Early thrombus remodelling of isolated calf deep vein thrombosis.
OBJECTIVE
this prospective study was designed to evaluate the evolution of thrombus propagation and lysis in relation to patterns and distribution of isolated calf DVT.


METHODS
fifty-two limbs in 48 patients mean age 59+/-15, range 24-78 years, with isolated calf DVT that had at least one exam within 10 days of DVT detection were included in the study. Patients with a documented episode of prior DVT or evidence of post-thrombotic changes during the initial ultrasound exam were excluded. The initial thrombus length, patterns and location of the thrombi were recorded. On follow-up the propagation and lysis patterns of the clot were studied.


RESULTS
remodelling of the thrombus, excluding echotexture and vein diameter changes on ultrasound, occurred in 23 limbs, (44%). Ascending propagation only was seen in seven limbs (13%) descending propagation only in two (4%) and in both directions in five (10%). Propagation at least to popliteal vein was detected in seven limbs (13%). Thrombus developed or extended to initially uninvolved veins in six limbs (12%). Pulmonary embolism developed only in one patient (2%; 95% CI: 0-11%). The site and the size of thrombus or the number of veins involved in the baseline exam did not correlate with the remodeling of thrombus. Soleal and gastrocnemial veins were comparable with the posterior tibial and peroneal veins in terms of thrombus propagation and lysis.


CONCLUSIONS
early thrombus remodelling occurs in 44% of limbs with isolated calf DVT. This includes ascending and descending thrombus propagation and lysis. Thrombus development or propagation to initially uninvolved calf veins is found in 12%. Thrombus remodelling does not appear to be related to size, site and patterns of thrombosis.
Labropoulos
N
N
Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Kang
S S
SS
Mansour
M A
MA
Giannoukas
A D
AD
Moutzouros
V
V
Baker
W H
WH
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*