Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis.

Kyu-Ho Yi,Hye-Won Hur,Jong-Jin Lee,Hee-Jin Kim

doi:10.1007/s00276-021-02821-7

Abstract

PurposeAn antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important.MethodsThis study measured the diameters and surface areas of the proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured.ResultsThe mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm2, respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm2), distal posterior tibial vein (3.29 mm and 0.091 cm2), and peroneal vein (3.43 mm and 0.081 cm2). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis.ConclusionsThe distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein.

Highlights

Deep-vein thrombosis (DVT) is a frequent vascular disorder that is associated with high morbidity
The main objective of DVT treatment is to inhibit the expansion of the thrombus load within the affected vein and avoid subsequent pulmonary embolism
Previous research has shown that a residual thrombus and recurrent DVT are powerful predictors of subsequent post-thrombotic syndrome (PTS)

Summary

Introduction

Deep-vein thrombosis (DVT) is a frequent vascular disorder that is associated with high morbidity. The prevalence of DVT has increased to 0.1% in the general population, Kyu-Ho Yi and Jong-Jin Lee contributed . Administering a systemic thrombolytic agent is the conventional therapy for reducing the risk of pulmonary embolism and DVT reoccurrence. Applying only a systemic thrombolytic agent is associated with post-thrombotic syndrome (PTS) in 20–50% of treated patients [14]. PTS should be avoided since it is a chronic problem of DVT that includes ulceration, swelling, and dermatosclerosis [10]. Systemic thrombolytic agents should not be applied alone to patients with high blood pressure, stroke, and arterial aneurysms [14].

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Conclusion