Lack of compressibility of the common femoral vein: an unequivocal sign of proximal deep venous thrombosis on duplex ultrasound?

Background: The aim of the study was to assess the regression rate of persistent echogenic masses in patients with idiopathic deep venous thrombosis (DVT) who were after initial 6 months randomized to long-term anticoagulation treatment or to discontinuation of anticoagulation. Patients and methods: We followed 168 patients with idiopathic DVT for two years since diagnosis. After 6 months of standard therapy (heparin / LMWH, warfarin with target INR 2-3) we randomized patients with persistent echogenic masses of over 20% of venous diameter to either discontinuation of warfarin or to continuation of warfarin for another 6 months. We evaluated the size of thrombotic masses with duplex ultrasound. Results: After 6 months of standard therapy complete regression was observed in 69 patients while in 99 patients echogenic masses persisted, with 71 patients maintaining an obstruction of at least 20% of venous cross-sectional area. 52 patients were randomized. 27 patients continued warfarin therapy and in 25 patients warfarin was discontinued. After discontinuation of warfarin a further trend to regression was seen in both groups. A significant difference in regression of thrombotic masses between the 6th and 12th month of follow up was seen in patients continuing to receive warfarin, both within the popliteal vein (2.81 ± 1.56 vs. 2.10 ± 1.67 mm, p < 0.05) and the femoral vein (3.95 ± 2.74 vs. 2.30 ± 1.34 mm, p < 0.05). Conclusions: After 6 months of DVT treatment persistent echogenic masses can be found in almost two thirds of patients. Even after discontinuation of anticoagulation treatment echogenic masses further regress. However, the rate of regression in patients with deep venous thrombosis between the 6th and 12th month was greater in patients randomized to continue warfarin during this period than in patients without anticoagulation.

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Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

Thrombosis and Haemostasis ◽

10.1055/s-0039-1697955 ◽

2019 ◽

Vol 119 (12) ◽

pp. 2064-2073 ◽

Cited By ~ 5

Author(s):

Tim Sebastian ◽

David Spirk ◽

Rolf P. Engelberger ◽

Jörn F. Dopheide ◽

Frederic A. Baumann ◽

...

Keyword(s):

Stent Thrombosis ◽

Femoral Vein ◽

Anticoagulation Therapy ◽

Duplex Ultrasound ◽

Incidence Rates ◽

Postthrombotic Syndrome ◽

Clinical Trial Registration ◽

Common Femoral Vein ◽

The Common

Abstract Background Patients with postthrombotic syndrome (PTS) treated with stents are at risk of stent thrombosis (ST). The incidence of ST in the presence and absence of anticoagulation therapy (AT) is unknown. Risk factors are not well understood. Patients and Methods From the prospective Swiss Venous Stent registry, we conducted a subgroup analysis of 136 consecutive patients with PTS. Incidence of ST was estimated from duplex ultrasound or venography, and reported for the time on and off AT. Baseline, procedural, and follow-up data were evaluated to identify factors associated with ST. Results Median follow-up was 20 (interquartile range [IQR] 9–40) months. AT was stopped in 43 (32%) patients after 12 (IQR 6–14) months. Cumulative incidence of ST was 13.7% (95% confidence interval [CI] 7.8–19.6%) and 21.2% (95% CI 13.2–29.2%) during the first 6 and 36 months, respectively. The time-adjusted incidence rate was 11.2 (95% CI 7.7–16.2) events per 100 patient-years, 11.3 (95% CI 7.3–17.3) for the period on, and 11.2 (95% CI 5.3–23.6) for the period off AT. May–Thurner syndrome (MTS) was associated with decreased incidence of ST (hazard ratio [HR] 0.37, 95% CI 0.15–0.91), whereas age < 40 years (HR 2.26, 95% CI 1.03–4.94), stents below the common femoral vein (HR 3.03, 95% CI 1.28–7.19), and postthrombotic inflow veins (HR 2.92, 95% CI 1.36–6.25) were associated with increased incidence. Conclusion The 6-month incidence of ST was considerably high. Beyond 6 months, consecutive annual incidence rates persisted at 4.1 and 3.4% per year thereafter. Patients with higher incidence of ST were younger, had stents below the common femoral vein, postthrombotic leg inflow veins, and less often MTS. Incidence rates for the period on and off AT must be interpreted with caution. Clinical Trial Registration The study is registered on the National Institutes of Health Web site (ClinicalTrials.gov; identifier NCT02433054).

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Duplex ultrasound of the common femoral vein in pregnancy and puerperium

British Journal of Radiology ◽

10.1259/0007-1285-64-765-785 ◽

1991 ◽

Vol 64 (765) ◽

pp. 785-791 ◽

Cited By ~ 12

Author(s):

M. J. Duddy ◽

J. M. McHugo

Keyword(s):

Femoral Vein ◽

Duplex Ultrasound ◽

Common Femoral Vein ◽

The Common ◽

In Pregnancy

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Venous Reflux at the Sapheno-Femoral Junction

Phlebology The Journal of Venous Disease ◽

10.1177/026835559501000402 ◽

1995 ◽

Vol 10 (4) ◽

pp. 132-135 ◽

Cited By ~ 14

Author(s):

G. M. Somjen ◽

J. Donlan ◽

J. Hurse ◽

J. Bartholomew ◽

A. H. Johnston ◽

...

Keyword(s):

Saphenous Vein ◽

Ultrasound Examination ◽

Varicose Veins ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Venous Reflux ◽

Duplex Scan ◽

Common Femoral Vein ◽

Long Saphenous Vein ◽

The Common

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.

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Measuring diameters of great saphenous vein and common femoral vein using duplex ultrasound

Phlebologie ◽

10.12687/phleb2225-5-2014 ◽

2014 ◽

Vol 43 (05) ◽

pp. 263-267

Author(s):

E. Mendoza

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Standing Position ◽

Common Femoral Vein ◽

Venous Diameter ◽

The Common ◽

Proximal Thigh ◽

Transverse View

SummaryFor years, measurement of the diameter of the great saphenous vein and, occasionally, the common femoral vein has been a component of many clinical studies on varicose vein treatment. There is consensus that the measurements should be conducted with the patient in the standing position and with a transverse view through the vein, but no standardised site of measurement of the venous diameter has yet been established. The shape of the great saphenous vein varies greatly at the saphenofemoral junction. Due to the curvature of the great saphenous vein, it is difficult to find a point at which the transverse view measured is at right angles to the course of the vein. According to the available data, the optimal site for measuring the great saphenous vein diameter is the proximal thigh. When measuring the common femoral vein, a transverse view immediately distal to the junction of the great saphenous vein is suggested and studies have also confirmed this.

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