Calf vein thrombosis: Difference between revisions
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{{Image|Grays-583.gif|right|350px|The popliteal vein formed by the union of the peroneal veins and the anterior and posterior tibial veins.}} | {{Image|Grays-583.gif|right|350px|The popliteal vein formed by the union of the peroneal veins and the anterior and posterior tibial veins.}} | ||
In [[medicine]], '''calf vein thrombosis''' is [[deep venous thrombosis]] (DVT) of the infrapopliteal calf veins.<ref name="pmid8918317">{{cite journal |author=Mattos MA, Melendres G, Sumner DS, ''et al'' |title=Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=738–44 |year=1996 |month=November |pmid=8918317 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(96)70006-X |issn=}}</ref><ref name="pmid16175012">{{cite journal |author=Jennersjö CM, Fagerberg IH, Karlander SG, Lindahl TL |title=Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis |journal=Blood Coagul. Fibrinolysis |volume=16 |issue=7 |pages=517–23 |year=2005 |month=October |pmid=16175012 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0957-5235&volume=16&issue=7&spage=517 | {{TOC|left}} | ||
In [[medicine]], '''calf vein thrombosis''' is [[deep venous thrombosis]] (DVT) of the infrapopliteal calf veins.<ref name="pmid8918317">{{cite journal | |||
|author=Mattos MA, Melendres G, Sumner DS, ''et al'' |title=Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=738–44 |year=1996 |month=November |pmid=8918317 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(96)70006-X |issn=}}</ref> | |||
<ref name="pmid16175012">{{cite journal |author=Jennersjö CM, Fagerberg IH, Karlander SG, Lindahl TL |title=Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis |journal=Blood Coagul. Fibrinolysis |volume=16 |issue=7 |pages=517–23 |year=2005 |month=October |pmid=16175012 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0957-5235&volume=16&issue=7&spage=517 }}</ref> These veins are also called distal calf veins. The trifurcation of the popliteal vein is about 10 cm distal from the mid-patella.<ref name="pmid9424975">{{cite journal |author=Birdwell BG, Raskob GE, Whitsett TL, ''et al'' |title=The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis |journal=Ann. Intern. Med. |volume=128 |issue=1 |pages=1–7 |year=1998 |month=January |pmid=9424975 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=9424975 |issn=}}</ref> The distal veins are the posterior tibial vein, anterior tibial vein, and peroneal vein. Thromboses occur more often in the peroneal and posterior tibial veins than the anterior tibial veins.<ref name="pmid8918317">{{cite journal |author=Mattos MA, Melendres G, Sumner DS, ''et al'' |title=Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=738–44 |year=1996 |month=November |pmid=8918317 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(96)70006-X |issn=}}</ref> | |||
Distal DVTs are more common than proximal DVTs in studies using [[venography]]<ref name="pmid16175012"/> but not in studies using [[ultrasonography]]<ref name="pmid15197015">{{cite journal |author=Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM |title=Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis |journal=Ann. Intern. Med. |volume=140 |issue=12 |pages=985–91 |year=2004 |month=June |pmid=15197015 |doi= |url= |issn=}}</ref>. Many distal DVTs are | Distal DVTs are more common than proximal DVTs in studies using [[venography]]<ref name="pmid16175012"/> but not in studies using [[ultrasonography]]<ref name="pmid15197015">{{cite journal |author=Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM |title=Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis |journal=Ann. Intern. Med. |volume=140 |issue=12 |pages=985–91 |year=2004 |month=June |pmid=15197015 |doi= |url= |issn=}}</ref>. Many distal DVTs are asymptomatic.<ref name="pmid4184105">{{cite journal |author=Kakkar VV, Howe CT, Flanc C, Clarke MB |title=Natural history of postoperative deep-vein thrombosis |journal=Lancet |volume=2 |issue=7614 |pages=230–2 |year=1969 |month=August |pmid=4184105 |doi= |url= |issn=}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
The d-dimer test may not reliably detect thromboses of the calf vein with [[sensitivity and specificity|sensitivity]] of about 65%.<ref name="pmid16175012">{{cite journal |author=Jennersjö CM, Fagerberg IH, Karlander SG, Lindahl TL |title=Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis |journal=Blood Coagul. Fibrinolysis |volume=16 |issue=7 |pages=517–23 |year=2005 |month=October |pmid=16175012 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0957-5235&volume=16&issue=7&spage=517 |issn=}}</ref> | The [[d-dimer]] test may not reliably detect thromboses of the calf vein with [[sensitivity and specificity|sensitivity]] of about 65%.<ref name="pmid16175012">{{cite journal |author=Jennersjö CM, Fagerberg IH, Karlander SG, Lindahl TL |title=Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis |journal=Blood Coagul. Fibrinolysis |volume=16 |issue=7 |pages=517–23 |year=2005 |month=October |pmid=16175012 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0957-5235&volume=16&issue=7&spage=517 |issn=}}</ref> | ||
