Soleal Vein Research Articles

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

P5246Preoperative soleal vein diameter determined by ultrasonography is an independent predictor of deep vein thrombosis regardless of the type of major orthopedic surgery

P5246Preoperative soleal vein diameter determined by ultrasonography is an independent predictor of deep vein thrombosis regardless of the type of major orthopedic surgery

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review.

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

Asymptomatic Isolated Calf Deep Vein Thrombosis: Does It Worsen after Varicose Vein Surgery?

In our varicose vein center, on a trial basis, among the patients with asymptomatic calf deep vein thrombosis (CDVT) we carefully selected the patients for varicose vein surgery using the requirements as follows; 1) the patients had varicose veins with incompetent saphenous veins, 2) sequential examination including DUS confirmed stability and clinical insignificance of asymptomatic CDVT, 3) the patients do not have any risk factors for DVT such as a coagulation profile disorder (antithrombin deficiency, protein C deficiency, protein S deficiency, or antiphospholipid syndrome) or malignancies, 4) surgery is possible under local anesthesia alone, and 5) the patients can understand the concept of asymptomatic CDVT and undergo the surgery on their own will and informed consent. The patients who fulfilled these conditions underwent the varicose vein surgery. Twenty-eight patients with 30 limbs with varicose veins had asymptomatic CDVT, found by preoperative duplex ultrasonography (DUS). Among CDVT, 91% of CDVT existed in the soleal veins. After the diagnosis of the asymptomatic CDVT, serial DUS was performed and showed no changes in the status of the thrombus. Then varicose vein surgery (high ligation of the saphenous junctions either with or without stripping of the saphenous veins) was performed. After the surgery, the CDVT was re-evaluated by DUS. In 27 limbs, CDVT did not show any changes in the status of the thrombus, and in 3 limbs the CDVT was partially resolved. These data suggest that, at least, as far as the patients fulfilled these conditions, varicose vein surgery did not worsen the asymptomatic CDVT. (This is a translation of Jpn J Phlebol 2016; 27: 405–412.)

東日本大震災後の被災地において深部静脈血栓症を持続させる因子の検討

For a period of 4 years, we conducted deep vein thrombosis (DVT) examinations among people living in temporary homes and those living in their own homes in areas affected by the Great East Japan Earthquake. We divided those with positive results for DVT after receiving numerous examinations into a DVT disappeared group and a DVT remained group. The thrombus formation sites were the soleus muscle veins for both groups. In terms of characteristics, multiple organized thrombi were recognized, and there was no spread to the central side. In addition, the DVT remained group exhibited an increased maximum diameter of the soleal vein. We believe that stasis of blood flow due to the extension of the soleal veins contributed to the continued formation of thrombi.

Sarcomatoid Carcinoma of the Liver

An 86-year-old man with a remote history of colon cancer was admitted to medicine with fever, cough, dyspnea, malaise, and weight loss. A surveillance colonoscopy was negative within the year. He had been admitted 1 week prior for pneumonia and treated with a 7-day course of ceftriaxone and azithromycin. He denied improvement after the previous antibiotic course and described worsening dyspnea and lower extremity edema. His admission labs revealed mildly elevated ProBNP, positive influenza A PCR nasal swab, and AST/ALT/ALP/Albumin of 123/59/338/2, respectively Chest X-ray revealed worsening pulmonary vascular congestion and increasing right pleural effusion. He was started on Lasix and Tamiflu. Echocardiogram showed normal left ventricular ejection fraction and wall motion. Despite treatment for presumed diastolic heart failure with aggressive diuresis and supportive care for influenza A, the patient remained edematous and listless without clinical improvement. Lower extremity venous duplex revealed a deep venous thrombosis in the soleal vein although a follow up lung ventilation-perfusion scan was indeterminate. Liver tests were re-assessed and returned 31/43/126/1.7. Abdominal ultrasonography revealed a large heterogeneous mass occupying most of the posterior and inferior portion of the right liver lobe measuring 22 x 13 x 14 cm. On the evening after the ultrasound examination, the patient suffered a cardiac arrest after a possible aspiration event. Despite full ACLS protocol, return of spontaneous circulation was not achieved and the patient was pronounced dead.Figure 1Post-mortem examination showed metastatic high grade sarcomatoid carcinoma found throughout the splenic capsule, lungs, colon, gallbladder and mesentery with the most significant lesion found in the liver measuring 18 cm in greatest dimension.Figure 2Figure 3Sarcomatoid carcinoma of the liver is rare tumor, composing 0.2% of primary hepatic malignancies, but arising more frequently in those with Hepatitis B, and cirrhosis. It is a highly aggressive tumor with poor prognosis and high rates of recurrence after resection. Diagnosis currently is dependent on tissue biopsy and typical histopathologic findings of malignant spindle cells and supportive immunohistochemical staining of vimentin, and epithelial membrane antigen and liver tumor markers HePar.

