Meissner M H, Caps M T, Bergelin R O, Manzo R A, Strandness D E
Department of Surgery, University of Washington School of Medicine, Seattle, USA.
J Vasc Surg. 1997 Nov;26(5):749-56. doi: 10.1016/s0741-5214(97)70086-7.
The clinical significance of isolated calf vein thrombosis (CVT), particularly with respect to development of the postthrombotic syndrome, remains controversial. The purpose of this study was to define the early natural history of CVT in relation to persistent lower extremity symptoms, propagation, recanalization, and the development of valvular incompetence.
Over a 116-month period, 499 patients with acute deep venous thrombosis (DVT) were referred to our research laboratory, of whom 58 (12%) had thrombosis confined to the calf veins of at least one extremity. The lower extremities of 268 patients (29 with isolated CVT) were followed-up clinically and with duplex ultrasonography at intervals of 1 day, 7 days, 1 month, every 3 months for the first year, and yearly thereafter.
Seventy percent of extremities with CVT were symptomatic at presentation. Although the prevalence of clinical signs and symptoms decreased to 29% by 1 month, 23% of patients had persistent pain, edema, or both at 12 months. In contrast, 9% of uninvolved extremities contralateral to a CVT and 54% of extremities with proximal DVT remained symptomatic at 1 year (p = 0.004). Recanalization proceeded rapidly such that the mean thrombus load was reduced by 50% at 1 month and to zero at 1 year. The prevalence of valvular incompetence progressively increased such that reflux was present in 24% of extremities at 1 year. Although its investigation was not a primary goal of this study, pulmonary embolism was diagnosed at presentation and during follow-up in 11% and 3% of patients, respectively.
The natural history of CVT is complicated by persistent symptoms and the development of valvular incompetence in approximately one-quarter of patients. This potential for persistent lower extremity symptoms should be considered in evaluating the clinical relevance of isolated calf vein DVT.
孤立性小腿静脉血栓形成（CVT）的临床意义，尤其是关于血栓形成后综合征的发生，仍存在争议。本研究的目的是明确CVT的早期自然病程，及其与持续的下肢症状、血栓蔓延、再通以及瓣膜功能不全发生之间的关系。
在116个月的时间里，499例急性深静脉血栓形成（DVT）患者被转诊至我们的研究实验室，其中58例（12%）的血栓局限于至少一个肢体的小腿静脉。对268例患者（29例为孤立性CVT）的下肢进行临床随访，并在第1天、第7天、第1个月、第1年每3个月以及此后每年进行双功超声检查。
CVT患者中70%在就诊时出现症状。尽管临床体征和症状的发生率在1个月时降至29%，但23%的患者在12个月时仍有持续的疼痛、水肿或两者皆有。相比之下，CVT对侧未受累肢体在1年时有9%仍有症状，近端DVT肢体有54%仍有症状（p = 0.004）。再通进展迅速，以至于平均血栓负荷在1个月时降低50%，在1年时降至零。瓣膜功能不全的发生率逐渐增加，以至于1年时24%的肢体出现反流。尽管本研究的主要目的并非调查肺栓塞，但分别有11%和3%的患者在就诊时和随访期间被诊断为肺栓塞。
CVT的自然病程因持续症状以及约四分之一患者出现瓣膜功能不全而变得复杂。在评估孤立性小腿静脉DVT的临床相关性时，应考虑到下肢持续症状的这种可能性。