Comprehensive duplex [[ultrasonography]] of the whole leg may adequately indicate patients at low risk of short term complications over three months.<ref name="pmid15197015">{{cite journal |author=Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM |title=Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis |journal=Ann. Intern. Med. |volume=140 |issue=12 |pages=985–91 |year=2004 |month=June |pmid=15197015 |doi= |url= |issn=}}</ref> Simplified compression [[ultrasonography]] limited to the trifurcation of the popliteal vein may need repeating in 5 days.<ref name="pmid9424975">{{cite journal |author=Birdwell BG, Raskob GE, Whitsett TL, ''et al'' |title=The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis |journal=Ann. Intern. Med. |volume=128 |issue=1 |pages=1–7 |year=1998 |month=January |pmid=9424975 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=9424975 |issn=}}</ref> | |||
==Treatment== | ==Treatment== | ||
Treatment and follow-up options have been reviewed.<ref name="pmid22032881">{{cite journal| author=Masuda EM, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q| title=The controversy of managing calf vein thrombosis. | journal=J Vasc Surg | year= 2012 | volume= 55 | issue= 2 | pages= 550-61 | pmid=22032881 | doi=10.1016/j.jvs.2011.05.092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22032881 }} </ref> | |||
For patients with symptomatic calf-vein thrombosis, compression stockings along with [[anticoagulation]] may prevent recurrences.<ref name="pmid2863541">{{cite journal |author=Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U |title=Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis |journal=Lancet |volume=2 |issue=8454 |pages=515–8 |year=1985 |month=September |pmid=2863541 |doi= |url= |issn=}}</ref> | For patients with symptomatic calf-vein thrombosis, compression stockings along with [[anticoagulation]] may prevent recurrences.<ref name="pmid2863541">{{cite journal |author=Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U |title=Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis |journal=Lancet |volume=2 |issue=8454 |pages=515–8 |year=1985 |month=September |pmid=2863541 |doi= |url= |issn=}}</ref> | ||
Latest revision as of 16:29, 25 April 2012
In medicine, calf vein thrombosis is deep venous thrombosis (DVT) of the infrapopliteal calf veins.[1] [2] These veins are also called distal calf veins. The trifurcation of the popliteal vein is about 10 cm distal from the mid-patella.[3] The distal veins are the posterior tibial vein, anterior tibial vein, and peroneal vein. Thromboses occur more often in the peroneal and posterior tibial veins than the anterior tibial veins.[1]
Distal DVTs are more common than proximal DVTs in studies using venography[2] but not in studies using ultrasonography[4]. Many distal DVTs are asymptomatic.[5]
Diagnosis
The d-dimer test may not reliably detect thromboses of the calf vein with sensitivity of about 65%.[2]
Comprehensive duplex ultrasonography of the whole leg may adequately indicate patients at low risk of short term complications over three months.[4] Simplified compression ultrasonography limited to the trifurcation of the popliteal vein may need repeating in 5 days.[3]
Treatment
Treatment and follow-up options have been reviewed.[6]
For patients with symptomatic calf-vein thrombosis, compression stockings along with anticoagulation may prevent recurrences.[7]
Prognosis
While unusual, case reports exist of pulmonary embolism from calf vein thrombosis.[8]
References
- ↑ 1.0 1.1 Mattos MA, Melendres G, Sumner DS, et al (November 1996). "Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study". J. Vasc. Surg. 24 (5): 738–44. PMID 8918317. [e]
Cite error: Invalid
<ref>tag; name "pmid8918317" defined multiple times with different content - ↑ 2.0 2.1 2.2 Jennersjö CM, Fagerberg IH, Karlander SG, Lindahl TL (October 2005). "Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis". Blood Coagul. Fibrinolysis 16 (7): 517–23. PMID 16175012. [e]
Cite error: Invalid
<ref>tag; name "pmid16175012" defined multiple times with different content - ↑ 3.0 3.1 Birdwell BG, Raskob GE, Whitsett TL, et al (January 1998). "The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis". Ann. Intern. Med. 128 (1): 1–7. PMID 9424975. [e]
- ↑ 4.0 4.1 Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM (June 2004). "Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis". Ann. Intern. Med. 140 (12): 985–91. PMID 15197015. [e]
- ↑ Kakkar VV, Howe CT, Flanc C, Clarke MB (August 1969). "Natural history of postoperative deep-vein thrombosis". Lancet 2 (7614): 230–2. PMID 4184105. [e]
- ↑ Masuda EM, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q (2012). "The controversy of managing calf vein thrombosis.". J Vasc Surg 55 (2): 550-61. DOI:10.1016/j.jvs.2011.05.092. PMID 22032881. Research Blogging.
- ↑ Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U (September 1985). "Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis". Lancet 2 (8454): 515–8. PMID 2863541. [e]
- ↑ Loudon JR (October 1976). "Fatal embolism from calf-vein thrombosis". Lancet 2 (7988): 742–3. PMID 61423. [e]