54 patients in whom isolated calf vein DVT was diagnosed between 1990 and 1995. Proximal propagation of clot, lysis of thrombi, and development of symptomatic pulmonary emboli were examined. Of the patients, 28 received anticoagulation therapy, and 26 did not, but they had follow-up with serial duplex scans. At late follow-up 1 to 6 years later (median, 3 years), 23 patients were examined for the post-thrombotic syndrome, and all 23 underwent clinical examination, color-flow duplex scanning, and air plethysmography. Results: Proximal propagation of DVT from the calf veins into the popliteal or thigh veins occurred in 2 of 49 cases (4%) within 2 weeks of diagnosis. No patient had clinically overt pulmonary emboli develop regardless of whether anticoagulation therapy was received or not. The most common site for calf DVT was the peroneal vein (71%). Complete lysis of calf thrombi was found in 88% of the cases by 3 months. At 3 years, 95% of the patients were either asymptomatic or mildly symptomatic, and 5% had discoloration of the limb. No ulcers occurred. By air plethysmography, physiologic abnormalities were found in 27% of the cases, which was not significantly different from normal controls. Valvular reflux by duplex scanning of the calf vein segment with DVT was found in 2 of 23 cases (9%). However, reflux in at least one venous segment not involved with DVT was found in 7 of 23 cases (30%), which was higher than, but not statistically different from, normal controls, with reflux occurring in 5 of 26 cases (19%). Conclusions: Isolated calf vein DVT leads to few early complications (ie, clot propagation, pulmonary emboli) and few adverse sequelae at 3 years. The peroneal vein is most commonly involved and should be a part of the routine screening for DVT. Lysis of clot usually occurs by 3 months. Although valvular reflux rarely is found in the affected calf vein at 3 years, reflux may be found in adjacent uninvolved veins in approximately 30% of the cases. The question of whether this will lead to future sequelae, such as ulceration, will require longer follow-up.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJournal of Vascular Surgery
Volume28
Issue number1
DOIs
StatePublished - 1998
Externally publishedYes

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Natural History
Venous Thrombosis
Veins
Thrombosis
Embolism
Popliteal Vein
Plethysmography
Extremities
Lung
Postphlebitic Syndrome
Air
Iliac Vein
Femoral Vein
Thigh
Ulcer
Color

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Masuda, E. M., Kessler, D. M., Kistner, R. L., Eklof, B., Sato, D. T., DePalma, R., ... McIntyre, K. (1998). The natural history of calf vein thrombosis: Lysis of thrombi and development of reflux. Journal of Vascular Surgery, 28(1), 67-74. https://doi.org/10.1016/S0741-5214(98)70201-0

The natural history of calf vein thrombosis : Lysis of thrombi and development of reflux. / Masuda, E. M.; Kessler, D. M.; Kistner, R. L.; Eklof, B.; Sato, D. T.; DePalma, R.; Kistner, R. L.; Salles-Cunha, S.; Moneta, Gregory (Greg); McIntyre, K.

In: Journal of Vascular Surgery, Vol. 28, No. 1, 1998, p. 67-74.

