[en] [en] BACKGROUND: Half of all lower limb deep vein thromboses (DVT) are distal DVT that are equally distributed between muscular calf vein thromboses (MCVT) and deep calf vein thromboses (DCVT). Despite their high prevalence, MCVT and DCVT have never been compared so far, which prevents possible modulation of distal DVT management according to the kind of distal DVT (MCVT or DCVT).
METHODS: Using data from the French, multicenter, prospective observational OPTimisation de l'Interrogatoire dans l'évaluation du risque throMbo-Embolique Veineux (OPTIMEV) study, we compared the clinical presentation and risk factors of 268 symptomatic isolated DCVT and 457 symptomatic isolated MCVT and the 3-month outcomes of the 222 DCVT and 390 MCVT that were followed-up.
RESULTS: During the entire follow-up, 86.5% of DCVT patients and 76.7% of MCVT patients were treated with anticoagulant drugs (P = .003). MCVT was significantly more associated with localized pain than DCVT (30.4% vs 22.4%, P = .02) and less associated with swelling (47.9% vs 62.7%, P < .001). MCVT and DCVT patients exhibited the same risk factors profile, except that recent surgery was slightly more associated with DCVT (odds ratio, 1.70%; confidence interval, 1.06-2.75), and had equivalent comorbidities as evaluated by the Charlson index. At 3 months, no statistically significant difference was noted between MCVT and DCVT in death (3.8% vs 4.1%), venous thromboembolism recurrence (1.5% vs 1.4%), and major bleeding (0% vs 0.5%).
CONCLUSION: Isolated symptomatic MCVT and DCVT exhibit different clinical symptoms at presentation but affect the same patient population. Under anticoagulant treatment and in the short-term, isolated distal DVT constitutes a homogeneous entity. Therapeutic trials are needed to determine a consensual mode of care of MCVT and DCVT.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Galanaud, Jean-Philippe; Vascular Medicine Unit, Department of Internal Medicine, Montpellier University Hospital, Montpellier, France. jp-galanaud@chu-montpellier.fr
Sevestre, Marie-Antoinette
Genty, Céline
Laroche, Jean-Pierre
Zizka, Violaine
Quéré, Isabelle
Bosson, Jean-Luc
OPTIMEV SFMV investigators
Sprynger, Muriel ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
Comparison of the clinical history of symptomatic isolated muscular calf vein thrombosis versus deep calf vein thrombosis.
This study was funded by a grant from the Hospital Clinical Research Program of the French Ministry of Health and a grant from Sanofi-Aventis . This study was supported by the French Society of Vascular Medicine (SFMV). All investigators are members of the Société Française de Médecine Vasculaire.
A. Caggiati, J.J. Bergan, P. Gloviczki, B. Eklof, C. Allegra, H. Partsch International Interdisciplinary Consensus Committee on Venous Anatomical Terminology Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application J Vasc Surg 41 2005 719 724
M. Righini, G. Le Gal, D. Aujesky, P.M. Roy, O. Sanchez, and F. Verschuren Complete venous ultrasound in outpatients with suspected pulmonary embolism J Thromb Haemost 7 2009 406 412
M. Righini Is it worth diagnosing and treating distal deep vein thrombosis? No J Thromb Haemost 5 2007 S55 S59
N. Labropoulos, K.M. Webb, S.S. Kang, M.A. Mansour, D.R. Filliung, and G.P. Size Patterns and distribution of isolated calf deep vein thrombosis J Vasc Surg 30 1999 787 791
M. Righini, S. Paris, G. Le Gal, J.P. Laroche, A. Perrier, and H. Bounameaux Clinical relevance of distal deep vein thrombosis Review of literature data Thromb Haemost 95 2006 56 64
S.M. Schellong, T. Schwarz, K. Halbritter, J. Beyer, G. Siegert, and W. Oettler Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis Thromb Haemost 89 2003 228 234
C. Kearon, S.R. Kahn, G. Agnelli, S. Goldhaber, G.E. Raskob, and A. Comerota Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines. 8th Ed Chest 133 2008 454 545
