1.Approximately 600,000 new cases are diagnosed in
the U.S. each year
Thrombus formation in deep veins of legs or thighs
Deep Vein Thrombosis
Tibial veins, soleal/gastrocnemius veins, popliteal vein
femoral vein, deep femoral vein,
common femoral vein, iliac veins.
2.Approximately one-third develop pulmonary embolism
Deep Vein Thrombosis
15%
Death
3.VTE: Epidemiology
Untreated Proximal DVT
30-50% risk PE
12-15% mortality
Treated DVT
<8% risk PE
Mortality <2%
4.VTE: Epidemiology
Incidence - USA/Europe
DVT: 160 per 100,000
Symptomatic non-fatal PE: 20 per 100,000
Fatal PE: 50 per 100,000
5.VTE: Pathophysiology
Virchow’s Triad
Alterations in blood flow - Venous Stasis
Alterations in blood constituents
Vascular endothelium damage
6.VTE: Predisposing Factors
Principal Risk Factors
Immobilization
Trauma
Surgery
Infection
Post-partum period
Other Factors
Age
Obesity
Malignancy
Previous VTE
Varicose Veins
Dehydration
Hormonal Therapy
7.VTE: Signs & Symptoms
DVT
Asymptomatic
Pain/tenderness
Erythema
Acute swelling
Pallor- Phlegmasia Alba
Cyanosis-Phlegmasia Cerulea
PE
Dyspnea & Tachypnea
Diaphoresis
Hemoptysis
Low-grade fever
Pleuritic CP
Cough
Hypotension
Coma
CXR
EKG
8.VTE: Diagnosis
Venography – ex-gold standard
Duplex Ultrasound
Comfortable
Inexpensive
No risk
Good sensitivity and specificity for distal
Less sensitive for proximal DVT
9.Arteries and Veins
10.The Superficial Femoral Vein A Potentially Lethal Misnomer Warner P. Bundens, MD; John J. Bergan, MD; Nicholas A. Halasz, MD; Jay Murray, MD; Margaret Drehobl, MD. JAMA. 1995;274:1296-1298
A total of 46 family practitioners and general internists, 95 anatomists, and 85 laboratory directors.
Only 24% (11/46) of the respondents would have administered anticoagulants to the patient as described
11.Only 3% (3/95) of anatomists felt the term "superficial femoral vein" was correct, 22% (21/95) felt it was an acceptable alternative, and only 7% (7/95) of anatomists felt the term was preferred for everyday use
The term "superficial femoral vein" is used by 93% (79/85) of vascular laboratories in lower limb venous duplex reports.
The Superficial Femoral Vein A Potentially Lethal Misnomer Warner P. Bundens, MD; John J. Bergan, MD; Nicholas A. Halasz, MD; Jay Murray, MD; Margaret Drehobl, MD. JAMA. 1995;274:1296-1298
12.
13.Correct nomenclature
The term “superficial femoral vein “
should never be used, because the femoral vein is in fact a deep vein and is not part of the superficial venous system.
Confusion arising from use of the inappropriate name has been responsible for many cases of clinical mismanagement and death
Management of “superficial femoral vein” thrombosis should be the same as any DVT