Calf Deep Vein Thrombosis Research Articles

Obstructive Shock in Acute Vena Cava Filter Thrombosis: A Rare Presentation.

Inferior vena cava (IVC) filters are commonly placed to prevent the development or worsening of pulmonary emboli. They are also inherently thrombogenic. Here we discuss a case of acute IVC filter thrombosis with the unusual presentation of obstructive shock resulting in death. A man, age 70 years, underwent laminectomy for multilevel spinal stenosis. An IVC filter was placed preoperatively for acute calf deep vein thrombosis (DVT). On postoperative day 4 he developed tachycardia, hypotension, and signs of lower extremity arterial insufficiency. No lower extremity swelling was noted. Imaging showed complete IVC occlusion caudal to the IVC filter with extension to bilateral iliofemoral veins. Arterial flow was preserved. Therapeutic heparinization was initiated and urgent percutaneous thrombectomy was performed. However, the patient developed multi-organ failure and died shortly thereafter. This report describes an uncommon etiology of obstructive shock and highlights a potentially life-threatening thrombotic complication associated with IVC filters that clinicians should be vigilant about.

Exploratory rivaroxaban trial for isolated calf deep vein thrombosis with a risk factor of thrombosis extension: an open-label, multicenter, randomized controlled trial

BackgroundLimited evidence exists regarding the incidence of recurrent venous thromboembolism (VTE) in patients diagnosed with isolated distal deep vein thrombosis (DVT) who are at risk of thrombosis extension whether they receive anticoagulation therapy or not. ObjectivesThe study aimed to investigate the incidence of recurrent VTE and the impact of rivaroxaban in this patient population. MethodsThis open-label, exploratory, and randomized controlled trial was conducted at 7 centers in Japan between April 2019 and April 2022. Adult patients with isolated distal DVT at risk of thrombosis extension received either rivaroxaban combined with physical therapy or physical therapy alone for 90 days. Whole-leg ultrasound was performed at 14 and 90 days. We assessed a composite outcome of symptomatic or asymptomatic proximal DVT or symptomatic pulmonary embolism as the primary outcome until the end of the treatment period using an intention-to-treat analysis. Major bleeding was evaluated as a key secondary outcome. ResultsOut of 90 enrolled patients, 3 were excluded due to withdrawal of consent; therefore, we analyzed 87 participants. The rivaroxaban group (n = 42) reported no primary outcomes (0%; 95% CI, 0.0%-8.4%), whereas the physical therapy group (n = 45) had 2 cases of symptomatic proximal DVT (4.4%; 95% CI, 0.5%-15.1%). Major bleeding events occurred in 4 patients in the rivaroxaban group (9.5%; 95% CI, 2.7%-22.6%), whereas no events occurred in the physical therapy group (0%; 95% CI, 0%-7.9%). ConclusionPreliminary data suggest that rivaroxaban may reduce the risk of VTE recurrence among this patient subset, albeit with an increased incidence of bleeding events.

Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants for Japanese Patients With Venous Thromboembolism - The Primary Results From the KUROSIO Study.

Direct oral anticoagulants (DOACs) are recommended as the first-choice anticoagulation therapy in the acute phase of venous thromboembolism (VTE). However, there is limited real-world data for Japanese VTE patients. The KUROSIO study (UMIN000023747) was a prospective long-term observational study comprising 1,017 patients with concurrent acute symptomatic pulmonary thromboembolism and proximal deep vein thrombosis (DVT) or isolated calf DVT initially treated with DOACs. After excluding 24 patients, 993 (mean age, 66.3±15.1 years; 58.6% females) were analyzed. The incidences of recurrent symptomatic VTE and major bleeding for up to 52 weeks after diagnosis were 3.2% and 2.2%, respectively. Multivariate analyses revealed chemotherapy and anemia as significant risk factors associated with recurrent symptomatic VTE and major bleeding, respectively. The efficacy and safety of DOACs in Japanese patients with VTE were determined in this real-world observational study.

