Computed tomography in deep venous thrombosis with limb oedema

Area of Science:

• Vascular Surgery
• Radiology
• Orthopedic Surgery

Background:

• Deep venous thrombosis (DVT) is a significant cause of lower limb morbidity.
• Understanding soft tissue compartment edema distribution in DVT is crucial for managing complications.
• Compartment syndrome is a risk in lower limb swelling, necessitating pressure monitoring.

Purpose of the Study:

• To investigate the distribution of edema in lower limb soft tissue compartments in patients with deep venous thrombosis.
• To measure interstitial fluid hydrostatic pressure and tissue compliance within different compartments.
• To assess the risk of compartment syndrome in DVT-affected lower limbs.

Main Methods:

• Computed tomography (CT) scans were performed on 12 patients with DVT.
• Edema distribution was analyzed in subcutaneous and muscular compartments at different levels proximal to the ankle.
• Interstitial fluid hydrostatic pressure was measured in the subcutis and anterior/posterior muscular compartments.
• Tissue compliance was assessed in these compartments.

Main Results:

• Edema was evenly distributed in subcutaneous and muscular compartments 25 cm proximal to the ankle.
• Muscular compartments showed significantly less swelling 10 cm proximal to the ankle.
• Interstitial fluid hydrostatic pressure was significantly increased in all measured compartments.
• Tissue compliance was significantly lower in muscular compartments compared to the subcutis.
• Measured pressures were generally below the 30 mmHg threshold for compartment syndrome.

Conclusions:

• Deep venous thrombosis leads to increased interstitial fluid pressure and decreased tissue compliance in lower limb compartments.
• While pressures can be elevated, they typically remain below the threshold for acute compartment syndrome.
• CT imaging provides valuable insights into edema distribution, aiding in the understanding of DVT pathophysiology.