1
|
Mangiafico M, Costanzo L. Superficial Venous Thrombosis: A Comprehensive Review. Healthcare (Basel) 2024; 12:500. [PMID: 38391875 PMCID: PMC10888259 DOI: 10.3390/healthcare12040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Superficial venous thrombosis (SVT), an inflammatory-thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives.
Collapse
Affiliation(s)
- Marco Mangiafico
- Unit of Internal Medicine, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
| | - Luca Costanzo
- Unit of Angiology, Department of Cardio-Thoraco-Vascular, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
| |
Collapse
|
2
|
Liu L, Zhao B, Xu G, Zhou J. A nomogram for individualized prediction of lower extremity deep venous thrombosis in stroke patients: A retrospective study. Medicine (Baltimore) 2022; 101:e31585. [PMID: 36343060 PMCID: PMC9646671 DOI: 10.1097/md.0000000000031585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To develop and validate a nomogram for individualized prediction of lower extremity deep venous thrombosis (DVT) in stroke patients based on extremity function and daily living ability of stroke patients. In this study, 423 stroke patients admitted to the Rehabilitation Medical Center of the First Affiliated Hospital of Nanjing Medical University from December 2015 to February 2019 were taken as the subjects, who were divided into the DVT group (110) and No-DVT group (313) based on the existence of DVT. Inter-group comparison of baseline data was performed by 1-way Analysis of Variance, Kruskal-Wallis rank-sum test, or Pearson chi-square test. Data dimensions and predictive variables were selected by least absolute shrinkage and selection operator (LASSO); the prediction model was developed and the nomogram was prepared by binary logistics regression analysis; the performance of the nomogram was identified by the area under the receiver operating characteristic curve (AUC), Harrell's concordance index, and calibration curve; and the clinical effectiveness of the model was analyzed by clinical decision curve analysis. Age, Brunnstrom stage (lower extremity), and D-dimer were determined to be the independent predictors affecting DVT. The independent predictors mentioned above were developed and presented as a nomogram, with AUC and concordance index of 0.724 (95% confidence interval [CI]: 0.670-0.777), indicating the satisfactory discrimination ability of the nomogram. The P value of the results of the Hosmer-Lemeshow test was 0.732, indicating good fitting of the prediction model. Decision curve analysis showed that the clinical net benefit of this model was 6% to 50%. We developed a nomogram to predict lower extremity deep venous thrombosis in stroke patients, and the results showed that the nomogram had satisfactory prediction performance and clinical efficacy.
Collapse
Affiliation(s)
- Lingling Liu
- School of Rehabilitation Medicine, Nanjing Medical University, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Benxin Zhao
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guangxu Xu
- School of Rehabilitation Medicine, Nanjing Medical University, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * Correspondence: Juan Zhou, Department of Ultrasonography, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing 210029, ChinaGuangxu Xu, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing 210029, China (e-mail: and )
| | - Juan Zhou
- Department of Ultrasonography, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * Correspondence: Juan Zhou, Department of Ultrasonography, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing 210029, ChinaGuangxu Xu, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing 210029, China (e-mail: and )
| |
Collapse
|
3
|
PAPAGEORGOPOULOU CP, NIKOLAKOPOULOS KM, NTOUVAS IG, PAPADOULAS S. Superficial vein thrombosis: controversies on approach and therapy. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Barner S, Massoudy M, Stücker M. Oberflächliche Venenthrombose. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1184-7306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie oberflächliche Venenthrombose wird zunehmend als ernstes Krankheitsbild und nicht nur als eine Befindlichkeitsstörung aufgefasst. Zu unterscheiden sind Oberflächenthrombosen in Varizen und in nichtvarikösen Gefäßen. Zur Diagnostik einer Oberflächenthrombose gehört immer eine sonografische Untersuchung zum Ausschluss einer tiefen Thrombose. Während Thromben in Seitenastvenen auch ohne Antikoagulation behandelt werden können, gelten Thromben mit einer Länge von über 5 cm in Stammvenen oder größeren Seitenästen als Indikation für eine Antikoagulation mit Fondaparinux in Prophylaxe-Dosierung über einen ausreichend langen Zeitraum von 30–45 Tagen. Reichen die Oberflächenthrombosen näher als 3 cm an eine Junktion der Stammvene heran, ist eine Behandlung wie bei einer tiefen Beinvenenthrombose angezeigt. Bei ätiologisch unklaren Oberflächenthrombosen sollte eine maligne Grunderkrankung ausgeschlossen werden.