Ultrasound Characteristics of Calf Deep Vein Thrombosis and Residual Vein Obstruction After Low Molecular Weight Heparin Treatment

Calf deep vein thrombosis (CDVT) is frequently found in symptomatic outpatients, but CDVT ultrasound diagnostic criteria are still debated. It has been proposed that only clots with ≥5mm maximum diameter can be considered as CDVT. To assess clot diameters and characteristics of CDVT, and to assess the recanalization rate of CDVT after anticoagulant treatment. In a prospective, multicenter cohort study symptomatic outpatients in whom CDVT was diagnosed by ultrasound were enrolled. Posterior tibial, fibular, medial and lateral gastrocnemius, and soleal veins were compressed transversally over their entire length. Clot diameter was measured during maximum compression and ultrasound was repeated after 6 weeks of low molecular weight heparin treatment. In 172 patients (age 70±1y, male 32%) CDVT was detected in 132 (76.7%) muscle veins only, and in 24 (14%) axial veins only, while 16 (9.3%) patients had both muscular and axial CDVT. A total of 212 clots were found with a diameter of 5.8±1.8mm (IQR 4.5-6.8mm) with the 10th percentile being≥3.5mm. A cut off value of ≥5mm had a sensitivity of 0.76 (95% CI 0.69-0.82), whereas a value of ≥3.5mm had a sensitivity of 0.94 (95% CI 0.89-0.97). Recanalization (i.e. residual vein obstruction ≤2mm) was found in 51% of patients and the recanalization rate was not correlated with clot diameter at enrolment (rho-0.128 p=0.93) or with type of CDVT (axial vs. muscular thrombosis). Patients with significantly reduced mobility had lower probability of CDVT recanalization. A clot diameter ≥5mm is found in only 76% of CDVT patients and a clot diameter ≥3.5mm may be more appropriate as a threshold for CDVT. After 6weeks of anticoagulant treatment, half of CDVT patients had recanalization and recanalization was not correlated with clot characteristics at enrolment, but with mobility of the patients.

Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery

BackgroundDeep vein thrombosis (DVT) develops after major orthopedic surgery despite the current use of prophylaxis. DVT frequently develops in the soleal vein (SV) and might develop easily at the site of SV dilatation because of blood flow stasis. However, whether preoperative SV dilatation detected by ultrasonography predicts DVT after major orthopedic surgery remains unknown. ObjectiveWe examined whether SV dilatation detected by preoperative ultrasonography predicts DVT after major orthopedic surgery. MethodsUltrasonography was performed preoperatively and postoperatively in 243 patients with orthopedic diseases (mean age of 67±13 years, 77% women) who underwent total hip arthroplasty (THA, n=180) or total knee arthroplasty (TKA, n=63). Presence of DVT was diagnosed by ultrasonography and SV diameter ≥10mm was defined as SV dilatation. Patients with preoperative DVT were excluded. ResultsSixty-nine patients (28%) developed postoperative DVT. SV dilatation was found in 24 patients (10%), and 16 (67%) of those patients had postoperative DVT. Multivariate logistic regression analysis showed that female gender [odds ratio (OR): 4.09, p=0.004], TKA (OR: 2.52, p=0.011), and SV dilatation (OR: 6.67, p<0.001), but not presence of comorbidities, medications, or plasma d-dimer value, independently predict postoperative DVT. Subgroup analyses according to the operation site showed that female gender (OR: 3.27, p=0.043) and SV dilatation (OR: 3.72, p=0.022) were independent predictors of postoperative DVT in the THA group. SV dilatation (OR: 12.0, p=0.027) was an independent predictor of postoperative DVT also in the TKA group. ConclusionsIn addition to gender and TKA, SV dilatation detected by ultrasonography is an independent predictor of DVT after major orthopedic surgery. Determination of SV diameter by ultrasonography before major orthopedic surgery is useful for assessing the risk of postoperative DVT.

