Original communication| Volume 17, ISSUE 2, P153-177, February 1945

The problem of thrombo-embolism

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      The incidence of venous thromboses in peripheral veins is much higher than ordinarily suspected. Four groups of venous thromboses, namely, the superficial venous thrombosis, the ascending plantar vein thrombosis, the calf muscle thrombosis, and the pelvic vein thrombosis, can be recognized as being the primary sources of clotting. Any one of these may produce, by propagation, an iliofemoral thrombosis, the classic milk leg. The treatment of such thromboses should vary according to the primary site, the extent and the age of the thrombosis. Anticoagulant therapy, paravertebral sympathetic block, proximal venous ligation, and roentgen-ray therapy all have their indications but should be used selectively. Visualization of the venous system by opaque substances may be used occasionally but its routine use does not seem necessary. Pulmonary embolism is still often the earliest manifestation of an unrecognized thrombus in the periphery; its appearance calls for emergency measures and, following the recovery of the patient, for a thorough investigation of the source of the embolus, since recurrent emboli are increasingly dangerous. Early attention must be paid to the elimination of clotted plasma from the thrombophlebitic leg, since much permanent disability may result from this source.
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