[Diagnostic viewpoints in deep leg-/pelvic venous thrombosis]

Abstract

In 60 to 90% of patients with deep vein thrombosis, successful recanalization with prevention of postthrombotic syndrome and decreased risk of pulmonary embolism can be achieved through early diagnosis and aggressive treatment, thrombolysis or surgical correction. In our experience, if treatment is delayed more than four days after onset, the results are unfavorable; in the latter case, provided necrotizing inflammation is not present, we treat only with anticoagulation. The indication for surgery is considered established if thrombolytic treatment is contraindicated, in the presence of necrotizing inflammation, if thrombolysis is unsuccessful and for recurrent pulmonary embolism which is carried out mostly with a caval filter. Anticoagulation alone in most patients will not lead to successful results. Sixty percent of deep vein thromboses arise ascending from lower leg thromboses. Further points of predilection are the junctions of the popliteal vein, the veins in the inguinal region and the caval bifurcation. In principle, any calf pain should suggest the possibility of beginning lower leg thrombosis. With regard to the history, it is important to know if the event is the first of its kind or recurrent (Table 1). Additionally, deep vein thrombosis may be suspected in the presence of local trauma, in women on contraceptives, in patients with hemoblastoses, after surgery in the lower pelvic or leg region and, in particular in women, in the presence of pelvic venous impediment.(ABSTRACT TRUNCATED AT 250 WORDS)