Kudlaty Elizabeth, Oriowo Babatunde, Yang Michael J, Go Michael R, Satiani Bhagwan
Division of Vascular Diseases & Surgery, Wexner Medical Center, The Ohio State University School of Medicine, Columbus, OH.
ProMedica Physicians Jobst Vascular, Toledo, OH.
Ann Vasc Surg. 2017 Nov;45:154-159. doi: 10.1016/j.avsg.2017.05.028. Epub 2017 Jun 6.
Isolated great saphenous vein thrombus (GSVT) is generally regarded as benign, and treatment is heterogeneous. Complications include thrombus propagation, new saphenous vein thrombosis, deep vein thrombosis (DVT), pulmonary embolism (PE), and symptom persistence. Our objective was to review our institution's experience with isolated GSVT to understand its natural history, the frequency of complications, real-world treatment, and the impact of proximity to the saphenofemoral junction (SFJ), on the rate of complications.
Records of patients who had lower extremity venous duplex (LEVD) demonstrating GSVT without concomitant DVT between July 2008 and June 2014 were reviewed. Demographic, medical, management, outcomes, and follow-up LEVD data were collected.
Of 605 patients with acute GSVT, 67 limbs in 61 patients with isolated GSVT were the study group; 14.8% of patients had a hypercoagulable state, 31.1% had prior GSVT or DVT, and 23.0% of patients had malignancy; 28.4% of GSVT were observed, 13.4% were treated with aspirin/NSAIDs, and 58.2% were anticoagulated; 38.8% of limbs remained symptomatic following treatment at a mean follow-up period of 761 days; 37 limbs had GSVT <5 cm of the SFJ (group 1), and 30 had GSVT >5 cm from the SFJ (group 2). Seven patients developed PE, all in group 1 (P = 0.02). Twenty-nine limbs (43.3%) had follow-up LEVD at a mean of 23 days. In this subset, 13 patients at the initial scan (44.8%) had thrombus <5 cm of the SFJ (group 1) and 16 (55.2%) had thrombus >5 cm from the SFJ (group 2). Five limbs (17.2%) had GSVT propagation/new superficial vein thrombosis (SVT), and 6 (20.7%) developed new DVT. There was no GSVT propagation/new SVT in group 1, whereas 5 limbs (31.2%) had GSVT propagation/new SVT in group 2 (P = 0.048). DVT occurred in 2 limbs (15.3%) in group 1 and 4 limbs (25%) in group 2.
Isolated GSVT tends to affect patients with hypercoagulable states, prior venous thromboembolism, malignancy, or recent surgery. Management is heterogeneous, and type of treatment does not seem to affect outcomes. Patients with GSVT have significant risk of persistent symptoms, recurrence, DVT, and PE. GSVT within 5 cm of the SFJ seemed to be associated with an increased rate of PE. GSVT more than 5 cm from the SFJ seemed to be associated with propagation/new SVT. Proximity to the SFJ did not impact occurrence of DVT.
孤立性大隐静脉血栓（GSVT）一般被认为是良性的，治疗方法多样。并发症包括血栓蔓延、新的大隐静脉血栓形成、深静脉血栓形成（DVT）、肺栓塞（PE）以及症状持续存在。我们的目的是回顾我们机构处理孤立性GSVT的经验，以了解其自然病程、并发症发生率、实际治疗情况，以及与隐股静脉交界处（SFJ）的距离对并发症发生率的影响。
回顾2008年7月至2014年6月期间下肢静脉双功超声（LEVD）显示为GSVT且无合并DVT的患者记录。收集人口统计学、医学、治疗、结局及随访LEVD数据。
在605例急性GSVT患者中，61例患者的67条肢体为孤立性GSVT研究组；14.8%的患者有高凝状态，31.1%的患者既往有GSVT或DVT，23.0%的患者有恶性肿瘤；28.4%的GSVT采取观察，13.4%的患者用阿司匹林/非甾体抗炎药治疗，58.2%的患者接受抗凝治疗；平均随访761天时，38.8%的肢体治疗后仍有症状；37条肢体的GSVT距离SFJ<5 cm（第1组），30条肢体的GSVT距离SFJ>5 cm（第2组）。7例患者发生PE，均在第1组（P = 0.02）。29条肢体（43.3%）平均在23天时进行了随访LEVD检查。在该亚组中，初始扫描时13例患者（44.8%）的血栓距离SFJ<5 cm（第1组），16例患者（55.2%）的血栓距离SFJ>5 cm（第2组）。5条肢体（17.2%）发生GSVT蔓延/新的浅静脉血栓形成（SVT），6条肢体（20.7%）发生新的DVT。第1组无GSVT蔓延/新的SVT，而第2组有5条肢体（31.2%）发生GSVT蔓延/新的SVT（P = 0.048）。第1组2条肢体（15.3%）发生DVT，第2组4条肢体（25%）发生DVT。
孤立性GSVT往往影响有高凝状态、既往静脉血栓栓塞、恶性肿瘤或近期手术的患者。治疗方法多样，治疗类型似乎不影响结局。GSVT患者有持续症状、复发、DVT和PE的显著风险。距离SFJ 5 cm以内的GSVT似乎与PE发生率增加有关。距离SFJ超过5 cm的GSVT似乎与蔓延/新的SVT有关。与SFJ的距离不影响DVT的发生。
