Association of post-thrombotic changes with disease severity in patients presenting with symptomatic calf vein thrombosis

BACKGROUND/OBJECTIVE: This study was designed to evaluate the development of post-thrombotic signs and symptoms in patients with isolated calf deep vein thrombosis (DVT) in relation to changes seen by ultrasound examination in the affected veins. METHODS: A total of 117 limbs in 104 patients, with isolated symptomatic calf vein thrombosis, were included in the study. These were objectively diagnosed with ultrasound examination. The distribution and extent of the initial DVT were recorded in detail. Patients with a documented episode of prior DVT or those having thrombus in the popliteal vein or higher were excluded. Follow-up at 3 to 24 months was performed with clinical and ultrasound examination. Ultrasound examination was performed with the patient in the standing position to ensure optimal testing for detecting post-thrombotic changes. Affected venous segments were classified as having an occlusion, complete recanalization, and partial recanalization, with or without reflux. RESULTS: At 1 year, of 98 limbs studied, most (99%) had recanalization of their calf vein thrombosis; 53% (n = 52) had complete, 46% (n = 45) had partial, and 1% (n = 1) had no recanalization. Ultrasound studies of those limbs showed reflux (R) in 22% (n = 22), obstruction (O) in 9% (n = 9), R + O in 33% (n = 32), and normal findings in 36% (n = 35) of limbs. Only 17% of limbs had signs of edema (CEAP 3), 2% had skin changes (CEAP 4), and 0% had any signs of ulcers (CEAP 5, 6). Of these findings, only 14 patients experienced persistent symptoms at 1 year. CONCLUSIONS: Patients with symptomatic calf vein DVT generally have good clinical outcomes, with most being asymptomatic and having mild disease. Although a small deterioration is seen up to 2 years, few limbs developed skin changes. The presence of reflux in calf veins does not appear to be a significant predictor of severe disease development in the medium term.