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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 December;22(4):376-82


language: English

Deep venous thrombosis: rate of spontaneous lysis and thrombus extension

Markel A., Meissner M., Manzo R. A., Bergelin R. O., Strandness D. E. Jr.

Department of Surgery, University of Washington, Washington, DC, USA


Aim. ­Although rec­a­nal­iza­tion ­occurs after an epi­sode of ­venous throm­bo­sis, the exact tim­ing for this pro­cess, the rate of clear­ing at the dif­fer­ent ­venous seg­ments and the ­nature of the mech­a­nisms ­involved and their pro­gres­sion are not well known. Rec­og­ni­tion of these com­pet­ing ­events is impor­tant in under­stand­ing the nat­u­ral his­to­ry and the mech­a­nisms respon­sible for lysis of the throm­bus and for the devel­op­ment of the post-throm­bot­ic syn­drome
Meth­ods. Dur­ing the ­course of 5 con­sec­u­tive years, 110 ­patients (126 legs) with deep vein throm­bo­sis (DVT) were pros­pec­tive­ly fol­lowed using ultra­son­ic ­duplex. Fol­low-up stud­ies were per­formed at inter­vals of 1 and 7 days, 1 month, every 3 ­months for the 1st year, and year­ly there­af­ter. Mean dura­tion of fol­low-up was 329 days.
­Results. When only legs with ­initial com­plete occlu­sion are con­sid­ered, the prev­a­lence of occlu­sion pro­gres­sive­ly decreas­es to 33% after 6 ­months, 17% after the 1st year, and 0% after 3 years. Rec­a­nal­iza­tion of indi­vid­u­al seg­ments ­occurred even more rap­id­ly. After 3 ­months, rec­a­nal­iza­tion of com­plete­ly occlud­ed seg­ments was ­present in 93% of com­mon femo­ral veins, 79% of super­fi­cial femo­ral veins (prox­i­mal seg­ment), 84% of pop­li­teal veins, and 72% of pos­te­ri­or tibi­al veins. The rate of rec­a­nal­iza­tion was high­est for mul­ti­seg­men­tal dis­ease. Prop­a­ga­tion of throm­bi to adja­cent ­venous seg­ments ­occurred in 15% of the limbs. Prop­a­ga­tion was usu­al­ly lim­it­ed to 1 or 2 adja­cent seg­ments.
Con­clu­sion. Lysis ­occurred early and was pro­gres­sive. After 1 year most legs have rec­a­nal­ized. After 3 years rec­a­nal­iza­tion ­occurred in all legs ­although resid­u­al throm­bo­sis (par­tial obstruc­tion) was still ­present in 50% of the limbs. Prop­a­ga­tion of the throm­bus was a lim­it­ed pro­cess.

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