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Late clinical and hemodynamic sequelae of isolated calf vein thrombosis
R B McLafferty1, G L Moneta, M A Passman
1Department of Surgery, Oregon Health Sciences University, Portland, USA.
Insights
Isolated calf vein thrombosis (ICVT) can lead to mild venous valvular insufficiency in about a third of patients, often in unaffected segments. Most patients experience few significant long-term symptoms after ICVT.
Area of Science:
- Vascular Medicine
- Venous Thromboembolism
- Medical Diagnostics
Background:
- Isolated calf vein thrombosis (ICVT) is common, yet its long-term consequences are poorly understood.
- Assessing late clinical and hemodynamic effects of ICVT is crucial for patient management.
Purpose of the Study:
- To investigate the long-term clinical symptoms and vascular laboratory abnormalities following isolated calf vein thrombosis (ICVT).
Main Methods:
- Retrospective analysis of 37 patients diagnosed with ICVT via color flow duplex scanning.
- Clinical evaluation including history, physical examination, venous recovery time (VRT), and duplex valve closure time (DVCT).
- Comparison with a control group of 17 healthy individuals.
Main Results:
- At a mean follow-up of 3.4 years, 35% had reticular veins, 27% had varicose veins, and 5.4% had edema.
- Abnormal VRT was found in 23% of ICVT extremities vs. 9% of contralateral limbs (p < 0.05).
- Abnormal DVCT occurred in 26% of ICVT extremities vs. 6% of controls (p < 0.05), with most abnormalities in segments not originally affected by ICVT.
Conclusions:
- A significant portion of patients develop mild to moderate venous valvular insufficiency after ICVT, predominantly in segments not initially involved.
- Clinical symptoms attributable to ICVT are generally mild, with few patients experiencing severe issues long-term.
Purpose:
Despite the frequent occurrence of isolated calf vein thrombosis (ICVT), little is known about the long-term clinical and hemodynamic sequelae of this condition. This study was conducted to determine late clinical symptoms and vascular laboratory abnormalities in patients after ICVT.
Methods:
Of 146 patients in whom ICVT was documented by color flow duplex scanning between 1989 and 1994, 37 were reexamined. Data included history, physical examination, venous recovery time (VRT), and duplex valve closure time (DVCT). A control group with no history of venous disease also underwent identical clinical and hemodynamic testing.
Results:
Thirty-seven patients (18 male and 19 female) with a median age of 56 years (range, 22 to 76 years) were examined at a mean follow-up of 3.4 years (range, 2.2 to 5.8 years) after the diagnosis of ICVT in 39 extremities. Seventeen subjects (34 extremities) were recruited as normal controls. Presenting symptoms at the time of ICVT included calf pain in 17 patients, calf swelling in seven, pain and swelling in seven, pulmonary symptoms in four, pulmonary symptoms and calf pain in one, and no symptoms in one. In the patients with ICVT, VRT was abnormal in 23% of extremities with ICVT and in 9% of extremities without ICVT. None of the extremities in the control group had an abnormal VRT (p < 0.05). DVCT was abnormal in one or more venous segments in 26% of extremities diagnosed with ICVT and in 6% of control extremities (p < 0.05). Follow-up clinical examination in patients with ICVT revealed 13 (35%) with reticular veins, 10 (27%) with varicose veins, two (5.4%) with edema, one (2.7%) with pigmentation and ulcer (contralateral extremity to ICVT with a previous history of proximal deep venous thrombosis), 13 (35%) with mild discomfort, and one (2.7%) with severe pain. All symptoms attributable to ICVT were mild in nature except in one patient who had severe pain and no physical or hemodynamic vascular laboratory abnormalities at follow-up.
Conclusion:
At an average of 3.4 years after ICVT, approximately one third of patients showed evidence of mild to moderate venous valvular insufficiency, but mostly in segments not involved with ICVT, and few had significant clinical symptoms attributable to venous disease.