Vol. 53 | No. 1 | January-June 2025 Back

Open Access

Clinical Features and Associated Outcomes of Isolated Calf Vein Thrombosis From a Five-Year Tertiary Medical Center Experience: An Analytical Retrospective Cohort Study

Ida Katrina P. Tumang, Jonathan James Bernardo, Richard Henry Tiongco II
May 2025 DOI 10.69944/pjc.e5196d136d

Abstract

BACKGROUND: The significance of isolated calf deep vein thrombosis (ICDVT) remains unclear with current guidelines not being based on strong level of evidence. Given the uncertainties, the therapeutic approaches vary among institutions; hence, it is prudent to look at existing experience of an institution where examination of calf veins is routinely done during venous duplex ultrasound of the lower extremities. 

METHODS: Using an analytical retrospective cohort design, this study investigated the clinical profile and outcomes of patients noted to have ICDVT on venous duplex scan at a single tertiary center from October 1, 2018 to June 30, 2023. 

RESULTS: A total of 151 subjects were included in the study. Most of the cases had either stabilization (36.42%, 95% CI: 28.75%-44.64%) or complete resolution (35.76%, 95% CI: 28.14%-43.96%) of ICDVT. Recurrence occurred in 15.89% (95% CI: 10.46%-22.72%) while proximal DVT extension only occurred in 10.60% (95% CI: 6.18-16.64%) of the subjects. None of the factors studied, including therapeutic management, were significantly associated with proximal DVT extension, recurrence, pulmonary embolism and stabilization of ICDVT. When it comes to resolution of ICDVT, only therapeutic management was found to have significant association.

CONCLUSION: Previously cited medical risk factors do not play a role in the development of ICDVT complications. While anticoagulation contributes to resolution of ICDVT, it can safely be managed conservatively in cases of high bleeding risk.

Keywords: Calf vein thrombosis, anticoagulation

References
  1. Righini M, Galanaud J-P, Guenneguez H, Brisot D, Diard A, Faisse P, et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol. 2016;3: e556–62. Available from: https://doi.org/10.1016/S2352-3026(16)30131-4
  2. Elmi G, Aluigi L, Allegri D, Rinaldi ER, Camaggi V, Di Giulio R, et al. Calf deep vein thrombosis: frequency, therapeutic management, early outcomes and all-causes mortality in a cohort of hospitalized patients. Int Angiol. 2020;39:467-76. Available from: https://doi.org/10.23736/S0392-9590.20.04528-9
  3. Galanaud JP, Quenet S, Rivron-Guillot K, Quere I, Sanchez Muñoz-Torrero JF, Tolosa C, et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11086 patients. J Thromb Haemost. 2009;7:2028–34. Available from: https://doi.org/10.1111/j.1538-7836.2009.03629.x
  4. Heller T, Becher M, Kröger J-C, Beller E, Heller S, Höft R, et al. Isolated calf deep venous thrombosis: frequency on venous duplex scan and clinical characteristics. BMC Emergency Medicine. 2021;21:126. Available from: https://doi.org/10.1186/s12873-021-00516-1
  5. Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, Geersing G-J, et al. Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. CHEST. 2021;160(6):E545-E608. Available from: https://doi.org/10.1016/j.chest.2021.07.055
  6. Liao S, Woulfe T, Hyder S, Merriman E, Simpson D, Chunilal S. Incidence of venous thromboembolism in different ethnic groups: a regional direct comparison study. Journal of Thrombosis and Haemostasis. 2014;12(2):214-9. Available from: https://doi.org/10.1111/jth.12464
  7. Stevens SM, Woller SC, Baumann Kreuziger L, Doerschug K, Geersing G-J, Klok FA, et al. Antithrombotic therapy for VTE disease: Compendium and review of CHEST guidelines 2012-2021. Chest [Internet]. 2024;166(2):388–404. Available from: https://doi.org/10.1016/j.chest.2024.03.003
  8. Utter GH, Dhillon TS, Danielsen BH, Salcedo ES, Shouldice DJ, Humphries MD, et al. Use of statewide administrative data to assess clinical outcomes: A retrospective cohort study of therapeutic anticoagulation for isolated calf vein thrombosis. Med Care [Internet]. 2020;58(7):658–62. Available from: https://doi.org/10.1097/MLR.0000000000001347
  9. Utter GH, Dhillon TS, Salcedo ES, Shouldice DJ, Reynolds CL, Humphries MD, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg [Internet]. 2016;151(9):e161770. Available from: https://doi.org/10.1001/jamasurg.2016.1770
  10. Schellong S, Ageno W, Casella IB, Chee KH, Schulman S, Singer DE, et al. Profile of patients with isolated distal deep vein thrombosis versus proximal deep vein thrombosis or pulmonary embolism: RE-COVERY DVT/PE study. Semin Thromb Hemost [Internet]. 2022;48(04):446–58. Available from: https://doi.org/10.1055/s-0041-1729169
  11. Palareti G, Cosmi B, Lessiani G, Rodorigo G, Guazzaloca G, Brusi C, et al. Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost [Internet]. 2010;104(5):1063–70. Available from: https://doi.org/10.1160/TH10-06-0351
  12. Singh K, Yakoub D, Giangola P, DeCicca M, Patel CA, Marzouk F, et al. Early follow-up and treatment recommendations for isolated calf deep venous thrombosis. J Vasc Surg [Internet]. 2012;55(1):136–40. Available from: https://doi.org/10.1016/j.jvs.2011.07.088
  13. Shimabukuro N, Mo M, Hashiyama N, Matsubara S, Nemoto H, Kobayashi Y, et al. Clinical course of asymptomatic isolated distal deep vein thrombosis of the leg: A single-institution study. Ann Vasc Dis [Internet]. 2019;12(4):487–92. Available from: https://doi.org/10.3400/avd.oa.19-00128

 

License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.