下腿無症候性深部静脈血栓症併存下に下肢静脈瘤手術は安全に施行できるか？

In our varicose vein center, on a trial basis, among the patients with asymptomatic calf deep vein thrombosis (CDVT) we carefully selected the patients for varicose vein surgery using the requirements as follows; 1) the patients had varicose veins with incompetent saphenous veins, 2) sequential examination including DUS confirmed stability and clinical insignificance of asymptomatic CDVT, 3) the patients do not have any risk factors for DVT such as a coagulation profile disorder (antithrombin deficiency, protein C deficiency, protein S deficiency, or antiphospholipid syndrome) or malignancies, 4) surgery is possible under local anesthesia alone, and 5) the patients can understand the concept of asymptomatic CDVT and undergo the surgery on their own will and informed consent. The patients who fulfilled these conditions underwent the varicose vein surgery. Twenty-eight patients with 30 limbs with varicose veins had asymptomatic CDVT, found by preoperative duplex ultrasonography (DUS). Among CDVT, 91% of CDVT existed in the soleal veins. After the diagnosis of the asymptomatic CDVT, serial DUS was performed and showed no changes in the status of the thrombus. Then varicose vein surgery (high ligation of the saphenous junctions either with or without stripping of the saphenous veins) was performed. After the surgery, the CDVT was re-evaluated by DUS. In 27 limbs, CDVT did not show any changes in the status of the thrombus, and in 3 limbs the CDVT was partially resolved. These data suggest that, at least, as far as the patients fulfilled these conditions, varicose vein surgery did not worsen the asymptomatic CDVT. (This is a translation of Jpn J Phlebol 2016; 27: 405-412.).

Soleal and gastrocnemius vein thrombosis in a patient with a muscular hematoma

Soleal and gastrocnemius vein thrombosis in a patient with a muscular hematoma

Relevant factors for soleal vein dilatation obtained from screening activities in disaster areas

Relevant factors for soleal vein dilatation obtained from screening activities in disaster areas

Management of Acute Isolated Soleal Vein Thrombosis in a Pregnant Patient With an Osteopathic Approach to Evaluation

In pregnant women, the risk of venous thromboembolism increases 4 to 5 fold over that in nonpregnant women. Deep vein thromboses in the calf occur in approximately 6% of cases, with a 20% incidence of propagation, but new imaging methods suggest a higher rate. Nevertheless, the management of isolated soleal vein thrombosis is currently one of the most debated issues in the field of venous thromboembolism, and a clear set of principles for the management of this unique clinical problem remains undefined. The authors present the case of a 37-year-old woman with a history of recurrent spontaneous abortions and cervical insufficiency who presented with a short cervix and acute right isolated soleal vein thrombosis. Long-term anticoagulantion therapy was recommended. Future studies on the risk of isolated soleal vein thrombosis propagation in the setting of pregnancy are required to identify the most effective treatment options for this clinical problem.

Clinical Significance of the Soleal Vein and Related Drainage Veins, in Calf Vein Thrombosis in Autopsy Cases with Massive Pulmonary Thromboembolism.