Cancer-Associated Thrombosis: Management of a Patient With an Isolated Calf Deep Vein Thrombosis.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.Venous thromboembolism occurs frequently in patients with cancer and is the second leading cause of death, after the cancer itself. There is a well-established consensus of the need for anticoagulation in patients with a proximal deep vein thrombosis or pulmonary embolism. But with improved imaging technology and widescale use of contrast imaging for cancer staging, many incidental pulmonary emboli are detected in patients with cancer. Furthermore, many isolated distal deep vein thromboses and subsegmental pulmonary emboli are identified. There have been questions if these small or asymptomatic thromboses require anticoagulation management similar to more proximal or symptomatic thromboses. In this Oncology Grand Rounds, we will review the existing evidence for these situations. We will also review management strategies for cancer-associated thrombosis, reflecting the evolving drugs and evidence over the past 20 years.

Comparison of clinical outcomes among patients with isolated axial vs muscular calf vein thrombosis: A systematic review and meta-analysis

ObjectiveThrombi in the axial calf veins have quite different anatomical and physiological characteristics from that in the muscular calf veins, but their treatment was usually addressed in the same manner. We performed a meta-analysis of randomized and cohort studies to compare clinical outcomes among patients with isolated axial vs muscular calf deep vein thrombosis (DVT). MethodsRecurrent venous thromboembolism (VTE) was selected as the primary outcome. Resolution, proximal propagation of calf DVT, pulmonary embolism (PE), major bleeds, and clinically relevant non-major bleeds were separately analyzed as secondary outcomes. Data were pooled and compared with risk ratio (RR) and 95% confidence interval (CI). ResultsThirteen studies, consisting of 4889 patients, met the inclusion criteria and were included for analysis. A greater rate of recurrent VTE (FE model: RR, 1.23; 95% CI, 1.00-1.53; I2 = 29%), resolution (FE model: RR, 1.32; 95% CI, 1.01-1.72; I2 = 31%), proximal propagation (FE model: RR, 1.63; 95% CI, 1.10-2.41; I2 = 40%), and PE (FE model: RR, 2.79; 95% CI, 1.31-5.95; I2 = 0%) in the axial group compared with the muscular group. There was no difference in the pooled estimates for major bleeds (FE model: RR, 1.09; 95% CI, 0.61-1.95; I2 = 0%), and clinically relevant non-major bleeds (FE model: RR, 1.80; 95% CI, 0.93-3.48) in the axial and muscular arms. ConclusionsPatients with calf DVT limited to muscular veins might have a lower rate of recurrent VTE, resolution, proximal propagation, and PE vs those with axial calf vein involvement and exhibited similar safety outcomes.

Suboptimal Use of DOACs Post-Discharge for Geriatric Hip Fractures with Isolated Calf Deep Vein Thrombosis: Do Clinician Prescribing Preferences and Patient Compliance Alters Clinical Outcomes?

This study aimed to examine the impacts of DOACs compliance and prescribing preferences on clinical outcomes in elderly hip fracture patients with isolated calf deep vein thrombosis (ICDVT). We conducted a retrospective cohort study that evaluated 702 patients who underwent surgical treatment combined with ICDVT in an academic university hospital between January 2016 and October 2021. DOACs compliance was investigated through telephone and outpatient follow-up, and ICDVT clinical outcomes were collected 30 and 90 days post-discharge, respectively. Variables of interest were collected through the electronic medical record system, and data were analyzed after adjusting for predictors of non-completely dissolved (CD) of ICDVT. The DOACs compliance survey revealed that 375 (53.42%) patients were fully adherent, 270 (38.46%) were fairly adherent, and 57 (8.12%) were poorly adherent. Approximately 62% of patients had ICDVT dissipation within 30 days after discharge, reaching 94% within 90 days. DOACs QD/BID regimen is often based on economic status, activity capacity, discharge destination and post-operative weight-bearing activities (p<0.05).The mechanism of injury, ASA classification, surgical technique and timing of ICDVT formation were significantly correlated with DOACs 14/28 days regimen (p<0.05).Multivariate analysis revealed that rural patients [OR 1.518 (95% CI, 1.117-2.236)], pre-operative ICDVT[OR 2.816 (95% CI, 1.862-4.259)] and thrombus length [OR 1.157 (95% CI, 1.263-1.821)] were ICDVT risk factors for non-CD. Furthermore, DOACs fair compliance [OR 0.087 (95% CI, 0.042-0.178)], DOACs full compliance [OR 0.283 (95% CI, 0.139-0.579)], and hospitalization duration [OR 0.793 (95% CI, 0.694-0.907)] were ICDVT protective factors for CD. Better compliance with DOACs benefits early ICDVT dissipation, but final clinical outcomes have to be validated with longer follow-up periods. When managing elderly patients with hip fractures, indications for anticoagulation should be considered and individualized protocols should be used.

