Servier – Phlebolymphology

This prospective study was designed to evaluate the natural history of isolated calf deep vein thrombosis (DVT) in relation to their patterns and distribution.

One hundred seventeen limbs in 104 patients, with isolated symptomatic calf vein thrombosis were included in the study. These were objectively diagnosed with ultrasound. The distribution and extent of the initial DVT was recorded in detail. Patients with a documented episode of prior DVT or those having thrombus in the popliteal vein or higher were excluded. Follow-up at 3 to 48 months was performed with clinical examination and ultrasound. Ultrasound examination was done with the patient in the standing position to ensure optimal testing for detecting postthrombotic changes. Affected venous segments were classified as having an occlusion, complete recanalization, partial recanalization, with or without reflux.

At 1 year, out of 98 limbs analyzed, most (99%) had recanalization of their calf vein thrombosis; 53% (n=52) had complete, 46% (n=45) had partial, and 1% (n=1) had no recanalization. Ultrasound studies of those limbs showed reflux (R) in 22% (n=22), obstruction (O) in 9% (n=9), R + O in 33% (n=32), and normal findings in 36% (n=35) of limbs. Only 17% of limbs had signs of edema (CEAP 3, according to the clinical-etiological-anatomical-pathophysiological classification system), 2% had skin changes (CEAP 4) and 0% had any signs of ulcers (CEAP 5,6). Of these findings, only 14 patients experienced persistent symptoms at 1 year.

Patients with symptomatic calf vein DVT generally have good clinical outcomes, with most being asymptomatic, and having mild disease. While small deterioration is seen up to 4 years, few limbs developed skin changes. The presence of reflux in calf veins does not appear to be a significant predictor of severe disease development in the medium term