To clarify the histopathological characteristics of deep vein thrombosis (DVT) resulting in lethal pulmonary thromboembolism (PE). We investigated 100 autopsy cases of PE from limb DVT. The distribution and chronology of DVT in each deep venous segment were examined. Venous segments were classified into three groups: iliofemoral vein, popliteal vein and calf vein (CV). The CV was subdivided into two subgroups, drainage veins of the soleal vein (SV) and non drainage veins of SV. Eighty-nine patients had bilateral limb DVTs. CV was involved in all limbs with DVT with isolated calf DVTs were seen in 47% of patients. Fresh and organized thrombi were detected in 84% of patients. SV showed the highest incidence of DVTs in eight venous segments. The incidence of DVT gradually decreased according to the drainage route of the central SV. Proximal tips of fresh thrombi were mainly located in the popliteal vein and tibioperoneal trunk, occurring in these locations in 63% of limbs. SV is considered to be the primary site of DVT; the DVT then propagated to proximal veins through the drainage veins. Lethal thromboemboli would occur at proximal veins as a result of proximal propagation from calf DVTs.

Abstract 14779: Soleal Vein Dilatation Assessed by Ultrasonography is an Independent Predictor for Deep Vein Thrombosis After Total Hip Arthroplasty

Introduction: Deep vein thrombosis (DVT) develops after lower limb arthroplasty despite the current use of prohylaxis. Thus, accurate risk stratification is warranted to establish new prophylactic strategies. Soleal vein (SV) dilatation is often found by ultrasonography, which is performd for the screeing of the DVT. However, if the SV dilatation is usable for prediction of the DVT after the lower limb arthroplasty remains unclear. Hypothesis: We aimed to examine whether the SV dilatation assessed by ultrasonography predicts the DVT after the lower limb arthroplasty. Methods: Ultrasonography was performed pre- (mean 5 days) and postoperatively (mean 8 days) in 135 osteoarthritic patients (age 66+/-13 years, 76% women) who underwent total hip arthroplasty (THA; n = 99) or knee arthroplasty (TKA; n = 36). The patients with preoperative DVT were excluded. Presence of DVT was diagnosed by ultrasonography, which was performed from the bilateral femoral to lower limb. Increased diameter of SV (&gt;10 mm) assessed by ultrasonography was defined as the SV dilatation. Results: Thirty seven patients (27%) developed the DVT, which was proximal in one (3%) and distal in 36 (97%), after the lower limb arthroplasty. SV dilation was observed in 14 patients (10%). Of these, 11 (79%) had the postoperative DVT. Multivariate logistic regression analysis indicated that age (odds ratio [OR] 1.1, 95% CI 1.01 to 1.11, p=0.016), female (OR 4.9, 95% CI 1.18 to 19.9, p=0.028), TKA (OR 2.7, 95% CI 1.01 to 7.37, p=0.047), and SV dilatation (OR 18.8, 95% CI 4.0 to 88.8, p&lt;0.001), but not presence of comorbidities, medications, operative time, plasma D-dimer value, independently predict postoperative DVT in the whole studied patients. Subgroup analyses according to the operation site demonstrated that the SV dilation was an independent predictor of postoperative DVT in the THA group (OR 11.1, 95% CI 2.1 to 59.0, p&lt;0.01), however, not in the TKA group. Conclusions: In addtion to well-known risk factors for postoperative DVT, the SV dilatation assessed by ultrasonography is an independent predictor of the DVT after the THA. Assessment of the SV diameter by ultrasonography is useful for identfying patients with high risk for the postoprtative DVT after the THA.