Elderly hip fracture patients with isolated calf muscle vein thrombosis are more likely to have suffered an intertrochanteric fracture and be hypertensive

PurposeThis study aimed to characterize the preoperative deep venous thrombosis (DVT) of lower extremity by locations and evaluate the diagnostic ability of plasma D-dimer level in elderly patients with hip fracture.MethodThis retrospective study reviewed the elderly patients presenting with a hip fracture definitely undergoing surgical treatment and identified those who had preoperative DVT. Data on demographics, lifestyle habits, comorbidities and laboratory indexes were extracted and collected. Four groups were divided by presence and locations of thrombi: non-DVT (controls), isolated calf muscle vein thrombosis (CMVT), deep calf vein thrombosis (DCVT) and proximal DVT group. The comparisons were conducted between either DVT group or the non-DVT group. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used for determining the diagnostic ability of D-dimer for each group.ResultsAmong 951 eligible patients included, 298 (31.3%) were found have preoperative DVT. Compared to non-DVT group, patients with CMVT had significantly lower albumin and hemoglobin concentration, more likely an intertrochanteric fracture and a higher prevalence of hypertension (P = 0.001, 0.006, 0.002 and 0.024, respectively); DCVT group was not observed to be significantly different in terms of any variables (all P > 0.05); and proximal DVT group had older age and more patients ≥ 80 years, lower albumin and hemoglobin concentration, higher prevalence of hypertension, more likely an intertrochanteric fracture, extended time from injury to imaging examination and higher age-adjusted Charlson comorbidity index (ACCI) (all P < 0.05). D-dimer demonstrated nonsignificant diagnostic ability for CMVT and DCVT, and a significant but poor ability for proximal DVT (AUC, 0.621; 95% CI 0.542–0.710; P = 0.011).ConclusionVarying characteristics were found among preoperative DVT stratified by locations after elderly hip fractures, and D-dimer level demonstrated no or poor diagnostic ability for DVTs by locations.Level of evidence level III, diagnostic.Trial registration statement Not applicable.

Surgical management of a large mycotic aneurysm of the distal popliteal artery.

The patient presented with right calf pain, swelling and fevers following a percutaneous coronary intervention for unstable angina two weeks prior via ipsilateral groin access. Physical exam revealed a diffusely swollen, painful lower extremity. Ankle brachial indices were normal. Blood cultures grew methicillin-sensitive Staphylococcus aureus and ultrasound demonstrated a sub-centimeter distal popliteal artery aneurysm with inflammation and calf deep vein thromboses (DVT). Transesophageal echocardiography and sepsis workup revealed no etiologic source.

Calf deep vein thrombosis: Really a wolf in sheep's clothing?

Calf deep vein thrombosis: Really a wolf in sheep's clothing?

D-Dimer and Fibrinogen Values according to the Localization of Deep Venous Thrombosis

AbstractD-dimer and fibrinogen are nonspecific diagnostic biomarkers for venous thromboembolism (VTE). The aim of this article was to present the values of D-dimer and fibrinogen in relation to the anatomical localization of deep vein thrombosis (DVT). This was an observational study, which included 1,142 patients hospitalized from 2010 to 2019 at the Department of Angiology, Clinical Center University of Sarajevo. Data on gender, age, and thrombosis location were collected of all patients. Fibrinogen and D-dimer values were available for 983 and 500 patients, respectively. Thrombosis location was classified as iliofemoral (521–45.6% patients), femoral–popliteal (486–42.6% patients), isolated calf DVT (63–5.5% patients), and upper extremity DVT (UEDVT in 72–6.3% patients). A majority, 448 (89.6%), of patients had high D-dimer (the cutoff is 0.55 mg/L) and 662 (67.3%) patients had high fibrinogen (reference range: 1.8–3.8 g/L).The highest D-dimer was detected in patients with iliofemoral DVT (mean: 10.48 mg/L), χ2 = 50.78, p = 0.00. The highest fibrinogen was detected in patients with iliofemoral DVT as well (mean 4.87 g/L), χ2 = 11.1, p = 0.01. D-dimer and fibrinogen values are significantly higher in patients iliofemoral DVT than femoral–popliteal and isolated calf DVT, and D-dimer values are significantly higher in lower extremity DVT than UEDVT, but these biomarkers cannot be used alone to discriminate between thrombosis locations. Further imaging is required.

