Mattos M A, Melendres G, Sumner D S, Hood D B, Barkmeier L D, Hodgson K J, Ramsey D E
Department of Surgery, Southern Illinois University School of Medicine, Springfield 62702, USA.
J Vasc Surg. 1996 Nov;24(5):738-44. doi: 10.1016/s0741-5214(96)70006-x.
This retrospective study was performed to identify the patterns of calf vein thrombosis in patients in whom deep vein thrombosis (DVT) was suspected and to better define the role of color-flow duplex scanning (CDS) in the evaluation of this patient population.
Over a recent 9-month period, we reviewed the vascular laboratory charts of 540 symptomatic patients (696 limbs) who underwent CDS for clinically suspected acute DVT. Patients who had a previous episode of DVT were excluded.
CDS satisfactorily visualized all three paired calf veins in 655 of the limbs (94%). Inadequate scans (n = 41) were attributed to edema in 29, excessive calf size in eight, and anatomic inaccessibility in four. Peroneal veins were the most difficult to visualize (n = 29), followed by posterior tibial (n = 10) and anterior tibial (n = 9) veins. CDS identified acute DVT in 159 of 655 limbs (24%) that had adequate scans. Calf vein thrombi were detected in 110 of the 655 limbs (17%) and in 69% of the 159 limbs with DVT. Clots were confined to the calf veins in 53 limbs with DVT (33%). Isolated calf vein thrombi were found in 45% of outpatient limbs and in 27% of inpatient limbs with DVT. The peroneal (81%) and posterior tibial veins (69%) were more frequently involved (p < 0.001) than the anterior tibial veins (21%). In limbs with calf DVT, the prevalence of thrombosis isolated to the peroneal and posterior tibial veins was similar (37% and 25%, respectively); no limb had an isolated anterior tibial DVT (p = 0.02).
CDS is a reliable method for evaluating calf veins for DVT. Calf vein thrombosis is common in patients who have acute DVT and often occurs as an isolated finding. The peroneal and posterior tibial veins are involved in the majority of cases; thrombi occur much less frequently in the anterior tibial veins. We conclude that CDS should be the noninvasive method of choice for the initial evaluation of patients in whom DVT is suspected, and we recommend that calf veins should always be studied but that routine scanning of the anterior tibial veins may not be necessary.
进行这项回顾性研究以确定疑似深静脉血栓形成（DVT）患者的小腿静脉血栓形成模式，并更好地明确彩色血流双功扫描（CDS）在评估该患者群体中的作用。
在最近9个月期间，我们回顾了540例有症状患者（696条肢体）的血管实验室图表，这些患者因临床疑似急性DVT而接受了CDS检查。排除既往有DVT发作史的患者。
CDS在655条肢体（94%）中令人满意地显示了所有三对小腿静脉。扫描不充分（n = 41）的原因是29例为水肿，8例为小腿尺寸过大，4例为解剖位置难以接近。腓静脉最难显示（n = 29），其次是胫后静脉（n = 10）和胫前静脉（n = 9）。在655条扫描充分的肢体中，CDS在159条肢体（24%）中发现了急性DVT。在655条肢体中的110条（17%）以及159条有DVT的肢体中的69%检测到小腿静脉血栓。53条有DVT的肢体（33%）的血栓局限于小腿静脉。在门诊有DVT的肢体中，45%发现孤立性小腿静脉血栓，住院患者中有DVT的肢体中这一比例为27%。腓静脉（81%）和胫后静脉（69%）比胫前静脉（21%）更常受累（p < 0.001）。在有小腿DVT的肢体中，孤立于腓静脉和胫后静脉的血栓形成患病率相似（分别为37%和25%）；没有肢体有孤立的胫前DVT（p = 0.02）。
CDS是评估小腿静脉DVT的可靠方法。小腿静脉血栓形成在急性DVT患者中很常见，且常作为孤立发现出现。大多数病例累及腓静脉和胫后静脉；胫前静脉血栓形成的发生率要低得多。我们得出结论，CDS应是疑似DVT患者初始评估的首选非侵入性方法，并且我们建议应始终对小腿静脉进行检查，但常规扫描胫前静脉可能没有必要。
