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The origin of thrombi in the deep veins of the lower limb: a venographic study
Insights
Deep vein thrombosis (DVT) was diagnosed in 49.4% of patients with suspected DVT and 53% of patients with suspected pulmonary embolism. Most DVTs occurred in the calf, but 8% originated proximally without calf involvement.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
Background:
- Deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant clinical concerns.
- Accurate diagnosis is crucial for effective patient management.
Purpose of the Study:
- To evaluate the diagnostic yield of ascending venography in patients with suspected DVT and PE.
- To characterize the location and patterns of thrombus formation.
Main Methods:
- Ascending venography was performed on 952 patients.
- Patients were divided into two groups: clinically diagnosed DVT (n=812) and suspected PE (n=140).
Main Results:
- Thrombus was detected in 49.4% of the DVT group and 53% of the PE group.
- Of 535 limbs with thrombus, 92% involved the calf.
- In 8% of cases, thrombus originated in proximal veins or multiple discontinuous sites without calf involvement.
Conclusions:
- Ascending venography is a valuable tool for diagnosing DVT and PE.
- Calf vein thrombosis is the most common presentation, but proximal and multifocal thrombus patterns also occur and require consideration.
Abstract:
A series of 952 patients was examined by ascending venography; 812 with clinically diagnosed deep vein thrombosis (DVT) (group 1) and 140 with clinical features suggestive of pulmonary embolism (group 2). Thrombus was demonstrated in 401 (49.4 per cent) of group 1 and in 74 (53 per cent) of group 2 patients. A total of 535 limbs contained thrombus. In 493 (92 per cent) thrombus was present in the calf with either no further clot, or clot in continuity with that in more proximal veins. In the remaining 42 legs (8 per cent) thrombus either originated from multiple discontinuous sites in the legs and pelvis, or in proximal major veins without concomitant calf involvement. The clinical implications of these findings are discussed.