Increased incidence of venous thromboembolism associated with inferior vena cava filter placement in patients diagnosed with isolated calf deep vein thrombosis after intracranial hemorrhage or intracranial operation.

In this study, we sought to investigate the effectiveness of inferior vena cava (IVC) filter placement in reducing the incidence of venous thromboembolism (VTE) in patients diagnosed with isolated calf deep vein thrombosis (DVT) after an intracranial hemorrhage or intracranial operation. A retrospective chart review (January 2000-December 2019) was performed to identify patients diagnosed with calf DVT after intracranial hemorrhage or intracranial operation. A total of 100 patients met the study criteria and were divided into groups based on treatment: IVC filter placement (n = 22), prophylactic anticoagulation (n = 42), or imaging surveillance (n = 36). Treatment-related complications were identified, and differences between groups in the primary endpoint (VTE occurrence after DVT diagnosis) were assessed using logistic regression. VTE occurred in 15 patients after calf DVT diagnosis. The rate of VTE was higher in the IVC filter group (9/22; 41%) than in the anticoagulation (2/42; 5%; p = 0.002) and surveillance (4/36; 11%; p = 0.013) groups. These treatment effects remained significant after adjustments were made for baseline characteristics (IVC filter vs anticoagulation, p = 0.009; IVC filter vs surveillance, p = 0.019). There was a single occurrence of pulmonary embolism in the surveillance group (3%). A single case of IVC filter thrombus was identified; no anticoagulation-related complications were reported. The findings of this study do not support IVC filter placement as a primary and solitary treatment for isolated calf DVT occurring after intracranial hemorrhage or intracranial operation.

Venous Thromboembolism After Interventions on the Ovarian Veins in Patients With Pelvic Venous Disorder

Ovarian vein resection (OVR) and ovarian vein embolization (OVE) are effective options for treating patients with pelvic venous disorder (PeVD). However, due to in an abrupt cessation of blood flow in the ovarian veins (OVs), these interventions can be complicated by pelvic vein thrombosis (PVT). The aim of this study was to assess venous thromboembolism (VTE) rates after OVR and OVE in patients with PeVD. This retrospective cohort study included 272 patients with PeVD who underwent OVR (n=122) or OVE with coils (n=150). The rates and clinical manifestations of VTE were assessed in each group on days 1 and 3 after the intervention using duplex ultrasonography. Vein patency, blood flow velocity, and localization of thrombi in the pelvic (parametrial, uterine, and ovarian), iliac, superficial, and deep veins of the lower extremities were examined. PVT was defined as the formation of blood clots in nontarget (i.e. not intended to intervention) veins of the pelvis (parametrial, uterine veins, or tributaries of the internal iliac veins). VTE after OVR and OVE was identified in 52 (19%) out of 272 patients. In the OVR group, PVT and calf deep vein thrombosis were detected in 9% and 1% of patients, accordingly, while in the OVE group their rates were almost three times higher (24% and 3%; both P=0.001). In both groups, the most common VTE was PVT. The odds ratio for developing VTE with coils was 10 times higher (95% confidence interval: 2.35-56.43) after OVE than after OVR. Clinical manifestations of PVT were observed in 2.5% of patients, and the rest patients were asymptomatic. No cases of pulmonary embolism occurred. VTE after interventions of the ovarian vein in patients with PeVD occurs in every fifth patient. OVE is associated with a higher incidence of PVT.

