Pattern and distribution of thrombi in acute venous thrombosis
A. Markel, R. A. Manzo, R. O. Bergelin and D. E. Strandness Jr
Department of Surgery, University of Washington, Seattle 98195.
The location and extent of thrombosis in the deep venous system will
determine immediate and long-term outcome. During the past 3 years, we have
studied by duplex scanning 833 patients with suspected deep vein
thrombosis. In this group, 209 patients (25%) had a positive study. The
findings relative to location and extent of involvement are as follows. (1)
The right leg was involved in 35% of patients, the left leg in 48%.
Bilateral involvement was noted in 17%. (2) The veins most frequently
affected by deep vein thrombosis were as follows: superficial femoral in
74%, popliteal in 73%, common femoral in 58%, posterior tibial in 40%, deep
femoral in 29%, greater saphenous in 19%, and the inferior vena cava in 2%;
multisegment involvement was common. (3) Total occlusion was present in 82%
of the patients with deep vein thrombosis, and partial occlusion in 18%.
(4) Isolated occlusion of single veins was uncommon. (5) The proximal
(above-knee) area was involved in 95% of the cases with deep vein
thrombosis, and the calf in 40% of the cases. Isolated calf deep vein
thrombosis was found in 6% of the cases with right leg involvement and in
3% for the left. (6) Total leg involvement (iliocaval, femoropopliteal, and
calf) occurred in 10% of the patients. Our data confirm the fallibility of
the clinical diagnosis of deep vein thrombosis. The frequent involvement of
both limbs stresses the importance of not examining just the symptomatic
limb. Proximal venous thrombosis (popliteal to inferior vena cava) is much
more common than isolated calf vein thrombosis as a cause for symptoms and
the referral for study.