A.N. Nicolaides, J. Fareed, and A.K. Kakkar Prevention and treatment of venous thromboembolism International Consensus Statement. (Guidelines according to scientific evidence) Int Angiol 25 2006 101 161
E.M. Masuda, D.M. Kessler, R.L. Kistner, B. Eklof, and D.T. Sato The natural history of calf vein thrombosis: lysis of thrombi and development of reflux J Vasc Surg 28 1998 67 73 discussion 73-4
J.M. Lohr, K.V. James, R.M. Deshmukh, K.A. Hasselfeld, and B. Allastair Karmody Award Calf vein thrombi are not a benign finding Am J Surg 170 1995 86 90
J.M. Lohr, T.M. Kerr, K.S. Lutter, R.D. Cranley, K. Spirtoff, and J.J. Cranley Lower extremity calf thrombosis: to treat or not to treat? J Vasc Surg 14 1991 618 623
P.S. MacDonald, S.R. Kahn, N. Miller, and D. Obrand Short-term natural history of isolated gastrocnemius and soleal vein thrombosis J Vasc Surg 37 2003 523 527
T. Schwarz, B. Schmidt, J. Beyer, and S.M. Schellong Therapy of isolated calf muscle vein thrombosis with low-molecular-weight heparin Blood Coagul Fibrinolysis 12 2001 597 599
J.P. Galanaud, M.A. Sevestre, J.L. Bosson, J.P. Laroche, M. Righini, and D. Brisot Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep-vein thrombosis: results from the OPTIMEV study Thromb Haemost 102 2009 493 500
J.P. Galanaud, S. Quenet, K. Rivron-Guillot, I. Quere, J.F. Sanchez Muoz-Torrero, and C. Tolosa Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis versus proximal deep-vein thrombosis in 11086 patients (RIETE registry) J Thromb Haemost 7 2009 2028 2034
M.A. Sevestre, J. Labarre, P. Casez, L. Bressollette, M. Taiar, and G. Pernod Accuracy of complete compression ultrasound in ruling out suspected deep venous thrombosis in the ambulatory setting A prospective cohort study Thromb Haemost 102 2009 166 172
M.A. Sevestre, J. Labarre, P. Casez, L. Bressollette, M. Haddouche, and G. Pernod Outcomes for Inpatients with Normal Findings on Whole-Leg Ultrasonography A Multicenter Prospective Cohort Study Am J Med 123 2010 158 165
A. Elias, L. Mallard, M. Elias, C. Alquier, F. Guidolin, and B. Gauthier A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs Thromb Haemost 89 2003 221 227
J.L. Bosson, M. Riachi, O. Pichot, E. Michoud, P.H. Carpentier, and A. Franco Diameters of acute proximal and distal deep venous thrombosis of the lower limbs Int Angiol 17 1998 260 267
P.D. Stein, S.E. Fowler, L.R. Goodman, A. Gottschalk, C.A. Hales, R.D. Hull PIOPED II Investigators Multidetector computed tomography for acute pulmonary embolism N Engl J Med 354 2006 2317 2327
The PIOPED Investigators Value of the ventilation/perfusion scan in acute pulmonary embolism Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED) JAMA 263 1990 2753 2759
P.S. Wells, D.R. Anderson, J. Bormanis, F. Guy, M. Mitchell, and L. Gray Value of assessment of pretest probability of deep-vein thrombosis in clinical management Lancet 350 1997 1795 1798
W. D'Hoore, C. Sicotte, and C. Tilquin Risk adjustment in outcome assessment: the Charlson comorbidity index Methods Inf Med 32 1993 382 387
V.V. Kakkar, C.T. Howe, C. Flanc, and M.B. Clarke Natural history of postoperative deep-vein thrombosis Lancet 2 1969 230 232
C. Seinturier, J.L. Bosson, M. Colonna, B. Imbert, and P.H. Carpentier Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study J Thromb Haemost 3 2005 1362 1367
J.L. Gillet, M.R. Perrin, and F.A. Allaert Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis J Vasc Surg 46 2007 513 519
T. Schwarz, B. Schmidt, B. Schmidt, and S.M. Schellong Interobserver agreement of complete compression ultrasound for clinically suspected deep vein thrombosis Clin Appl Thromb Hemost 8 2002 45 49
T.B. Lautz, F. Abbas, S.J. Walsh, C. Chow, D.J. Amaranto, and E. Wang Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation? Ann Surg 251 2010 735 742
