Clinical Investigation On The Prognosis Of Muscle Calf Venous Thrombosis

Objective:To study the clinical prognosis and influencing factors of muscle calf venous thrombosis(MCVT),and to provide evidence for the clinical treatment of muscle calf venous thrombosis.Methods:From January 2017 to September 2018,117 patients with MCVT who were treated in the Department of Interventional Medicine of the Affiliated Hospital of Zunyi Medical University.There were 56 males and 61 females;the age ranged from 33 to 85years old,with an average of(60.72±13.63)years old;the thrombus was located in 31 cases of right lower leg,46 cases of left lower leg,and 40 cases of double calves.All patients were diagnosed as MCVT by color Doppler flow imaging(CDFI)of lower extremity veins,and then angiography was performed to further confirm the diagnosis of MCVT.The changes of thrombus in MCVT during treatment were reviewed by venography.The follow-up period was 1 month.Patients suspected of pulmonary embolism(PE)during follow-up were identified by CT angiography(CTA)of pulmonary artery and treated accordingly for PE.The main indicators included:patient age(?60 years old,<60 years old),gender;whether there were recent surgery,trauma,prolonged bed rest,hypertension,diabetes,hyperlipidemia;whether patients with MCVT receive anticoagulant therapy;prognosis of intramuscular venous thrombosis(dissolution absorption,spread,pulmonary embolism,thrombus stability no change).The data were processed by SPSS17.0 statistical analysis software and Excel2013 software.The count data were analyzed by chi-square test or Fisher's exact test,and multi-factor analysis was performed by logistic regression analysis.P<0.05 was considered statistically significant.RESULTS:In this group of 117 patients with MCVT,50 patients(42.7%)had thrombolysis and absorption of MCVT,38 cases(32.5%)had increased thrombus,29 cases(24.8%)had no change in thrombus,and 5 cases(4.3%)had pulmonary embolism due to increased thrombus spread.Univariate analysis:Thrombolysis absorption of MCVT:the thrombolytic absorption rate of the anticoagulation group(47.8%)was higher than that of the non-anticoagulation group(24%).The difference of thrombolytic absorption rate between the two groups was statistically significant(?~2=4.56,P=0.033);the thrombolytic absorption rate of the age<60 years old group(53.1%)was higher than that of the age group?60 years old(5.3%),and the difference of thrombolytic absorption rate between the two groups was statistically significant(?~2=5.97,P=0.015);there was no significant difference in thrombolysis absorption rate between the two groups in terms of gender,recent surgery,trauma,long-term bed rest,hypertension,diabetes and hyperlipidemia(P>0.05).(2)The rate of thrombosis spread in the non-anticoagulant group was 48%higher than that in the anticoagulant group(28.3%).There was a significant difference in the incidence of thrombosis spread between the two groups(?~2=4.084,P=0.043);the rate of thrombosis spread in the recent surgical group was 39.2%higher than that in the non-recent surgical group(20.1%).There was a significant difference in the incidence of thrombosis spread between the two groups(?~2=4.135,P=0.042).The incidence of thrombus spread in the injured group was 43.7%higher than that in the non-invasive group(18.9%).There was a significant difference in the incidence of thrombus spread between the two groups(maple=8.185,P=0.004);the prevalence of thrombus spread in the long-term bed group(46.1%)was higher than that in the non-long-term bed group(25.6%).There was a significant difference in the incidence of thrombus spread between the two groups(?~2=4.989,P=0.026).The delayed rate of 39.7%was higher than that of the group under 60years old(22.4%).There was a significant difference in the incidence of thrombosis spread between the two groups(?~2=3.867,P=0.049).There was no significant difference in the prevalence of thrombosis between the two groups in terms of gender,hypertension,diabetes and hyperlipidemia(P>0.05).(3)PE caused by muscle calf venous thrombosis:the incidence of pulmonary embolism in the non-anticoagulant group(16%)was higher than that in the anticoagulant group(1.1%).There was a significant difference between the two groups(P=0.007).There were no significant differences in age,sex,short-term surgical history,trauma,long-term bed rest,hypertension,diabetes and hyperlipidemia between the two groups(P>0.05).(4)No change in thrombosis stability of MCVT:There were no significant differences in age,sex,anticoagulation therapy,recent surgical history,trauma,long-term bed rest,hypertension,diabetes and hyperlipidemia between the two groups(P>0.05).Incorporate correlation factors into multivariate logistic regression analysis:age(B=-0.782,OR=0.457,P=0.047),anticoagulant therapy(B=1.124,OR=3.078,P=0.031)were independent correlative factors affecting thrombolysis and absorption of MCVT.Whether to accept anticoagulation therapy(B=-1.655,OR=0.191,P=0.007)and trauma(B=1.490,OR=4.436,P=0.047)were independent correlative factors affecting the spread of MCVT thrombosis.Conclusion:The prognosis of MCVT thrombosis is closely related to patient's age,short-term operation,trauma,anticoagulation therapy and long-term bed rest.Patients who do not receive anticoagulation therapy and trauma are prone to thrombosis spread,which may lead to pulmonary embolism.The spread of MCVT thrombosis to DVT may lead to unstable thrombosis,so we should actively intervene in the occurrence of pulmonary embolism.