Patterns and Distribution of Deep Vein Thrombus in the Lower Extremity

Introduction Practices vary widely among sonography laboratories in the imaging and evaluation of calf thrombus, contributing to diagnostic and treatment uncertainty. Our goal was to isolate and determine patterns of deep vein thrombus to question the level of sonography required for best diagnosis. Materials and Methods We retrospectively evaluated all patients that had a positive venous duplex exam from 2004 to 2013. Our lab performed 11,503 venous studies during the 8-year period, with 382 showing, via symptom review and reporting, acute first-time thrombus. Results Mean age 62 years 8 months old, 209 females (54.71%), 171 male (44.76%), 221 left sided (57.85%), 161 right sided (42.15%). Percentages for the following segments: above the knee (139, 36.39%), calf (375, 98.17%), superficial (54, 14.14%), IVC (14, 3.66%), iliac (36, 9.42%), CFV (67, 17.54%), PFV (7, 1.83%), FV (114, 29.84%), popliteal AK (123, 32.20%), popliteal fossa (142, 37.17%), popliteal BK (148, 38.74%), gastrocnemius veins (141, 36.91%), peroneal (243, 63.61%), posterior tibial vein (191, 50.00%), soleal (109, 28.53%), anterior tibial veins (3, 0.79%), great saphenous vein (38, 10%), small saphenous vein (18, 5%), and varicosities (8, 2%). Conclusion Calf vein thrombus is found with above the knee thrombus (98.17%). Peroneal (63.61%), posterior tibial (50%), gastrocnemius (36.91%), and soleal (28.53%) veins should be routinely imaged. Binomial logistic regression was conducted with eleven-predictor variables significantly predicted proximal thrombus (above the knee). A test with all eleven-predictor variables, compared with the null model, was significant ( x2 [14] = 288.511, p &lt; 0.001), showing that these variables predict above-the-knee thrombus better than without them (or by chance). We have developed a tool that shows the potential trajectories or tracks of a given patient's DVT (with associated probabilities), based on aggregated patient data.

Relationship between reconstruction of the clivo -axial angle and curative effect in posterior approach surgery for the treatment of upper cervical spine anomaly instability

Objective The aim of this study was to describe the clinical outcomes and improvement of clivo-axial angle (CAA) during the posterior approach surgery of upper cervical anomaly instability patients. Methods All of 32 patients with symptomatic upper cervical anomaly instability were followed up from 2004 Apr. to 2014 Aug. in which 1 patient was excluded because of reoperation. There were 10 patients with OS odontiodeum,5 with odontoid deformity, 4 with Klipple-Feil syndrome, 4 with atlantoaxial dislocation, 4 with atlantoaxial instability, 1 with rheumatoid arthritis, 1 with old odontoid fracture, 1 with OS odontoideum and foramen magnum stenosis, 1 with basilarinvagination and Klipple-Feil syndrome. They were all performed posterior reduction internal fixation and fusion, and then released spinal cord compression with the promotion of CAA. The patients were divided into two groups on the basis of decompression or not: nondecompression group 17 cases (male 8 cases, female 9 cases; age 13-65 years old, average 50.1 years old) and decompression group 14 cases (male 7 cases, female 7 cases; age 19-68 years old, average 49.6 years old). The CAA numbers were measured and compared. The clinic date was compared between preoperatively and postoperatively, which included Neck Disability Index and Nurick Classification System for Myelopathy. Results All patients were followed up, the follow-up time of non-decompression group was 0.7-10.7 years, average 2.9 years; the follow-up time of compression group was 0.3-5.5 years, average 2.9 years. Analysis of CAA, NDI and Nurick score were performed with t-test. The postoperative CAA, NDI and Nurick score improved significantly compared to preoperative ones. There was no difference between non-decompression group and decompression group. One patient felt nausea and vomited, one got soleal vein thrombosis, one had a swelling face and blurring vision and one had decompression syndrome after operation, all of these were improved using respectively therapy. No such serious complications as injury to vertebral artery, infection or internal fixation loosening occurred. Conclusion Neck ability and spinal cord function was significantly improved through increasing CAA for the upper cervical anomaly instability patients underwent posterior reduction internal fixation andfusion. Key words: Atlanto-axial joint; Atlanto-occipital joint; Joint instability; Spinal cord compression; Cranial fossa, posterior

Risk factors for venous thromboembolism after spine surgery.