Collapse
Affiliation(s)
- Saskia Barner
- Klinik für Dermatologie, Venerologie und Allergologie der Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken der Ruhr-Universität Bochum im St.-Maria-Hilf-Krankenhaus, Ruhr-Universität Bochum, Bochum Deutschland
| | - Madina Massoudy
- Klinik für Dermatologie, Venerologie und Allergologie der Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken der Ruhr-Universität Bochum im St.-Maria-Hilf-Krankenhaus, Ruhr-Universität Bochum, Bochum Deutschland
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie der Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken der Ruhr-Universität Bochum im St.-Maria-Hilf-Krankenhaus, Ruhr-Universität Bochum, Bochum Deutschland
| |
Collapse
|
5
|
Tung-Chen Y, Pizarro I, Rivera-Núñez MA, Martínez-Virto AM, Lorenzo-Hernández A, Sancho-Bueso T, Salgueiro G, Fernández-Capitán C. Sonographic evolution of the superficial vein thrombosis of the lower extremity. J Ultrasound 2020; 24:253-259. [PMID: 32472339 DOI: 10.1007/s40477-020-00482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Superficial venous thrombosis (SVT) is a common clinical problem across various treatment settings. SVT shares risk factors with deep venous thrombosis (DVT) and carries a risk of thromboembolic complications, greater than previously expected. Little is known about the pathophysiology, resolution and recurrence of this disease. OBJECTIVES The objective of the present study was to describe the natural course of SVT, and factors correlated with the progression or resolution of the thrombus. METHODS We included 218 patients with a recent diagnosis of SVT that were consecutively referred to a thrombosis clinic from the Emergency Department (ED) between January 2016 and April of 2018. RESULTS The resolution of the thrombus prior to discharge was correlated to gender (female 73.8% vs. male 57.5%, p = 0.015), presence of varicose veins (62.4% vs. 46.4, p = 0.026), absence of family or personal history of thrombosis (98% vs. 91.3%, p = 0.021). The factor most correlated to thrombus resolution prior to discharge was the result of the 2nd ultrasound (improvement 83.9% vs. 16.1%, p < 0.001) immediately after initiation of heparin treatment. In the multivariate analysis, a high thrombus burden in the early follow-up ultrasound was the most significant predictive variable with prior to discharge recanalization (B = 20.9, 95% CI 9.8-44.7; p < 0.001). CONCLUSION The follow-up of SVT with duplex lower extremity ultrasound allows us to monitor the evolution and early identify residual thrombosis, as a marker of hypercoagulability and recurrence. This study offers new perspectives for future research, necessary to improve the management of this disease, to reduce long-term complications.
Collapse
Affiliation(s)
- Y Tung-Chen
- Department of Emergency Medicine, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - I Pizarro
- Department of Family and Community Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - M A Rivera-Núñez
- Department of Emergency Medicine, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - A M Martínez-Virto
- Department of Emergency Medicine, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - A Lorenzo-Hernández
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - T Sancho-Bueso
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - G Salgueiro
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - C Fernández-Capitán
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
6
|
Premkumar P, Kalipatnapu S, Selvaraj D, Agarwal S. Superficial venous thrombosis: Single-center experience and current recommendations. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Sohns JM, Menke J, Bergau L, Weiss BG, Kröhn H, Weiberg D, Derlin T, Schmuck S. Screening of extravascular findings in pulmonary embolism computer tomography: 397 patients with 1950 non-pulmonary artery findings. Vascular 2017; 26:99-110. [DOI: 10.1177/1708538117724628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives The aim of this study was to investigate the possible benefits from computed tomography scans of patients with a suspected pulmonary artery embolism with a focus on relevant extravascular findings. Methods A total of 400 consecutive computed tomography pulmonary angiographies were evaluated. Computed tomography scans were analyzed in detail for the presence of pulmonary artery embolisms, as well as any other findings. Extra-artery discoveries were classified into none-relevant (Group A), intermediate (Group B), or relevant (Group C) findings. Results Aggregated computed tomography pulmonary angiographies detected other diagnosis than pulmonary artery embolism in 236 patients (59%). There were 1950 non-pulmonary artery embolism findings (4.9 per patient; n = 397). In the pulmonary artery embolism group, there were 447 extra-pulmonary artery embolism findings (5.2 per patient; n = 86) and in the non-pulmonary artery embolism group, 1503 findings (4.8 per patient; n = 311). Patients with pulmonary artery embolism had a significantly higher rate of pro-coagulate risk factors ( p < 0.001). Conclusions Computed tomography pulmonary angiographies may help to identify further diagnoses. This study represents a retrospective review of a single center experience for incidental computed tomography findings during pulmonary artery embolism work-up and emphasizes the importance of analyzing the whole field-of-view.