Retrospective Analysis of Complications After Gonadal Vein Interventions for Pelvic Venous Disorder

IntroductionTo investigate and compare complications after gonadal vein embolization (GVE) with coils and gonadal vein resection (GVR) in patients with pelvic venous disorder (PeVD). MethodsThis single-center retrospective cohort study included 277 female patients with PeVD who underwent GVE with coils (n = 150) or GVR (n = 122) in the period from 2000 to 2020. The participants were selected from a cohort of 4975 patients with chronic pelvic pain (CPP), of whom 1107 suffered from the PeVD-related CPP and 305 underwent surgical or endovascular intervention on the gonadal veins. The GVR technique was open retroperitoneal in 92, endoscopic transperitoneal in 18, and retroperitoneal in 12 patients. Clinical outcomes included 30-day complication rates and 3-year PeVD recurrence rates. The pain intensity was assessed before and after the procedure using a visual analogue scale. All patients underwent duplex ultrasound after the procedure, and those with persisting pain and suspected gonadal vein perforation with coil were also examined using computed tomographic venography. ResultsA substantial pelvic pain relief was achieved within 30 d after GVE and GVR in 73% and 100% patients, accordingly (Р = 0.001). Complications after GVE were identified in 85 (56%) patients. The major complications included pelvic vein thrombosis (PVT) and calf deep vein thrombosis (24%), postembolization syndrome (22%), and coil protrusion (5.3%). Complications after GVR occurred in 14 (11%) patients and consisted of PVT (10%) and ileus (1.6%). The 3-year recurrence rates after GVE and GVR were 11% and 5%, accordingly (P = 0.04). ConclusionsIn patients with PeVD, the gonadal vein embolization with coils is associated with a high complication rate, which can be reduced with further development of the GVE technique, the use of new embolic agents, and the selection of a treatment method based on the patient's body composition.

Deep vein thrombosis in donor or recipient veins encountered during lower extremity reconstruction with a free anterolateral thigh perforator flap: How do we deal with it?

BackgroundThe free anterolateral thigh perforator (ALTP) flap has been successfully adopted to reconstruct traumatic soft tissue defects in the lower extremities. However, the occurrence of deep vein thrombosis (DVT) in donor or recipient veins has been overlooked, and there has been no reliable guideline to manage it. Therefore, in this study, we review our cases where the ALTP flaps were transferred to traumatic lower limbs even though DVT was found in the pedicle or recipient veins. Furthermore, based on our experiences, we suggest an algorithmic approach for dealing with DVT.Patients and methodsThis study included 108 patients who underwent lower extremity reconstruction using a free ALTP flap between January 2014 and January 2021. All medical records were reviewed, including preoperative assessment data, intraoperative findings, and postoperative complications. Notably, when DVT was found in both the donor and recipient veins, we thoroughly assessed operative findings, surgical solutions, and final outcomes.ResultsSixty-one of 108 (56.4%) patients underwent computed tomographic venography (CTV) preoperatively, revealing DVT in 11 of these 61 (18%) patients. Three of these 11 patients had iliofemoral DVT, and surgery was delayed more than two weeks after detection. The remaining eight patients had calf DVT and underwent free ALTP flap transfer as scheduled. Conversely, 47 of 108 (43.6%) patients did not undergo CTV, and an occult DVT was found in five of these 47 (10.6%) patients. In two of these five patients, free flap surgery was replaced with amputation and local flap coverage. In the remaining three patients and one patient with an occult DVT that was not found on CTV, the free ALTP flap transfer was carried out. In 15 patients with DVT, free ALTP flap transfer was performed using various alternative methods for venorrhaphy. Consequently, all flaps survived, with partial necrosis occurring in two patients.ConclusionIf DVT-affected veins are appropriately managed, the free ALTP flap can be successfully transferred to the traumatic lower limb even when DVT occurs in donor or recipient veins. The author's algorithm can help surgeons overcome the insufficiency of veins for pedicle anastomosis due to DVT and avoid postoperative thromboembolic complications.

