Macdonald P S, Kahn S R, Miller N, Obrand D
Department of Surgery, McGill University, Montreal, Quebec, Canada.
J Vasc Surg. 2003 Mar;37(3):523-7. doi: 10.1067/mva.2003.149.
Lower extremity deep vein thrombosis is often isolated to the sinusoidal veins draining the gastrocnemius and soleus muscles. The purpose of this study was to establish the incidence rate of propagation of isolated gastrocnemius and soleal vein thrombosis (IGSVT) into the deep veins of the calf and thigh.
All patients who were referred for color flow duplex ultrasonography (CFDU) for suspected deep vein thrombosis were prospectively evaluated for IGSVT. Patients with IGSVT received no systemic anticoagulation therapy and underwent serial CFDU at 5, 9, 14, 30, and 90 days after recruitment. The incidence and extent of IGSVT propagation were noted. Factors predictive of IGSVT extension were sought, including age, gender, side, symptoms, ambulatory status, and the presence of comorbid illness, including cardiac disease, cancer, hypercoagulable states, recent surgery or trauma, and previous venous disease.
One hundred thirty-five limbs with IGSVT were studied for 3 months, and 16.3% of cases with IGSVT extended the thrombus to the level of the adjacent tibial, or peroneal, veins or higher. Only 3% of the cases with IGSVT propagated as cephalad as the popliteal vein, and 90.9% of IGSVT propagation occurred within 2 weeks of CFDU diagnosis. No IGSVT propagated to the level of the popliteal vein beyond 2 weeks from the time of CFDU diagnosis. No IGSVT extended into the deep veins of the thigh. By the end of the 3-month study period, 45.9% of thrombi had completely resolved. Only the presence of cancer was prognostic for IGSVT progression.
During the 3-month study period, the short-term incidence rate of untreated IGSVT propagation to the level of the popliteal vein, even in the presence of cancer, was only 3%. Follow-up imaging to detect IGSVT propagation beyond 2 weeks from the time of diagnosis may not be necessary.
下肢深静脉血栓形成常局限于引流腓肠肌和比目鱼肌的窦状静脉。本研究的目的是确定孤立性腓肠肌和比目鱼肌静脉血栓形成（IGSVT）扩展至小腿和大腿深静脉的发生率。
对所有因疑似深静脉血栓形成而接受彩色多普勒超声检查（CFDU）的患者进行前瞻性IGSVT评估。IGSVT患者未接受全身抗凝治疗，并在入选后第5、9、14、30和90天接受系列CFDU检查。记录IGSVT扩展的发生率和范围。寻找预测IGSVT扩展的因素，包括年龄、性别、侧别、症状、活动状态以及合并疾病的存在，包括心脏病、癌症、高凝状态、近期手术或创伤以及既往静脉疾病。
对135条患有IGSVT的肢体进行了3个月的研究，16.3%的IGSVT病例血栓扩展至相邻胫静脉或腓静脉水平或更高。只有3%的IGSVT病例血栓向上扩展至腘静脉水平，90.9%的IGSVT扩展发生在CFDU诊断后2周内。自CFDU诊断后2周起，没有IGSVT扩展至腘静脉水平。没有IGSVT扩展至大腿深静脉。在3个月的研究期结束时，45.9%的血栓已完全溶解。只有癌症的存在是IGSVT进展的预后因素。
在3个月的研究期内，未经治疗的IGSVT扩展至腘静脉水平的短期发生率，即使在存在癌症的情况下，也仅为3%。可能无需进行随访成像以检测诊断后2周以上的IGSVT扩展情况。