Collapse
Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August University Göttingen, UMG, Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Georg-August University Göttingen, UMG, Göttingen, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Medical Center Göttingen, UMG, Göttingen, Germany
| | - Hannah Kröhn
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| |
Collapse
|
8
|
Cartal C, Bertoletti L, Décousus H, Frappe P. Prise en charge en médecine générale des thromboses veineuses superficielles des membres inférieurs. Enquête en Saône-et-Loire. ACTA ACUST UNITED AC 2016; 41:12-7. [PMID: 26631922 DOI: 10.1016/j.jmv.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
|
9
|
Cosmi B. Management of superficial vein thrombosis. J Thromb Haemost 2015; 13:1175-83. [PMID: 25903684 DOI: 10.1111/jth.12986] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
Abstract
Superficial vein thrombosis (SVT) is less well studied than deep vein thrombosis (DVT), because it has been considered to be a minor, self-limiting disease that is easily diagnosed on clinical grounds and that requires only symptomatic relief. The most frequently involved sites of the superficial vein system are the lower limbs, especially the saphenous veins, mostly in relation to varicosities. Lower-limb SVT shares the same risk factors as DVT; it can propagate into the deep veins, and have a complicated course with pulmonary embolism. Clinical diagnosis may not be accurate, and ultrasonography is currently indicated for both confirmation and evaluation of SVT extension. Treatment aims are symptom relief and prevention of venous thromboembolism (VTE) in relation to the thrombotic burden. SVT of the long saphenous vein within 3 cm of the saphenofemoral junction (SFJ) is considered to be equivalent to a DVT, and thus deserving of therapeutic anticoagulation. Less severe forms of lower-limb SVT not involving the SFJ have been included in randomized clinical trials of surgery, compression hosiery, non-steroidal anti-inflammatory drugs, unfractionated heparin, and low molecular weight heparins, with inconclusive results. The largest randomized clinical trial available, on 3004 patients with lower-limb SVT not involving the SFJ, showed that fondaparinux 2.5 mg once daily for 6 weeks is more effective than placebo in reducing the risk of the composite of death from any cause and symptomatic VTE (0.9% versus 5.9%). Further studies are needed to define the optimal management strategies for SVT of the lower limbs and other sites, such as the upper limbs.
Collapse
Affiliation(s)
- B Cosmi
- Department of Angiology & Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
10
|
Scott G, Mahdi AJ, Alikhan R. Superficial vein thrombosis: a current approach to management. Br J Haematol 2014; 168:639-45. [DOI: 10.1111/bjh.13255] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gemma Scott
- Haemophilia and Thrombosis Centre; University Hospital of Wales; Cardiff UK
| | - Ali Jassem Mahdi
- Haemophilia and Thrombosis Centre; University Hospital of Wales; Cardiff UK
| | - Raza Alikhan
- Haemophilia and Thrombosis Centre; University Hospital of Wales; Cardiff UK
| |
Collapse
|
11
|
Sohns C, Amarteifio E, Sossalla S, Heuser M, Obenauer S. 64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings. Clin Imaging 2009; 32:335-41. [PMID: 18760719 DOI: 10.1016/j.clinimag.2008.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 01/30/2008] [Indexed: 11/26/2022]
Abstract
AIM In this retrospective study, we assess the current role and future potential of computed tomography (CT) in the diagnostic algorithm of acute pulmonary embolism (PE). MATERIALS AND METHODS Two hundred patients underwent 64-multidetector-row spiral CT of the chest, pelvis, and thigh for suspected PE. CT scans were reviewed, and the degree of contrast enhancement and the presence of PE and/or (deep) venous thrombosis were recorded. In the case of PE, the level of thrombus was noted as central, main, or lobar. If the scan yielded a positive result for thrombosis, intravenous localization was also determined. Patient age, length of admission, clinical course, clinical indication, and incidental findings were registered as well. RESULTS PE was detected in 60 of the 200 patients with a high clinical probability of having PE (30%). Thirty-four patients had a positive CT scan result for venous thrombosis (17%). Twenty-four of the 60 patients had proximal deep venous thrombosis (40%), and 2 patients had arm venous thrombosis (3%). Thirty-four of the 60 patients had PE without venous thrombosis (57%). Eight of the 200 patients had deep venous thrombosis without suspicion of PE (4%). The distribution of the proximal thrombi showed 15 in a central artery (25%), 13 in a main pulmonary artery (22%), and 32 in a lobar segmental artery (53%). There was diffuse allocation of the thrombus in all lobes. Furthermore, CT scan noted a total of 120 incidental findings. CONCLUSION Our study indicates the potential clinical use of a diagnostic strategy for ruling out PE based on D-dimer testing and multidetector-row CT. A larger outcome study is needed before this approach can be adopted.
Collapse
Affiliation(s)
- Christian Sohns
- Department of Radiology, Georg-August-University Goettingen, Göttingen, Germany
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Abstract
Although optimal strategy for management of patients with suspected venous thromboembolism depends on local expertise and cost, diagnostic algorithms including clinical assessment and D-dimer have been validated in several trials. However, a new paradigm shift is emerging, giving an extended role of D-dimer measurement in clinical practice. D-dimer is a useful biomarker to help determine initial anticoagulant therapy in patients with thrombosis. Emerging evidence also endorses a 'predictive' role for raised D-dimer levels, since its measurement provides prognostic indications for a variety of conditions, including venous thromboembolism, disseminated intravascular coagulation, cardiovascular disease, infectious diseases, and cancer. Additional investigation is needed to clarify whether raised D-dimer is an epiphenomenon or it is actively involved in pathophysiology. Further studies are also required to establish whether D-dimer testing, alone or combined with other prognostic indicators, can be used to identify patient candidates for further triage and treatment. Nevertheless, the hazard(s) associated with raised D-dimer in plasma requires re-emphasis in the teaching of post-graduates, junior doctors and medical students, including the most effective treatments to inhibit clot spread and decrease the probability of further significant thrombotic incidents even in the absence of any 'detectable' thrombosis.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Sezione di Chimica e Clinica, Dipartimento di Patologia, Universita di Verona, Italy.
| | | | | | | |
Collapse
|