Muscular Calf Vein Thrombosis Is Associated With Increased 30-Day Mortality But Not 90-Day Mortality in Older Patients With Hip Fracture

Calf deep vein thrombosis (DVT) is common in patients with hip fractures. However, studies on whether calf DVT has an impact on the prognosis are limited. This retrospective cohort study explored the association between calf DVT and 30-day and 90-day all-cause mortality in older patients with hip fractures. A total of 564 consecutive patients who underwent ultrasound examination were identified from our hip fracture database and categorized into patients with calf DVT (axial DVT, muscular DVT) and no DVT. Of these, 86 patients (15.2%) had ultrasound-confirmed calf DVT, including 66 patients with muscular DVT, and 20 patients with axial DVT. The 30-day and 90-day all-cause mortality were 2.5% and 6.0%, respectively. Multivariate Cox analysis showed that calf DVT was significantly associated with an increased risk of 30-day mortality (hazard ratio [HR] 3.21, 95% confidence interval [CI] 1.05 to 9.84, p=0.04), but this risk relationship did not persist at 90-day follow-up (HR 1.59, 95% CI 0.69 to 3.71, p=0.28). When calf DVT was further categorized, muscular DVT remained an independent risk factor for 30-day mortality (HR 3.95, 95% CI 1.18 to 13.15, p=0.03), whereas this relationship was not found in axial DVT (HR 1.79, 95% CI 0.21 to 15.02, p=0.59). In conclusion, calf DVT, especially muscular calf DVT but not axial DVT, is independently associated with an increased risk of 30-day mortality in older patients with hip fracture, but this risk relationship did not persist at 90-day follow-up.

Incidence and risk factors of preoperative isolated calf deep venous thrombosis following hip fractures.

There is still a lack of data on isolated calf deep vein thrombosis (ICDVT) following hip fractures surgery. The study aimed to determine the incidence of preoperative ICDVT and the associated risk factors in patients with hip fractures requiring surgery.The 289 patients who required hip surgery were included, duplex ultrasonography was routinely used to make a definite diagnosis of preoperative ICDVT located in unilateral or bilateral calf. Data on demographics and laboratory-associated blood biomarkers results were included. Univariate analyses were used to analyse the data of demographics, comorbidities, personal history operation related indexes and laboratory biomarkers, then the multivariate logistic regression analysis was employed to identify the independent risk factors associated with ICDVT.Sixty-eight (23.5%) patients were diagnosed with preoperative ICDVTs. The univariate analyses showed significant differences regarding ICDVT were age, current smoking, alcohol consumption, time from injury to operation, albumin, white blood cells, lymphocyte, red blood cells, hemoglobin, hematocrit, and activated partial thromboplastin time level among the 44 factors. The multivariable model confirmed 3 risk factors were significantly independent in association with preoperative ICDVTs, including current smoking, time delay from injury to operation and activated partial thromboplastin time ( < 28seconds).The incidence of preoperative ICDVT in hip fracture was 23.5%, and patients with associated risk factors are prone to form ICDVTs, identification of these factors may help to reduce the incidence of ICDVT with hip fractures by taking early prevention measures.

Clinical presentation of isolated calf deep vein thrombosis in inpatients and prevalence of associated pulmonary embolism

ObjectiveControversy exists regarding the clinical significance and optimal treatment of isolated calf deep vein thrombosis (DVT). In the present study, the clinical presentation of isolated calf DVT and the association of isolated calf DVT with pulmonary embolism (PE) in hospitalized patients were investigated. MethodsA total of 1435 hospitalized patients had undergone whole leg duplex ultrasound between January 2018 and June 2020. Isolated calf vein DVT was diagnosed in 135 of these 1435 patients. ResultsThe soleal vein was the most frequently involved (52.6%). Thrombus was detected only in the axial veins in 57 patients (42.2%), muscular veins in 46 patients (34.4%), and both axial and muscular veins in 32 patients (23.7%). Of the 135 patients, 44 (32.6%) had undergone recent orthopedic surgery, 31 (23.0%) had active cancer, and 22 (16.3%) had a history of recent stroke. The reasons for duplex ultrasound examination were leg edema and/or pain for 57 patients (42.2%), the diagnosis of PE for 33 (24.4%), and an elevated D-dimer level for 27 patients (20.0%). For 16 patients (11.9%), DVT had been diagnosed as an incidental finding on imaging studies performed for other purposes. Of the 135 patients, 96 (71.1%) had received anticoagulation therapy. Concurrent PE was diagnosed in 45 patients (33.3%), 14 of whom had had lesions in the main pulmonary artery. Of the 45 patients with concurrent PE, 35 had not experienced leg edema and/or pain. Recurrent venous thromboembolism was observed in four patients (3.0%) at a mean follow-up of 15.5 ± 12.7 months. ConclusionsIn the present study, isolated calf DVT was associated with a high prevalence of PE in the hospitalized patients. Patients with isolated calf DVT, even without leg edema and/or pain, could have concurrent PE. Anticoagulation therapy should be considered for inpatients with isolated calf DVT. The muscular veins were frequently involved and, thus, should be thoroughly evaluated with imaging studies.