Research output: Contribution to journalArticle

Masuda, EM, Kessler, DM, Kistner, RL, Eklof, B, Sato, DT, DePalma, R, Kistner, RL, Salles-Cunha, S, Moneta, GG & McIntyre, K 1998, 'The natural history of calf vein thrombosis: Lysis of thrombi and development of reflux', Journal of Vascular Surgery, vol. 28, no. 1, pp. 67-74. https://doi.org/10.1016/S0741-5214(98)70201-0
Masuda, E. M. ; Kessler, D. M. ; Kistner, R. L. ; Eklof, B. ; Sato, D. T. ; DePalma, R. ; Kistner, R. L. ; Salles-Cunha, S. ; Moneta, Gregory (Greg) ; McIntyre, K. / The natural history of calf vein thrombosis : Lysis of thrombi and development of reflux. In: Journal of Vascular Surgery. 1998 ; Vol. 28, No. 1. pp. 67-74.
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abstract = "Purpose: Although the fact is well accepted that deep venous thrombosis (DVT) of the iliac, femoral, and popliteal veins can lead to the post- thrombotic (postphlebitic) syndrome, the significance of isolated calf DVT on the development of late venous sequelae and physiologic calf dysfunction is unknown. The purpose of this study was to review the outcome of 58 limbs with isolated calf DVT and report the clinical, physiologic, and imaging results up to 6 years after the onset of DVT. Methods: The study consisted of 58 limbs of 54 patients in whom isolated calf vein DVT was diagnosed between 1990 and 1995. Proximal propagation of clot, lysis of thrombi, and development of symptomatic pulmonary emboli were examined. Of the patients, 28 received anticoagulation therapy, and 26 did not, but they had follow-up with serial duplex scans. At late follow-up 1 to 6 years later (median, 3 years), 23 patients were examined for the post-thrombotic syndrome, and all 23 underwent clinical examination, color-flow duplex scanning, and air plethysmography. Results: Proximal propagation of DVT from the calf veins into the popliteal or thigh veins occurred in 2 of 49 cases (4{\%}) within 2 weeks of diagnosis. No patient had clinically overt pulmonary emboli develop regardless of whether anticoagulation therapy was received or not. The most common site for calf DVT was the peroneal vein (71{\%}). Complete lysis of calf thrombi was found in 88{\%} of the cases by 3 months. At 3 years, 95{\%} of the patients were either asymptomatic or mildly symptomatic, and 5{\%} had discoloration of the limb. No ulcers occurred. By air plethysmography, physiologic abnormalities were found in 27{\%} of the cases, which was not significantly different from normal controls. Valvular reflux by duplex scanning of the calf vein segment with DVT was found in 2 of 23 cases (9{\%}). However, reflux in at least one venous segment not involved with DVT was found in 7 of 23 cases (30{\%}), which was higher than, but not statistically different from, normal controls, with reflux occurring in 5 of 26 cases (19{\%}). Conclusions: Isolated calf vein DVT leads to few early complications (ie, clot propagation, pulmonary emboli) and few adverse sequelae at 3 years. The peroneal vein is most commonly involved and should be a part of the routine screening for DVT. Lysis of clot usually occurs by 3 months. Although valvular reflux rarely is found in the affected calf vein at 3 years, reflux may be found in adjacent uninvolved veins in approximately 30{\%} of the cases. The question of whether this will lead to future sequelae, such as ulceration, will require longer follow-up.",
author = "Masuda, {E. M.} and Kessler, {D. M.} and Kistner, {R. L.} and B. Eklof and Sato, {D. T.} and R. DePalma and Kistner, {R. L.} and S. Salles-Cunha and Moneta, {Gregory (Greg)} and K. McIntyre",
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T1 - The natural history of calf vein thrombosis

T2 - Lysis of thrombi and development of reflux

AU - Masuda, E. M.

AU - Kessler, D. M.

AU - Kistner, R. L.

AU - Eklof, B.

AU - Sato, D. T.

AU - DePalma, R.

AU - Kistner, R. L.

AU - Salles-Cunha, S.

AU - Moneta, Gregory (Greg)

AU - McIntyre, K.

