Saarinen Jukka P, Domonyi Kati, Zeitlin Rainer, Salenius Juha-Pekka
Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland.
J Vasc Surg. 2002 Nov;36(5):959-64. doi: 10.1067/mva.2002.127523.
The purpose of this study was to evaluate the long-term clinical and hemodynamic outcomes after isolated first-time calf deep venous thrombosis (cDVT).
This retrospective clinical study was set in an academic referral center. From 1990 to 1994, 617 patients were seen with acute DVT. This number included 82 patients with phlebographically confirmed cDVT. Of those patients, 50 attended the clinical assessment 6 to 10 years (mean, 8.4 years) after the acute event. All patients with cDVT underwent treatment with anticoagulant therapy (96% heparin and warfarin, 4% only warfarin). The duration of the heparin treatment was 4.0 to 8.0 days (mean, 6.4 days), and warfarin was given for 2.0 to 7.5 months (mean, 3.4 months). Compression stockings were used regularly (mean, 9.2 months; range, 0.25 to 64 months) in 30% of the patients after acute cDVT. The initial ipsilateral phlebograms were reevaluated to confirm the diagnosis of cDVT without popliteal involvement. The clinical assessment included evaluation of both legs according to CEAP clinical classification C0-6. Bilateral color-flow duplex scan imaging was performed to assess reflux in deep popliteal segments. Photoplethysmographic measurement of venous refilling time was conducted in both legs to observe deep reflux.
The mean age was 57 years (range, 30 to 76 years) at the time of the clinical assessment. Cause of acute cDVT was idiopathy in 52%, coagulopathy in 2%, trauma in 10%, immobilization in 22%, and postoperative in 14% of the cases. During the follow-up period, seven recurrent DVTs (14%) were seen. In the clinical assessment, 17 legs (34%) with previous cDVT had skin changes (CEAP C4-6). No active ulcers were found. Contralaterally, the frequency of C4-6 was 10% (n = 5; P <.05). After exclusion of recurrent DVTs, the distribution of the clinical classification still remained the same. Deep popliteal reflux was detected in 20 legs (40%) with previous cDVT. Contralaterally, popliteal reflux was seen in nine cases (18%; P <.05). Plethysmography showed deep reflux in 16 legs (33%) with cDVT and in nine cases (18%) contralaterally (P >.05). A significant association was found between deep popliteal reflux and skin changes (P <.05).
In the long-term follow-up, cDVT may lead to significant postthrombotic disease. Reflux in the primarily uninvolved popliteal vein is frequent and may be associated with more severe disease.
本研究旨在评估首次单纯小腿深静脉血栓形成（cDVT）后的长期临床和血流动力学结局。
这项回顾性临床研究在一家学术转诊中心进行。1990年至1994年期间，共诊治了617例急性深静脉血栓形成患者。其中包括82例经静脉造影证实为cDVT的患者。这些患者中，有50例在急性事件发生6至10年（平均8.4年）后接受了临床评估。所有cDVT患者均接受了抗凝治疗（96%使用肝素和华法林，4%仅使用华法林）。肝素治疗持续时间为4.0至8.0天（平均6.4天），华法林使用2.0至7.5个月（平均3.4个月）。30%的急性cDVT患者在之后定期使用弹力袜（平均9.2个月；范围为0.25至64个月）。重新评估最初的同侧静脉造影以确认无腘静脉受累的cDVT诊断。临床评估包括根据CEAP临床分级C0 - 6对双腿进行评估。进行双侧彩色血流双功扫描成像以评估腘深静脉段的反流情况。对双腿进行光电容积描记法测量静脉充盈时间以观察深静脉反流。
临床评估时的平均年龄为57岁（范围30至76岁）。急性cDVT的病因中，52%为特发性，2%为凝血病，10%为创伤，22%为制动，14%为术后。在随访期间，发现7例复发性深静脉血栓形成（14%）。在临床评估中，17条曾患cDVT的腿（34%）出现了皮肤改变（CEAP C4 - 6）。未发现活动性溃疡。对侧出现C4 - 6的频率为10%（n = 5；P <.05）。排除复发性深静脉血栓形成后，临床分级的分布仍保持不变。在20条曾患cDVT的腿（40%）中检测到腘深静脉反流。对侧有9例出现腘静脉反流（18%；P <.05）。光电容积描记法显示，16条患cDVT的腿（33%）出现深静脉反流，对侧有9例（18%）出现深静脉反流（P >.05）。发现腘深静脉反流与皮肤改变之间存在显著关联（P <.05）。
在长期随访中，cDVT可能导致严重的血栓形成后疾病。最初未受累的腘静脉反流很常见，且可能与更严重的疾病相关。
