脈管学55巻8号　pp

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1 Online publication September, 原著要旨 : 4 4 mmhg mmhg J Jpn Coll Angiol ; : 9 Key words: soleal vein classification, soleal vein thrombosis, crural vein thrombosis, ultrasonography, risk factor 序言対象と方法, ~ 7, 8 9, doi:.7/jca ±8 79±7 8: : D CT SSA-A 7. MHz Fig. 7 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol.

2 8 9 7 Figure Six groups of veins in the circulatory areas of soleal muscle and their drainage veins. proximal soleal vein, lateral soleal vein, central soleal vein, medial soleal vein, distal medial soleal vein, distal lateral soleal vein, medial gastrocnemial vein, lateral gastrocnemial vein, popliteal vein, posterior tibial veins, peroneal veins, anterior tibial veins D,. MHz mmhg 4 mmhg 9 mmhg 4 mmhg D LATECLE D μg/ml 4 S C kg 7. mg kg. mg 4 PT-INR. PT-INR.. PT-INR..,, 8, NYHA II D. μg/ml. μg/ml,, D CT StatMateV Microsoft Excel ± t Cochran-Cox Kaplan-Meier Logrank P<. 結果 Table a, b P<. Table a P<. Table b 脈管学 Vol.

3 Risk factor Local factor Saphenous varix Gait disorder Leg operation Leg trauma General factor Heart failure Bed rest Surgical rest Raynaud** Table a Initial risk factors (4) (9): r-, l-4, b- (): r-, l-, b- (): r-, l-, b- (): r-, l-, b- (4) (4)*: r-, l-, b- (7) : r-, l-, b- (8) : r-, l-, b- ( 9) : r-, l-, b- (7) ( 8): r-, l-, b- (4): r-, l-, b- (): r-, l-, b- (7): r-, l-, b- 9 (4) ( ): (): r-, l-, b- (44): r-, l-, b- (): r-, l-, b- Total No. 4: r-, l-7, b- : r-, l-4, b- r: right, l: left, b: both, *: P<., **: Raynaud s phenomenon Risk factor Local factor Gait disorder Saphenous varix Table b Occurrence risk factors (7) 9 (): r-, l-, b-7 7 (44): r-, l-4, b- General factor 8 () Heart failure (4): r-, l-, b- Raynaud (): r-, l-, b- Hypercoagulability (): r-, l-, b- Bed rest (): r-, l-, b- 9 (9)* (8): r-, l-, b-8 (): r-, l-, b- () : (): r-, l-, b- : : Total No. 4: r-, l-8, b- : r-7, l-4, b- *: P<., r: right, l: left, b: both Raynaud: Raynaud s phenomenon, hypercoagulability: female hormone Table a Table b NYHA II 7 III 8 Table c 8 Society for Vascular Surgery SVS III 7 Table a Symptoms in leg and chest Symptoms Leg : thrombus Swelling Cyanosis Calf pain Calf heaviness Calf cramp No Chest : embolus Dyspnea/ short breath Palpitation Oppression/ pain Cough/ hemoptysis Hypotension/ syncope No *: P<. (7) * () 8 () () (7) (4) (48) 9 (4) 4 Table a P<. P< Table b 9 4 P<. 4 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol.

4 4 Table b Right heart load diseases Co-existent disease Cardiac disease Aortic valve regurgitation (/4 *) Aortic valve stenosis ( mmhg **) Mitral valve regurgitation (/4 *) Tricuspid valve regurgitation (/ *) Chronic atrial fibrillation Post-acute myocardial infarction () 7 (9) (9) (4) Pulmonary disease COPD Acute PE Bronchial asthma (4) () Collagen related disease Raynaud s syndrome *: grade, **: pressure gradient PE: pulmonary embolism, COPD: chronic obstructive pulmonary disease Table c Clinical grades of heart failure Clinical grade Chronic (NYHA) I (no) II (palpitation, et al) III (dyspnea) IV (orthopnea) Acute (SVS*) I (growing edema) II (tachycardia, et al) III (shock) IV (cardiac arrest) CT 7 4 ** 7 () () 4 (8) 9 9 (7) 7 8 (8) () 7 *: Society for Vascular Surgery, **: total case No. acute case No /4 7 / mg 8 7. mg 7 8 mg /4 / 8.4±9. 7.7±8. 9.± ±..±.9 7.±..9±. Table 4a 9 7 P<. 9 脈管学 Vol.

