Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Thromb Haemost. 2006 Apr;4(4):800-6. doi: 10.1111/j.1538-7836.2006.01859.x.
To investigate patterns of venous insufficiency and changes in calf muscle deoxygenated hemoglobin (HHb) levels after an acute deep vein thrombosis (DVT).
A total of 78 limbs with an acute DVT involving 156 anatomic segments were evaluated with duplex scanning and near-infrared spectroscopy (NIRS) at 1, 3, 6 and 12 months. Venous segments were examined whether they were occluded, partially recanalized, and totally recanalized, and the development of venous reflux was noted. The NIRS was used to measure calf muscle HHb levels. Calf venous blood filling index (HHbFI) was calculated on standing, then the calf venous ejection index (HHbEI), and the venous retention index (HHbRI) were obtained after exercise.
The segments investigated were the common femoral vein (CFV; 38 segments), femoral vein (FV; 37), popliteal vein (POPV; 44), and calf veins (CV; 37). At 1 year, thrombi had fully resolved in 67% of the segments, 27% remained partially recanalized, 6% were occluded. The venous occlusion was predominant in the FV (24%) at 1 year. On the contrary, rapid recanalization was obtained in CV than proximal veins at each examination (P < 0.01). Venous reflux was predominant in POPV (55%), followed by FV (19%), and no reflux was found in CV. At 1 year, the HHbFI in POPV reflux patients was significantly higher than those with resolution (0.19 +/- 0.14, 0.11 +/- 0.05 microm s, P = 0.009, respectively). Similarly, there was a significant difference in the HHbRI between the two groups (3.08 +/- 1.91, 1.42 +/- 1.56, P = 0.002, respectively). In patients with FV occlusion, the value of HHbRI was significantly higher than those with complete resolution (2.59 +/- 1.50, 1.42 +/- 1.56, P = 0.011, respectively).
The lower extremity venous segments show different proportions of occlusion, partial recanalization, and total recanalization. The CV shows more rapid recanalization than proximal veins. The NIRS-derived HHbFI and HHbRI could be promising parameters as the overall venous function in the follow-up of acute DVT. These findings might be very helpful for physician in detecting patients who require much longer follow-up studies.
研究急性深静脉血栓形成（DVT）后静脉功能不全模式及小腿肌肉脱氧血红蛋白（HHb）水平变化。
对78条肢体共156个解剖节段的急性DVT患者，在1、3、6和12个月时采用双功超声扫描和近红外光谱（NIRS）进行评估。检查静脉节段是否闭塞、部分再通和完全再通，并记录静脉反流情况。用NIRS测量小腿肌肉HHb水平。站立时计算小腿静脉血充盈指数（HHbFI），运动后获得小腿静脉射血指数（HHbEI）和静脉潴留指数（HHbRI）。
研究的节段包括股总静脉（CFV；38个节段）、股静脉（FV；37个）、腘静脉（POPV；44个）和小腿静脉（CV；37个）。1年后，67%的节段血栓完全溶解，27%仍部分再通，6%闭塞。1年后FV节段静脉闭塞最常见（24%）。相反，每次检查时CV节段再通速度均快于近端静脉（P<0.01）。静脉反流以POPV节段最常见（55%），其次是FV节段（19%），CV节段未发现反流。1年后，POPV反流患者的HHbFI显著高于血栓溶解患者（分别为0.19±0.14、0.11±0.05微摩尔/秒，P = 0.009）。同样，两组间HHbRI也有显著差异（分别为3.08±1.91、1.42±1.56，P = 0.002）。FV闭塞患者的HHbRI值显著高于完全溶解患者（分别为2.59±1.50、1.42±1.56，P = 0.011）。
下肢静脉节段闭塞、部分再通和完全再通的比例不同。CV节段再通速度快于近端静脉。NIRS衍生的HHbFI和HHbRI有望作为急性DVT随访中总体静脉功能的参数。这些发现可能对医生识别需要更长随访时间的患者非常有帮助。
