Calf Vein Thrombosis Comparison of Outcomes for Axial and Muscular Venous Thrombosis

Abstract

Background The objective of this study was to characterize clinical features and outcomes among patients with calf deep vein thrombosis (DVT) limited to the muscular veins compared with axial veins. Methods Consecutive patients with ultrasound confirmed acute DVT involving the calf veins (January 1, 2016–August 1, 2018) were identified from the Gonda Vascular Center ultrasound database. Patients were divided into axial or muscular groups based on thrombus location. Demographics, management, and outcomes were compared. Results Over the study period, there were 647 patients with calf DVT equally distributed between axial (n = 321) and muscular (n = 326) locations. Within these groups, peroneal and soleal veins were most commonly involved. Nearly all cases were provoked (97%). Synchronous pulmonary embolism (PE) were more common for axial (30.8%) compared to muscular groups (20.2%; p = 0.001); nearly one-third had no pulmonary symptoms. Anticoagulation for a median of 3 months was initiated for 85.5% of both groups. Venous thromboembolism (VTE) recurrence was more common in the axial group (15.9% vs. 7.1%, p = 0.0015) including more frequent DVT propagation (9.4% vs. 3.1%; p = 0.0017) and PE (3.4% vs. 0.6%; p = 0.0168). Major bleeding, clinically relevant nonmajor bleeding, and mortality rates did not differ between groups. Withholding anticoagulation led to more frequent thrombus propagation in the axial group (3.4% vs. 0.9%; p = 0.029). Conclusion Several important features distinguish muscular from axial DVT. Axial DVT are more likely to have an associated PE and are more likely to experience recurrent VTE, particularly if anticoagulation is withheld.

Outcome of anticoagulation in isolated distal deep vein thrombosis compared to proximal deep venous thrombosis

“…Net clinical benefit, which combined bleeding and clotting outcomes, also favored treatment. Whereas up to 30% of patients with IDDVT may have coincidental PE, 4,19 these combined data underscore the importance of IDDVT as a relevant clinical entity with hard outcomes worthy of prompt and thoughtful evaluation including consideration of anticoagulant management.…”

“…IDDVT can be divided into axial (posterior tibial, peroneal calf, and anterior tibial) or muscular (soleal and gastrocnemius) deep vein categories. In a study of 643 patients with isolated calf DVT, thrombus location was nearly equally divided between axial vein and muscular veins 4 . During follow‐up, patients with axial DVT experienced a two‐fold higher rate of recurrent VTE including a five‐fold higher rate of PE.…”

“…Data were collected from a centralized electronic medical record as previously described 4,16 . These records contain detailed information about all inpatient hospitalizations, outpatient visits, radiology images and reports, laboratory results, pathology results, and patient correspondence.…”

“…For the purpose of this analysis, VTE recurrence included: (1) thrombus propagation within the venous segment originally affected, (2) development of a new DVT not related to original DVT, or (3) new PE 4,16 . Thrombus propagation had to be confirmed by comparing the new imaging with the original imaging clearly showing extension not seen on the original imaging study.…”

“…Isolated, distal DVT (IDDVT) involves venous segments of the calf and accounts for 30%-50% of all DVTs occurring the United States each year. [2][3][4][5] Hard outcomes following IDDVT such as VTE recurrence, major bleeding, and death are perceived to be substantially lower than proximal DVT (PDVT) and thereby felt to be a relatively benign clinical entity. Current guideline recommendations are predicated on this belief such that withholding anticoagulation with serial ultrasound surveillance is a preferred strategy among patients with IDDVT but with no additional risk factors.…”