5 Table a Acute thrombus distribution in muscular type Acute thrombus distribution Single thrombus Proximal vein Central vein Lateral vein Distal lateral vein Medial vein Distal medial vein Multiple thrombi *: p<. Unilateral thrombi Bilateral thrombi right leg left leg right leg left leg * * 9.±..± ±..±. NYHA-II P<. Table a NYHA-III P<. P<. 7 8 Table b 7 P<. 8 P<..±.4 mmhg.8±. mmhg P<..9±. mmhg Table b Acute thrombus distribution in crural type Acute thrombus Unilateral thrombi Bilateral thrombi distribution right leg left leg right leg left leg Single thrombus Anterior tibial vein Proximal vein Peroneal vein Central vein Lateral vein Distal lateral vein Posterior tibial vein Medial vein Distal medial vein 4 +* ** +* Multiple thrombi *: cases with old crural thrombi and new soleal thrombi, **: P<. +* 8 +* +* Thrombus change Disappearance Decrease Same Increase Total No. *: P<. Table 4a Changes of local thrombi 9 (9) ()* (7) () () ( ) () () Distal type () () 9 () 7 () Table 4b Changes of local thrombi and risk factors Thrombus change Risk factor Same: Local factor gait disorder leg ope./ trauma General factor Increase: Local factor General factor heart failure warfarin/ steroid r: right, l: left, b: both.±4.7 mmhg P<..±.8 mmhg.9±. mmhg P<. 8 P<. 94 P<. Table c 9 P< P<. P<. Table d /4 / 4 /4 4 4/ (7) 4 4: r-, l-, b- () : r-, l-, b- : r-, l-, b- 4 () : r-, l-, b- : r-, l-, b- () : r-, l-, b- THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol.

6 Table a Alterations of clinical grade in distal type NYHA grade Total No. I II III IV **: P<. Pre-anticoagulant 4 (47) (7) () () () () Anticoagulant 4 4 (7) (4) (4)** ( ) ( )** Table c Alterations of RVSP grade in distal type RVSP (mmhg) grade Total No. Normal (>) RV load (-9) PH (4 ) Pre-anticoagulant ( ) 4 (7) (94) (8) Anticoagulant 4 (9) (8) ()*** ( )** RVSP: right ventricle systolic pressure, RV: right ventricle, PH: pulmonary hypertension **: P<., ***: P<. Table b Alterations of clinical grade in muscular and crural types NYHA grade I II III IV I II III IV *: P<., **: P<. Pre-anticoagulant 9 (4) (9) (7) 7 () 8 (8) ( ) 4 () 8 () () () (7) () Anticoagulant case No.(%) (7) (9) (8) ( ) ( )** 4 9 (79) () ()* ( ) ( )* Table d Alterations of RVSP grade in muscular and crural types RVSP grade Normal RV load PH Normal RV load PH Pre-anticoagulant 7 ( ) (9) (94) () 9 ( ) 4 (74) 8 (9) () Anticoagulant 7 (9) () (7) ( )* 9 9 (47) () ()** ( )* RVSP: right ventricle systolic pressure, RV: right ventricle, PH: pulmonary hypertension *: P<., **: P< Table 4b 考察,, 8,, 脈管学 Vol.

7 7,,,, NYHA-II, 9, 9 4 COPD,, 4,, 8,, Xa 9,, mg PT-INR. 7 kg 4 HIT 88 4 COPD 7, 84, THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol.

