Vascular Medicine Unit, Department of Internal Medicine, Montpellier University Hospital, Montpellier, France.
J Vasc Surg. 2012 Oct;56(4):1032-8.e1. doi: 10.1016/j.jvs.2012.03.014. Epub 2012 Jul 24.
A current debate concerning suspected superficial vein thrombosis (SVT) focuses on the need of performing a compression ultrasound (CUS) exploration for confirming the diagnosis of SVT. This study was conducted to determine the clinical relevance and optimal CUS exploration in patients with symptomatic SVT.
We analyzed the characteristics of SVT and concomitant deep vein thrombosis (DVT) in patients included in the Prospective Observational Superficial Thrombophlebitis (POST) multicenter, observational prospective study. All patients underwent complete bilateral lower limb CUS, exploring both the superficial and deep venous systems.
A total of 844 patients with clinical symptoms of SVT were recruited, of which 99 isolated SVTs (21.4%) had saphenofemoral/popliteal junction involvement, and 198 (23.5%) had a concomitant DVT, with 41.8% of them proximal DVTs. In 83 patients (41.9%), DVT and SVT were not contiguous. Five of 639 patients (1%) had an isolated contralateral DVT (ie, not bilateral). Age ≥ 75 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.6-3.4), inpatient status (OR, 5.4; 95% CI, 3.4-8.7), a personal history of DVT or pulmonary embolism (OR, 1.8; 95% CI, 1.2-2.8), and SVT on nonvaricose veins (OR, 3.3; 95% CI, 2.1-5.0) were significantly and independently associated with an increased risk of concomitant DVT. Half of the patients exhibited none of these risk factors, and the prevalence of concomitant DVT dropped to 11%.
In patients with symptomatic SVT, a CUS exploration screening the whole venous system of the affected limb is useful because it provides information that has important consequences for the management of these patients.
目前，针对疑似浅静脉血栓形成（SVT）的争论焦点在于是否需要进行压缩超声（CUS）检查以确诊 SVT。本研究旨在明确有症状性 SVT 患者的临床相关性和最佳 CUS 检查策略。
我们分析了纳入前瞻性观察性浅静脉血栓形成（POST）多中心、观察性前瞻性研究的 SVT 患者的特征及其与深静脉血栓形成（DVT）的关系。所有患者均接受双侧下肢完整 CUS 检查，包括浅静脉和深静脉系统。
共纳入 844 例有 SVT 临床症状的患者，其中 99 例孤立性 SVT（21.4%）累及隐股/腘静脉交界处，198 例（23.5%）合并 DVT，其中 41.8%为近端 DVT。83 例（41.9%）患者的 DVT 和 SVT 不连续。639 例患者中有 5 例（1%）存在孤立性对侧 DVT（即非双侧）。年龄≥75 岁（优势比 [OR]，2.3；95%置信区间 [CI]，1.6-3.4）、住院状态（OR，5.4；95% CI，3.4-8.7）、DVT 或肺栓塞个人史（OR，1.8；95% CI，1.2-2.8）以及非曲张静脉 SVT（OR，3.3；95% CI，2.1-5.0）与合并 DVT 的风险显著增加独立相关。其中一半患者不存在上述危险因素，合并 DVT 的发生率降至 11%。
对于有症状性 SVT 的患者，CUS 检查可筛查受累肢体的整个静脉系统，该检查能提供对患者管理具有重要影响的信息。
