Original communication| Volume 17, ISSUE 2, P178-190, February 1945

Etiology and prevention of thrombosis of the deep leg veins

A study of 400 cases
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      • 1.
        1. A comparative study of the incidence of venous thrombosis of the legs in 400 unselected autopsies on adults, performed in the same hospital, before and after instituting preventive measures is presented.
      • 2.
        2. In the last 200 cases dissection of the femoral and adductor veins was carried out. Like others who have examined the femoral vein, we find that phlebothrombosis of the lower extremities begins in the deep vessels of the calf and tends to propagate toward the heart, and that thrombosis of the femoral veins alone is an uncommon occurrence. Both sets of veins are the most frequent, and for this reason the most important, of all the possible sources of both fatal and nonfatal pulmonary emboli.
      • 3.
        3. There were no important differences between the two series concerning age, sex, or location of the thrombosed calf veins. The lastmentioned feature has been considered in some detail in a previous publication.9
      • 4.
        4. Thrombosis of the deep veins of the leg is a frequent event in all classes of middle-aged and older patients who for any reason whatsoever must go to bed for longer than a very few days. The onset is insidious and without prominent symptoms. Phlebitis, as a cause or as a complication of deep extremity vein thrombosis, is very uncommon and for this reason is unimportant.
      • 5.
        5. The logical approach to the problem of phlebothrombosis and pulmonary embolism is prophylactic. Hitherto, in our opinion, there has been far too much emphasis upon diagnosis and treatment and too little on prevention.
      • 6.
        6. Prophylaxis is best based on simple and readily carried out physiologic principles.
      • 7.
        7. Re-education of physicians and nurses with respect to the seats and causes of thrombosis of the legs is urgently needed.
      • 8.
        8. The incidence of phlebothrombosis in a small series of medical patients proved to be significantly less than it was in the first 200 cases. It seems probable that the institution of active exercises for this group is responsible for the decrease.
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