de Vries Jeroen K, Kamphuisen Pieter Willem, Meijer Karina
Universitair Medisch Centrum Groningen, Groningen.
Ned Tijdschr Geneeskd. 2015;159:A9467.
Calf vein thrombosis is a much-debated entity. The literature shows that progression to deep venous thrombosis or pulmonary embolism occurs infrequently and is usually detected using serial two-point ultrasonography. Additionally, undetected and untreated calf vein thrombosis is not associated with serious adverse events in large management trials studying diagnostic strategies for suspected deep venous thrombosis. Recurrent venous thromboembolism can occur after calf vein thrombosis, but anticoagulant treatment does not reduce the incidence. In this article, three case histories describe the anatomical considerations for proper diagnosis of calf vein thrombosis, some aspects of the natural course, and the treatment that these patients received. A case is made for restrictive use of prolonged anticoagulation therapy as a means to reduce thromboembolic complications. Because symptomatic treatment has not been studied, expert opinion suggests a short (3-week) course of therapeutically-dosed low-molecular-weight heparin.
小腿静脉血栓形成是一个备受争议的实体。文献表明，进展为深静脉血栓形成或肺栓塞的情况很少发生，通常采用连续两点超声检查来检测。此外，在研究疑似深静脉血栓形成诊断策略的大型管理试验中，未被检测到且未治疗的小腿静脉血栓形成与严重不良事件无关。小腿静脉血栓形成后可能会发生复发性静脉血栓栓塞，但抗凝治疗并不能降低其发生率。在本文中，三个病例描述了正确诊断小腿静脉血栓形成的解剖学考量、自然病程的一些方面以及这些患者接受的治疗。有人主张限制使用延长抗凝治疗作为减少血栓栓塞并发症的一种手段。由于尚未对症状性治疗进行研究，专家意见建议采用短疗程（3周）治疗剂量的低分子肝素。
