J Korean Surg Soc.  2012 Jun;82(6):374-379.

Early treatment outcome of isolated calf vein thrombosis after total knee arthroplasty

• Yun WS
• Lee KK
• Cho J
• Kim HK
• Kyung HS
• Huh S

Abstract

PURPOSE
In contrast to proximal deep vein thrombosis (DVT), the treatment of isolated calf vein thrombosis (ICVT) remains controversial. This study aimed to investigate early treatment outcomes of ICVT after total knee arthroplasty (TKA).
METHODS
Medical records of 313 patients who underwent TKA from October 2007 to December 2009 were retrospectively reviewed. A DVT-computed tomography (CT) was performed 7 days after surgery. ICVT was identified in 76 limbs of 73 patients. Of them, follow-up DVT-CT was available in 39 limbs of 37 patients. The patients with ICVTs were categorized into two groups: oral anticoagulation group (group I, 17 patients with 18 limbs) and conservative treatment group (group II, 20 patients with 21 limbs). Group I received an oral vitamin K antagonist for 3 to 6 months following low molecular weight heparin. Change of thrombus extent and development of pulmonary embolism (PE) was assessed in follow-up DVT-CT.
RESULTS
Mean age was 68 years and 95% were female. Of 39 limbs with ICVT, 16 (41%) involved major lower leg veins (posterior tibial vein or peroneal vein), 13 (33%) involved muscular veins (soleal vein or gastrocnemius vein) and 10 (26%) involved both. During 1 to 6 months, follow-up DVT-CT revealed complete thrombus resolution in all limbs and there was no proximal propagation of thrombus or PE in both groups.
CONCLUSION
There is no evidence of DVT propagation or newly developed PE in the conservative treatment group. This result suggests that anticoagulation therapy for ICVT patients without PE after TKA may not be mandatory.

Keyword

Isolated calf vein thrombosis; Pulmonary embolism; Anticoagulation

MeSH Terms

Arthroplasty
Extremities
Female
Follow-Up Studies
Heparin, Low-Molecular-Weight
Humans
Knee
Leg
Medical Records
Pulmonary Embolism
Retrospective Studies
Thrombosis
Treatment Outcome
Veins
Venous Thrombosis
Vitamin K
Heparin, Low-Molecular-Weight
Vitamin K

Figure

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  Fig. 1 Computed tomography (CT) of 66-year-old woman who underwent right total knee arthroplasty (TKA). She was treated with oral anticoagulation therapy for 3 months due to isolated calf vein thrombosis (ICVT) with pulmonary embolism (PE). (A) CT at 7 days after TKA revealed PE in right posterior basal segmental artery (arrow) and thrombosis in right muscular calf veins (arrow heads). (B) Follow-up CT after 4 months revealed complete resolution of ICVT and PE.

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  Fig. 2 Computed tomography (CT) of 67-year-old man who underwent right total knee arthroplasty (TKA). He was treated with low molecular weight heparin for 5 days during admission and took antiplatelet agent for 3 months. (A) CT at 7 days after TKA revealed thrombosis in right peroneal vein (open arrow), posterior tibial vein (solid arrow), and muscular vein (arrow head). (B) Previous thrombus disappeared on follow-up CT after 3 months.

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