PubMed1982
After reviewing the predisposing factors for venous leg thrombosis prophylactic attempts for patients carrying a continuous risk of thromboembolism and for patients with transient hazards (e.g. after operations) are discussed. Mobilisation with non-elastic bandages and low-dose-heparin in combination with dihydroergotamine is recommended for short term prophylaxis. The unreliability of clinical diagnostic criterias ("thrombosis signs") is pointed out. So additional apparative diagnostic trials are necessary; their values are critically discussed. With certain limitations X-ray phlebography has been proved to be the method of reference. 131 iodine fibrinogen uptake test is recommended best for the detection of calf vein thrombosis. The Doppler sonography is indicated for the detection of pelvic vein thrombosis. Isotope phlebography of the pelvic veins is evaluated, supporting additional information about pulmonary perfusion defects. Due to various contraindications (age, localisation of thrombi, age of thrombi etc.) only a minority of patients with venous thromboses of the lower limbs can be treated by thrombectomy or fibrinolysis, which are regarded as methods of the first choice. So for the vast majority only conservative treatment is feasibly including mobilisation with compression aids and ankle joint exercises for bedridden patients. Direct or indirect anticoagulations seems not to be necessary for patients with calf vein thrombosis, but is indicated for thrombotic affections of the femoral and pelvic veins. Anticoagulation treatment is always combined with compression therapy and mobilisation, except for some patients who had been immobilized before the clinical attendance. The treatment of superficial thrombophlebitis consists of incision and extrusion of thrombotic masses, antiphlogistic drugs and mobilisation with compression bandages.