Superficial venous thrombosis: disease progression and evolving treatment approaches

Treatment of superficial venous thrombosis (SVT) has recently shifted as increasing evidence suggests a higher than initially recognized rate of recurrence as well as concomitant deep venous thrombosis. Traditional therapies aimed at symptom control and disruption of the saphenofemoral junction are being called into question. The incidence of deep venous thrombosis has been reported to be 6%–40%, with symptomatic pulmonary embolism occurring in 2%–13% of patients. Asymptomatic pulmonary embolism is said to occur in up to one third of patients with SVT based on lung scans. The role of anticoagulation, including newer agents, is being elucidated, and surgical disruption of the saphenofemoral junction, while still an option for specific cases, is less frequently used as first-line treatment. The individual risk factors, including history of prior episodes of SVT, the presence of varicosities, and provoking factors including malignancy and hypercoagulable disorders, must all be considered to individualize the treatment plan. Given the potential morbidity of untreated SVT, prompt recognition and understanding of the pathophysiology and sequelae are paramount for clinicians treating patients with this disease. A personalized treatment plan must be devised for individual patients because the natural history varies by risk factor, presence or absence of DVT, and extent of involvement

Clinical Characteristics of Patients with Isolated Calf Vein Thrombosis in a Large Teaching Hospital

Objective. To identify the clinical characteristics of a patient population newly diagnosed with acute isolated calf deep venous thrombosis (ICDVT) by duplex ultrasound scan (DUS). Methods. A retrospective review of the records of 100 consecutive patients diagnosed with ICDVT by DUS was conducted. Results. Patients (59% male) were predominantly Caucasian (86%) and inpatients (69%) with an average age of 53 years. The most frequent risk factors were malignancy (22%), immobility (18%), and previous DVT (13%). Thrombus was present in named tibial veins in 58% and muscular branches in 42%. The peroneal vein was most frequently involved (39/117, 33%) followed by the gastrocnemius veins (29/117, 22%) and muscular calf tributaries (14%). Conclusions. Our patient population with ICDVT was predominantly symptomatic, in-patient cohort with a high incidence of risk factors such as malignancy, immobility, previous DVT, trauma, and postoperative status. Partial or complete resolution was documented by DUS in 53%

External Iliac Artery Stenting: High Incidence of Concomitant Revascularization Procedures

Objectives: To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS). Methods: Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle–brachial indices, and primary patency were compared between group 1 (EIAS without distal revascularization) and group 2 (EIAS with concomitant distal revascularization).Results: No mortality and a 100% immediate technical success rate was recorded in group 1 (n = 12) and group 2 (n = 24). Eleven patients (30.6%) also had stenting of the adjacent common iliac artery. Two thirds of group 2 patients required concomitant femoral or distal revascularization. Conclusions: No difference in stent patency rates was found between patients in group 1 versus group 2. Patients requiring EIAS tend to have more diffuse arterial disease necessitating complicated open reconstruction and/or distal revascularization, as well as more proximal iliac stenting