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- W2404798626 abstract "Les thromboses veineuses profondes (TVP) distales isolées des membres inférieurs sont des TVP infrapoplitées, sans TVP proximale ou embolie pulmonaire associées. Elles peuvent toucher les veines jambières (veines tibiales antérieure/postérieure ou fibulaire [péronière]) ou les veines musculaires du mollet (veines soléaires ou gastrocnémiennes). Elles représentent la moitié des TVP des membres inférieurs. Si leurs facteurs de risque sont identiques à ceux des TVP proximales, le poids de ces facteurs diffère : les TVP distales sont davantage associées à des facteurs de risque transitoires et moins associées à des facteurs de risque permanents. L’histoire naturelle des TVP distales est imparfaitement connue et leur prise en charge débattue. En cas de suspicion de TVP distale, le diagnostic positif repose sur la réalisation d’un écho-Doppler veineux complet des membres inférieurs. À long terme, en comparaison avec les TVP proximales, le risque de récidive thromboembolique à l’arrêt du traitement serait deux fois moindre, et le risque de syndrome post-thrombotique plus faible, voire négligeable. Les recommandations françaises de l’Afssaps suggèrent de traiter par anticoagulation curative, six semaines un premier épisode de TVP distale avec facteur favorisant transitoire et pendant au moins trois mois les TVP distales idiopathiques, récidivantes, ou associées à un facteur de risque permanent. Par analogie aux TVP proximales, le port de la compression élastique est recommandé en cas de TVP distale. Des essais thérapeutiques en cours de réalisation permettront de proposer une prise en charge basée sur un plus haut niveau de preuve, notamment en ce qui concerne la place du traitement anticoagulant. Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants." @default.
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- W2404798626 date "2012-12-01" @default.
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- W2404798626 title "Thromboses veineuses profondes distales isolées des membres inférieurs : épidémiologie et prise en charge" @default.
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- W2404798626 doi "https://doi.org/10.1016/j.revmed.2012.05.012" @default.
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