PY - 1998

Y1 - 1998

N2 - Purpose: Although the fact is well accepted that deep venous thrombosis (DVT) of the iliac, femoral, and popliteal veins can lead to the post- thrombotic (postphlebitic) syndrome, the significance of isolated calf DVT on the development of late venous sequelae and physiologic calf dysfunction is unknown. The purpose of this study was to review the outcome of 58 limbs with isolated calf DVT and report the clinical, physiologic, and imaging results up to 6 years after the onset of DVT. Methods: The study consisted of 58 limbs of 54 patients in whom isolated calf vein DVT was diagnosed between 1990 and 1995. Proximal propagation of clot, lysis of thrombi, and development of symptomatic pulmonary emboli were examined. Of the patients, 28 received anticoagulation therapy, and 26 did not, but they had follow-up with serial duplex scans. At late follow-up 1 to 6 years later (median, 3 years), 23 patients were examined for the post-thrombotic syndrome, and all 23 underwent clinical examination, color-flow duplex scanning, and air plethysmography. Results: Proximal propagation of DVT from the calf veins into the popliteal or thigh veins occurred in 2 of 49 cases (4%) within 2 weeks of diagnosis. No patient had clinically overt pulmonary emboli develop regardless of whether anticoagulation therapy was received or not. The most common site for calf DVT was the peroneal vein (71%). Complete lysis of calf thrombi was found in 88% of the cases by 3 months. At 3 years, 95% of the patients were either asymptomatic or mildly symptomatic, and 5% had discoloration of the limb. No ulcers occurred. By air plethysmography, physiologic abnormalities were found in 27% of the cases, which was not significantly different from normal controls. Valvular reflux by duplex scanning of the calf vein segment with DVT was found in 2 of 23 cases (9%). However, reflux in at least one venous segment not involved with DVT was found in 7 of 23 cases (30%), which was higher than, but not statistically different from, normal controls, with reflux occurring in 5 of 26 cases (19%). Conclusions: Isolated calf vein DVT leads to few early complications (ie, clot propagation, pulmonary emboli) and few adverse sequelae at 3 years. The peroneal vein is most commonly involved and should be a part of the routine screening for DVT. Lysis of clot usually occurs by 3 months. Although valvular reflux rarely is found in the affected calf vein at 3 years, reflux may be found in adjacent uninvolved veins in approximately 30% of the cases. The question of whether this will lead to future sequelae, such as ulceration, will require longer follow-up.

AB - Purpose: Although the fact is well accepted that deep venous thrombosis (DVT) of the iliac, femoral, and popliteal veins can lead to the post- thrombotic (postphlebitic) syndrome, the significance of isolated calf DVT on the development of late venous sequelae and physiologic calf dysfunction is unknown. The purpose of this study was to review the outcome of 58 limbs with isolated calf DVT and report the clinical, physiologic, and imaging results up to 6 years after the onset of DVT. Methods: The study consisted of 58 limbs of 54 patients in whom isolated calf vein DVT was diagnosed between 1990 and 1995. Proximal propagation of clot, lysis of thrombi, and development of symptomatic pulmonary emboli were examined. Of the patients, 28 received anticoagulation therapy, and 26 did not, but they had follow-up with serial duplex scans. At late follow-up 1 to 6 years later (median, 3 years), 23 patients were examined for the post-thrombotic syndrome, and all 23 underwent clinical examination, color-flow duplex scanning, and air plethysmography. Results: Proximal propagation of DVT from the calf veins into the popliteal or thigh veins occurred in 2 of 49 cases (4%) within 2 weeks of diagnosis. No patient had clinically overt pulmonary emboli develop regardless of whether anticoagulation therapy was received or not. The most common site for calf DVT was the peroneal vein (71%). Complete lysis of calf thrombi was found in 88% of the cases by 3 months. At 3 years, 95% of the patients were either asymptomatic or mildly symptomatic, and 5% had discoloration of the limb. No ulcers occurred. By air plethysmography, physiologic abnormalities were found in 27% of the cases, which was not significantly different from normal controls. Valvular reflux by duplex scanning of the calf vein segment with DVT was found in 2 of 23 cases (9%). However, reflux in at least one venous segment not involved with DVT was found in 7 of 23 cases (30%), which was higher than, but not statistically different from, normal controls, with reflux occurring in 5 of 26 cases (19%). Conclusions: Isolated calf vein DVT leads to few early complications (ie, clot propagation, pulmonary emboli) and few adverse sequelae at 3 years. The peroneal vein is most commonly involved and should be a part of the routine screening for DVT. Lysis of clot usually occurs by 3 months. Although valvular reflux rarely is found in the affected calf vein at 3 years, reflux may be found in adjacent uninvolved veins in approximately 30% of the cases. The question of whether this will lead to future sequelae, such as ulceration, will require longer follow-up.

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