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Rivista di Angiologia

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

lingua: Inglese

Deep venous thrombosis: rate of spontaneous lysis and thrombus extension

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

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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