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Home > Vascular Annual Meeting > wheeler_isolated_gastro_soleal

Isolated Gastro/Soleal Deep Venous Thrombosis is Associated with Pulmonary Embolism and a High Incidence of Additional Ipsilateral and Contralateral DVT

Nicole M. Wheeler, Tim K. Liem, Erica L. Mitchell, Gregory J. Landry, Gregory L. Moneta
Oregon Health & Science University, Portland, Ore.

OBJECTIVES: Little is known about resolution of isolated gastro/soleal DVT (GSDVT) and rates of development of additional DVT and pulmonary embolism (PE) in patients with GSDVT. Recommendations for treatment and follow-up of GSDVT are therefore anecdotal.

METHODS: A vascular lab database was queried from January 2002 to December 2006 to identify patients with duplex diagnosed isolated GSDVT and follow-up duplex studies. Duplex exams were reviewed to determine resolution rates of GSDVT and development of new ipsilateral and contralateral DVT. Records were reviewed for co-morbid conditions, DVT risk factors, treatment with anticoagulation, the effect of anticoagulation on resolution of GSDVT, and objective diagnosis of PE.

RESULTS: Sixty-five limbs with isolated GSDVT were identified in 57 patients with follow-up duplex scans (mean 2.75 studies per patient, mean follow-up 113 days). Twenty-four patients (42%) received therapeutic anticoagulation. There were 4 PEs after initial GSDVT diagnosis, 2 within 4 days of diagnosis in untreated patients. GSDVT resolution by Kaplan-Meier analysis at 1, 3, 6 and 12 months was 20%, 32%, 36% and 53% respectively. Eleven patients (19%) developed additional ipsilateral DVT (3 axial calf DVT, 5 proximal DVT) or contralateral DVT (1 axial calf DVT, 1 isolated GSDVT, 1 proximal DVT) during follow-up. Of the 8 patients who developed additional ipsilateral DVT, 5 also developed concurrent contralateral DVT. Therefore, overall, 14% of patients developed contralateral DVT. Median time to development of additional DVT was 10 days. Neither thrombus resolution nor development of additional DVT were significantly affected by age, gender, anticoagulation, oral contraceptives, known hypercoagulable states, or co-morbidities (smoking, cancer, trauma, post surgical status, renal failure, hyperlipidemia, diabetes, cardiopulmonary abnormalities), p-values>0.05.

CONCLUSIONS: Isolated GSDVT is associated with PE and a significant incidence of new ipsilateral and contralateral DVT and should be treated. Untreated patients with isolated GSDVT should receive follow-up bilateral lower extremity venous duplex scans within 10 days of diagnosis.

AUTHOR DISCLOSURES: N.M. Wheeler, None; T.K. Liem, None; E.L. Mitchell, None; G.J. Landry, None; G.L. Moneta, None.