Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
J Vasc Surg Venous Lymphat Disord. 2022 Sep;10(5):1037-1043. doi: 10.1016/j.jvsv.2022.02.011. Epub 2022 Feb 23.
Controversy exists regarding the clinical significance and optimal treatment of isolated calf deep vein thrombosis (DVT). In the present study, the clinical presentation of isolated calf DVT and the association of isolated calf DVT with pulmonary embolism (PE) in hospitalized patients were investigated.
A total of 1435 hospitalized patients had undergone whole leg duplex ultrasound between January 2018 and June 2020. Isolated calf vein DVT was diagnosed in 135 of these 1435 patients.
The soleal vein was the most frequently involved (52.6%). Thrombus was detected only in the axial veins in 57 patients (42.2%), muscular veins in 46 patients (34.4%), and both axial and muscular veins in 32 patients (23.7%). Of the 135 patients, 44 (32.6%) had undergone recent orthopedic surgery, 31 (23.0%) had active cancer, and 22 (16.3%) had a history of recent stroke. The reasons for duplex ultrasound examination were leg edema and/or pain for 57 patients (42.2%), the diagnosis of PE for 33 (24.4%), and an elevated D-dimer level for 27 patients (20.0%). For 16 patients (11.9%), DVT had been diagnosed as an incidental finding on imaging studies performed for other purposes. Of the 135 patients, 96 (71.1%) had received anticoagulation therapy. Concurrent PE was diagnosed in 45 patients (33.3%), 14 of whom had had lesions in the main pulmonary artery. Of the 45 patients with concurrent PE, 35 had not experienced leg edema and/or pain. Recurrent venous thromboembolism was observed in four patients (3.0%) at a mean follow-up of 15.5 ± 12.7 months.
In the present study, isolated calf DVT was associated with a high prevalence of PE in the hospitalized patients. Patients with isolated calf DVT, even without leg edema and/or pain, could have concurrent PE. Anticoagulation therapy should be considered for inpatients with isolated calf DVT. The muscular veins were frequently involved and, thus, should be thoroughly evaluated with imaging studies.
孤立性小腿深静脉血栓形成（DVT）的临床意义和最佳治疗方法仍存在争议。本研究旨在探讨住院患者中孤立性小腿 DVT 的临床表现以及孤立性小腿 DVT 与肺栓塞（PE）的关系。
2018 年 1 月至 2020 年 6 月，对 1435 例住院患者进行了全腿多普勒超声检查。在这 1435 例患者中，诊断出 135 例孤立性小腿静脉 DVT。
最常受累的是比目鱼肌静脉（52.6%）。57 例（42.2%）患者血栓仅位于轴向静脉，46 例（34.4%）患者血栓位于肌间静脉，32 例（23.7%）患者轴向静脉和肌间静脉均有血栓。135 例患者中，44 例（32.6%）近期接受过骨科手术，31 例（23.0%）患有活动性癌症，22 例（16.3%）有近期中风史。因腿部水肿和/或疼痛进行双功能超声检查的患者有 57 例（42.2%），因诊断为 PE 进行检查的患者有 33 例（24.4%），因 D-二聚体水平升高进行检查的患者有 27 例（20.0%）。16 例（11.9%）患者因其他目的进行影像学检查时偶然发现 DVT。135 例患者中，96 例（71.1%）接受了抗凝治疗。45 例（33.3%）患者同时诊断为 PE，其中 14 例患者主肺动脉有病变。在这 45 例同时患有 PE 的患者中，35 例患者没有腿部水肿和/或疼痛。在平均 15.5±12.7 个月的随访中，4 例患者（3.0%）出现复发性静脉血栓栓塞。
本研究中，住院患者中孤立性小腿 DVT 与 PE 发生率较高相关。即使无腿部水肿和/或疼痛，孤立性小腿 DVT 患者也可能同时患有 PE。对于孤立性小腿 DVT 患者，应考虑抗凝治疗。肌间静脉常受累，因此应通过影像学检查进行彻底评估。