Validation of Caprini’s Saphenous Ablation Scores

Introduction: Deep Vein Thrombosis (DVT) after varicose vein surgery is well recognized. Less well documented is Endovenous Heat-Induced Thrombosis (EHIT), thrombus extension into a deep vein after superficial venous thermo ablation. There is no current agreement on the routine use of thromboprophylaxis in patients undergoing varicose vein surgery. more data on the incidence of VTE, and the need for postoperative thromboprophylaxis are necessary to formulate evidence-based clinical guidelines. Aim of the study: Comparison of the use of Caprini's Saphenous Ablation Scores versus Standard Caprini’s Score for the prophylaxis of VTE in EVLA. Patients &amp; Methods: 60 patients admitted to Royal Vascular Center, Alexandria - Egypt. From Jan. 1st, 2021, to June 30th 2021 divided in 3 groups. - Group A) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Caprini’s Saphenous Ablation Scores Fig 1-A &amp; B -Group B) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Standard Caprini’s Risk Assessment Score for VTE Fig 2-A&amp;B - C) Treated by ablation of Great saphenous vein without VTE prophylaxis Ablation was done using radial 1480 YAG laser fibers and Post-operative Duplex was done one day, 3 month and one-year. Results: Age: 35.6+0.2, 34.3+0.5 and 37.6+0.09 years in the 3 groups M/F: 6/14, 8/12 and 7/13. In group A) all patients showed absent reflux post operatively and in all follow up visits. Duplex examination revealed significant reflux in the great saphenous veins in all patients and ranged from 0.7:0.9 Sec. and mean duration 0.7+0.09 Sec. Vein diameter ranged from (0.6: 0.9,X+0.76 CM.) in group A), (0.6: 0.8,X+0.7 CM.) in group B) , (0.5: 0.8,X+0.65 CM.) in group C) According to Caprini’s saphenous score 14 patients 70% were classified as low risk, 4 patients 20% were of moderate risk and 2 patients 10% of high-risk in Group A, while applying standard Caprini’s Score in group B patients revealed: 6 patients 30% were of moderate risk and 14 patients 70% of high risk in Group B ) . 3 patients developed superficial thrombophlebitis 15% and one patient 5% developed left calf DVT in Group C, while no VTE events were shown in both A&amp;B Groups Significant drop in CVSS in patients in the three groups. Conclusion: Risk assessment of patients undergoing varicose veins ablation should be done and applying Caprini’s saphenous score as a better alternative to Standard Caprini’s score for VTE prophylaxis and is considered a safe and cost-effective tool in VTE prevention in these patients.

P1-25: Impact of isolated calf deep vein thrombosis on clinical manifestation.

P1-25: Impact of isolated calf deep vein thrombosis on clinical manifestation.

Unexpected Populations for Deep Vein Thrombosis: Presentation in an Endurance Athlete

This case presents an athletic 40-year-old female marathon runner who presented with a headache secondary to dural venous sinus thrombosis and right calf deep vein thrombosis (DVT). Though this is outside of the typical image we portray of a common DVT patient, athletes too experience hypercoagulable risk factors and medical issues, just as their less in-shape peers. This patient’s history of oral contraceptive use, Lynch syndrome, colon cancer, and pregnancy indicates potential risk factors for DVT. Even without these though, it is important to note that every endurance athlete experiences hemoconcentration, dehydration, and inflammation during exercise, training, and competition events. This case demonstrates the need for an increased index of suspicion in endurance athletes. The case exemplifies an all-too-frequent occurrence of allowing our differential to be skewed away from potentially life-threatening conditions like DVT, and their thrombotic sequelae, because of the “textbook population” descriptions of a given disease state. We hope this case will shed needed light on the phenomenon and lead to more controlled research on the probability and pathophysiology for thrombotic events in this broadened population so that its incidence and prevalence in endurance athletes can be accurately reported in the literature.