Caps M T, Manzo R A, Bergelin R O, Meissner M H, Strandness D E
Department of Surgery, University of Washington School of Medicine, Seattle 98195, USA.
J Vasc Surg. 1995 Nov;22(5):524-31. doi: 10.1016/s0741-5214(95)70031-5.
The aim of this study was to determine whether, in lower extremities with documented episodes of acute deep venous thrombosis (DVT), incompetence develops in veins that were not the site of thrombosis.
Patients were monitored with serial duplex ultrasonography at 1 day, 1 week, 1, 3, 6, 9, and 12 months, and then annually after detection of acute DVT. The following venous segments were analyzed: common femoral, greater saphenous, proximal superficial femoral, deep femoral, popliteal, and posterior tibial. The incidence of reflux development in both thrombosed and uninvolved segments was determined. Reflux was categorized as either transient or permanent.
A total of 227 limbs in 188 patients were serially studied. Mean follow-up was 19.9 months (range 1 to 88 months). Overall, 403 of the 1423 segments (28.3% +/- 2.3%) developed reflux during the study, of which 118 (29.3% +/- 4.4%) had no prior or concurrent history of thrombosis. Considering only the segments that developed incompetence, the percent without prior thrombosis at each level was as follows: common femoral vein (40.0%), greater saphenous vein (53.1%), deep femoral vein (20.6%), proximal superficial femoral vein (23.9%), popliteal vein (8.9%), and posterior tibial vein (31.9%). Valvular insufficiency developing in segments uninvolved with thrombus was more likely to be transient (40.2%) than was the reflux in thrombosed segments (22.6%). This difference was statistically significant (p < 0.05).
Permanent venous valvular damage can occur in the absence of thrombosis after DVT. Reflux in uninvolved venous segments has a different anatomic distribution and is more likely to be transient than the incompetence associated with thrombosis.
本研究旨在确定在有急性深静脉血栓形成（DVT）发作记录的下肢中，未发生血栓形成的静脉是否会出现功能不全。
在检测到急性DVT后，于第1天、1周、1、3、6、9和12个月以及之后每年对患者进行系列双功超声检查。分析以下静脉段：股总静脉、大隐静脉、股浅静脉近端、股深静脉、腘静脉和胫后静脉。确定血栓形成段和未受累段反流发生的发生率。反流分为短暂性或永久性。
对188例患者的227条肢体进行了系列研究。平均随访时间为19.9个月（范围1至88个月）。总体而言，在研究期间，1423个静脉段中有403个（28.3%±2.3%）出现反流，其中118个（29.3%±4.4%）既往或同时无血栓形成病史。仅考虑出现功能不全的静脉段，各水平无既往血栓形成的百分比分别为：股总静脉（40.0%）、大隐静脉（53.1%）、股深静脉（20.6%）、股浅静脉近端（23.9%）、腘静脉（8.9%）和胫后静脉（31.9%）。未发生血栓的静脉段出现的瓣膜功能不全比血栓形成段的反流更可能是短暂性的（40.2%）。这种差异具有统计学意义（p<0.05）。
DVT后在无血栓形成的情况下可发生永久性静脉瓣膜损害。未受累静脉段的反流具有不同的解剖分布，并且比与血栓形成相关的功能不全更可能是短暂性的。