8 8 8 9~ NYHA NYHA-II 9 4, NYHA-II,,, 4, 4, ~8,, CT, CT D. μg/ml D. μg/ml 9 D D D. μg/ml , 結論 mmhg mmhg 利益相反文献 Kearon C, Akl EA, Comerota AJ, et al: Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest ; 4: e49s-94s Lohr JM, Kerr TM, Lutter KS, et al: Lower extremity calf thrombosis: to treat or not to treat? J Vasc Surg 99; 4: 8 4 Ohgi S, Tachibana M, Ikebuchi M, et al: Pulmonary embolism in patients with isolated soleal vein thrombosis. Angiology 998; 49: 脈管学 Vol.

9 9 Kageyama N, Ro A, Tanifuji T, et al: Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism. Ann Vasc Dis 8; : 9 ; : 9 7 Sales CM, Haq F, Bustami R, et al: Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg ; : 4 8 Gillet JL, Perrin MR, Allaert FA: Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg 7; 4: 9; discussion 9 9 Hughes MJ, Stein PD, Matta F: Silent pulmonary embolism in patients with distal deep venous thrombosis: systematic review. Thromb Res 4; 4: Lautz TB, Abbas Farah, Walsh SJN, et al: Isolated gastrocnemius and soleal vein thrombosis: Should these patients receive therapeutic anticoagulation? Ann Surg 9; : 7 74 Horner D, Hogg K, Body R, et al: The anticoagulation of calf thrombosis (ACT) project: results from the randomized controlled external pilot trial. Chest 4; 4: Jpn J Med Ultrasonics 4; : J7 J4 ; : 9 4 Cosmi B, Legnani C, Cini M, et al: D-dimer and residual vein obstruction as risk factors for recurrence during and after anticoagulation withdrawal in patients with a first episode of provoked deep-vein thrombosis. Thromb Haemost ; : ; : 9 7 Reporting standards in venous disease. Prepared by the Subcommittee on Reporting Standards in Venous Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 988; 8: ; : Büller HR, Davidson BL, Decousus H, et al: Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 4; 4: ; 4: 4 48 Anticoagulant Therapy of the Soleal Vein Thrombosis: Changes of Local Thrombi and Alterations of Right Heart Load Shigetsugu Ohgi and Nagako Ohgi Department of Vascular Surgery, Hitachi Memorial Hospital, Shimane, Japan Department of Internal Medicine, Hitachi Memorial Hospital, Shimane, Japan Key words: soleal vein classification, soleal vein thrombosis, crural vein thrombosis, ultrasonography, risk factor Changes of local thrombi and alterations of right heart load by the anticoagulant therapy were investigated in the patients with soleal vein thrombosis (SVT) and crural vein thrombosis (CVT). The subjects were 4 in the SVT and in the CVT. In the changes of local thrombi, the effective rate of disappearance and decrease in size was % and was not significant between the SVT and the CVT. In the alterations of right heart load, the right heart systolic pressure decreased significantly. The rates of the patients with pulmonary hypertension more than 4 mmhg were significantly reduced in both SVT and CVT, and the rate of the patients with right ventricle load more than mmhg was significantly reduced in the SVT. Anticoagulant therapy could give more extensive reduction of the right heart load to the patients with SVT than those with CVT. (J Jpn Coll Angiol ; : 9) THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. Online publication September,

Table 1 Isolated venous thrombi in soleal muscle by ultrasonography US finding Acute Chronic Total No. Early stage non-retracted slightl

Table 1 Isolated venous thrombi in soleal muscle by ultrasonography US finding Acute Chronic Total No. Early stage non-retracted slightl Online publication October 8, 2010 原著第 50 回総会座長推薦論文孤立性ひらめ筋内静脈血栓と抗核抗体との関連 1 2 要旨 : 89 116 D 3 30 70 63 26 100 J Jpn Coll Angiol, 2010, 50: 417 422 Key words: isolated soleal venous thrombi, recurrent

脈管学55巻8号 pp

脈管学55巻8号　pp