The efficacy and safety of chemical prophylaxis to prevent the development of deep venous thrombosis (DVT) or pulmonary embolism (PE) following spine surgery are controversial because of the possibility of epidural hematoma formation. Postoperative venous thromboembolism (VTE) after spine surgery occurs at a frequency similar to that seen after joint operations, so it is important to identify the risk factors for VTE formation following spine surgery. We therefore retrospectively studied data from patients who had undergone spinal surgery and developed postoperative VTE to identify those risk factors. We conducted a retrospective clinical study with logistic regression analysis of a group of 80 patients who had undergone spine surgery at our institution from June 2012 to August 2013. All patients had been screened by ultrasonography for DVT in the lower extremities. Parameters of the patients with VTE were compared with those without VTE using the Mann-Whitney U-test and Fisher exact probability test. Logistic regression analysis was used to analyze the risk factors associated with VTE. A value of P < 0.05 was used to denote statistical significance. The prevalence of VTE was 25.0% (20/80 patients). One patient had sensed some incongruity in the chest area, but the vital signs of all patients were stable. VTEs had developed in the pulmonary artery in one patient, in the superficial femoral vein in one patient, in the popliteal vein in two patients, and in the soleal vein in 18 patients. The Mann-Whitney U-test and Fisher exact probability test showed that, except for preoperative walking disability, none of the parameters showed a significant difference between patients with and without VTE. Risk factors identified in the multivariate logistic regression analysis were preoperative walking disability and age. The prevalence of VTE after spine surgery was relatively high. The most important risk factor for developing postoperative VTE was preoperative walking disability. Gait training during the early postoperative period is required to prevent VTE.

Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis-Serial Changes of Sonography and D-Dimer.

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34-42.).

Outpatient Surveillance Protocol of Isolated Calf Deep-Vein Thrombosis

Objectives This study aims to compare the management of isolated soleal, gastrocnemius, peroneal, and posterior tibial vein thrombosis among outpatients with serial duplex ultrasound (DUS) over 30 days, versus anticoagulation. Methods After obtaining IRB approval, a retrospective chart review was conducted from January 2009 to December 2010. A total of 15, 877 lower extremity DUS were performed. Inpatients, trauma patients, and patients with thrombi in or proximal to the popliteal vein were excluded to focus exclusively on an unprovoked outpatient population. Univariate and multivariate analyses were conducted as well as descriptive statistics of the data. Results The cohort consists of one hundred sixty-eight (n = 168) outpatients with isolated calf deep vein thrombosis (ICDVT). Thrombus was most frequently identified in the soleal vein (45%) followed by the peroneal (39%), gastrocnemius (29%), and the posterior tibial vein (23%). Following diagnosis of ICDVT, thirty-eight patients (n = 38) received anticoagulation. The remaining cohort (n = 130) underwent surveillance with serial DUS at 3, 10, and 30 days. Eleven percent (11%) propagated to the popliteal vein or proximally during surveillance, versus 8% following anticoagulation. Among those that propagated proximally, 85% propagated within two weeks of initial diagnosis. Proximal propagation ( p = 0.8328), pulmonary embolism ( p = 0.0537), and development of new thrombus in additional calf veins ( p = 0.1471) did not differ among those treated with anticoagulation or serial DUS. Conclusions Serial DUS without anticoagulation is safe management of ICDVT in unprovoked ambulatory outpatients.

Relationship between Specific Distributions of Isolated Soleal Vein Thrombosis and Risk Factors.

The relationship between specific distributions of isolated soleal vein thrombosis (SVT) and risk factors was investigated. The subjects included 93 patients with SVT diagnosed with ultrasonography. In the acute thrombus distribution, the thrombi of central veins were significantly more frequent than the thrombi of medial veins in the unilateral SVT. The thrombi of central veins were not more significantly frequent than the thrombi of medial veins in the bilateral SVT. The risk factors of bilateral SVT are considered to be different from that of the unilateral SVT. (English translation of J Jpn Coll Angiol 2013; 53: 159-166).