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      Early treatment outcome of isolated calf vein thrombosis after total knee arthroplasty

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          Abstract

          Purpose

          In contrast to proximal deep vein thrombosis (DVT), the treatment of isolated calf vein thrombosis (ICVT) remains controversial. This study aimed to investigate early treatment outcomes of ICVT after total knee arthroplasty (TKA).

          Methods

          Medical records of 313 patients who underwent TKA from October 2007 to December 2009 were retrospectively reviewed. A DVT-computed tomography (CT) was performed 7 days after surgery. ICVT was identified in 76 limbs of 73 patients. Of them, follow-up DVT-CT was available in 39 limbs of 37 patients. The patients with ICVTs were categorized into two groups: oral anticoagulation group (group I, 17 patients with 18 limbs) and conservative treatment group (group II, 20 patients with 21 limbs). Group I received an oral vitamin K antagonist for 3 to 6 months following low molecular weight heparin. Change of thrombus extent and development of pulmonary embolism (PE) was assessed in follow-up DVT-CT.

          Results

          Mean age was 68 years and 95% were female. Of 39 limbs with ICVT, 16 (41%) involved major lower leg veins (posterior tibial vein or peroneal vein), 13 (33%) involved muscular veins (soleal vein or gastrocnemius vein) and 10 (26%) involved both. During 1 to 6 months, follow-up DVT-CT revealed complete thrombus resolution in all limbs and there was no proximal propagation of thrombus or PE in both groups.

          Conclusion

          There is no evidence of DVT propagation or newly developed PE in the conservative treatment group. This result suggests that anticoagulation therapy for ICVT patients without PE after TKA may not be mandatory.

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          Short-term natural history of isolated gastrocnemius and soleal vein thrombosis.

          Cheryl N Miller, D Obrand, S. J. Kahn … (2003)
          Lower extremity deep vein thrombosis is often isolated to the sinusoidal veins draining the gastrocnemius and soleus muscles. The purpose of this study was to establish the incidence rate of propagation of isolated gastrocnemius and soleal vein thrombosis (IGSVT) into the deep veins of the calf and thigh. All patients who were referred for color flow duplex ultrasonography (CFDU) for suspected deep vein thrombosis were prospectively evaluated for IGSVT. Patients with IGSVT received no systemic anticoagulation therapy and underwent serial CFDU at 5, 9, 14, 30, and 90 days after recruitment. The incidence and extent of IGSVT propagation were noted. Factors predictive of IGSVT extension were sought, including age, gender, side, symptoms, ambulatory status, and the presence of comorbid illness, including cardiac disease, cancer, hypercoagulable states, recent surgery or trauma, and previous venous disease. One hundred thirty-five limbs with IGSVT were studied for 3 months, and 16.3% of cases with IGSVT extended the thrombus to the level of the adjacent tibial, or peroneal, veins or higher. Only 3% of the cases with IGSVT propagated as cephalad as the popliteal vein, and 90.9% of IGSVT propagation occurred within 2 weeks of CFDU diagnosis. No IGSVT propagated to the level of the popliteal vein beyond 2 weeks from the time of CFDU diagnosis. No IGSVT extended into the deep veins of the thigh. By the end of the 3-month study period, 45.9% of thrombi had completely resolved. Only the presence of cancer was prognostic for IGSVT progression. During the 3-month study period, the short-term incidence rate of untreated IGSVT propagation to the level of the popliteal vein, even in the presence of cancer, was only 3%. Follow-up imaging to detect IGSVT propagation beyond 2 weeks from the time of diagnosis may not be necessary.
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            Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study.

            Lutz Buschmann, Jan Beyer-Westendorf, Kai Halbritter … (2010)
            Treatment of isolated calf muscle vein thrombosis (ICMVT) is controversial. There are no data from prospective, controlled studies. Objective of this article was to compare the efficacy and safety of a short-term course of anticoagulation with compression therapy alone. We prospectively randomized patients with symptomatic, sonographically proven ICMVT in the soleal and/or gastrocnemial muscle veins in two treatment arms. The first received low-molecular-weight heparin for 10 days at therapeutic dosage (nadroparin 180 anti-activated factor X units once daily) and compression therapy for three months, and the second received compression therapy alone. Primary efficacy endpoint of the study was sonographically proven progression of ICMVT into the deep veins and clinical pulmonary embolism (PE) as confirmed by objective testing. Secondary efficacy and primary safety endpoints were major bleeding, death not due to PE, and complete sonographically proven recanalization of the muscle vein. We assessed transient and permanent risk factors for venous thromboembolism. One-hundred seven patients were finally ruled eligible for evaluation: 89% outpatients, 11% hospitalized patients. In the heparin group (n=54) progression to deep vein thrombosis (DVT) occurred in two patients (3.7%), in the group compression therapy alone (n=53) progression to DVT occurred in two patients (n.s.). No clinical PE and no death occurred. Thrombus recanalization after 3 months was not statistically significant different between the two study groups. No major bleeding occurred. The data do not show superiority of a short-term regimen of low-molecular-weight heparin and compression therapy in comparison with compression therapy alone in patients with ICMVT in a rather low-risk population. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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              Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis.

              C. Olsson, B W Oqvist, C Lagerstedt … (1985)
              The need for oral anticoagulation in patients with calf-vein thrombosis was examined in a randomised study of 51 patients, of whom 23 received warfarin for 3 months and 28 did not. Both groups received an initial course of heparin and all wore compression stockings. Progress was monitored by the use of serial isotope tests and physical examination. Phlebography was repeated if recurrence was suspected. During the first 3 months, 8 patients in the non-warfarin group (29%) had recurrences compared with none in the warfarin group (p less than 0.01). 5 patients had recurrence with proximal extension and 1 patient had a pulmonary embolus. After 1 year, 22 out of 23 patients in the warfarin group had not had a recurrence, compared with 19 out of 28 (p less than 0.02). The findings indicate that oral anticoagulants should be given to all patients with thrombi that produce symptoms. Treatment for 3 months seems to be sufficient.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Surg Soc
                Journal ID (iso-abbrev): J Korean Surg Soc
                Journal ID (publisher-id): JKSS
                Title: Journal of the Korean Surgical Society
                Publisher: The Korean Surgical Society
                ISSN (Print): 2233-7903
                ISSN (Electronic): 2093-0488
                Publication date (Print): June 2012
                Publication date (Electronic): 29 May 2012
                Volume: 82
                Issue: 6
                Pages: 374-379
                Affiliations
                Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea.
                [1 ]Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
                [2 ]Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
                Author notes
                Correspondence to: Seung Huh. Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. Tel: +82-53-420-6520, Fax: +82-53-421-0510, shuh@ 123456knu.ac.kr
                Article
                DOI: 10.4174/jkss.2012.82.6.374
                PMC ID: 3373988
                PubMed ID: 22708100
                SO-VID: 5144c734-8f27-4127-bd3a-640f1e171386
                Copyright © Copyright © 2012, the Korean Surgical Society
                License:

                Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 09 January 2012
                Date revision received : 18 March 2012
                Date accepted : 03 April 2012
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: pulmonary embolism,isolated calf vein thrombosis,anticoagulation
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: pulmonary embolism, isolated calf vein thrombosis, anticoagulation

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