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Review
. 2017 Jun 25;10(2):99-106.
doi: 10.3400/avd.ra.17-00035.

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review

Affiliations
Review

Pathophysiology of Venous Thromboembolism with Respect to the Anatomical Features of the Deep Veins of Lower Limbs: A Review

Ayako Ro et al. Ann Vasc Dis. .

Abstract

Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.

Keywords: calf vein; deep vein thrombosis; pathophysiology; pulmonary thromboembolism; soleal vein.

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Figures

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Fig. 1 Clinical characteristics and classification of deep vein thrombosis (from ref. , Fig. 11).
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Fig. 2 A representative autopsy case of calf deep vein thrombosis. The popliteal vein and three crural branches are present. The vein is full of thrombus, and the valves are easily observed. The soleal and gastrocnemius veins run inside their respective muscles.
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Fig. 3 A representative autopsy case of soleal vein thrombosis. (a) After narrow removal of the surrounding soleal muscle. The dilated soleal vein with thrombi is present. (b) After broad removal of the surrounding muscle of (a). The complicated running course of the soleal vein can be observed. (c) Schema of the running of the soleal vein (indicated by brown).
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Fig. 4 Anatomical features of the gastrocnemius muscle, soleus muscle, gastrocnemius vein, and soleal vein.
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Fig. 5 Difference in hemodynamics during muscle contractions between the gastrocnemius and soleal veins.
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Fig. 6 Difference in the anatomical structure between the gastrocnemius and soleal veins.
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Fig. 7 Distribution and chronology of deep vein thrombosis in eight deep venous segments of 189 limbs, and the suspected mechanism of venous thromboembolism, resulting in lethal pulmonary thromboembolism (from ref. , Fig. 2).
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Fig. 8 Suspected mechanism of venous thromboembolism, resulting in lethal pulmonary thromboembolism (from ref. , Fig. S).
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Fig. 9 Fate of the deep vein thrombosis.
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Fig. 10 Mechanism of thrombus propagation in fatal pulmonary thromboembolism (from ref. , Fig. 15).

References

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