The origin of deep vein thrombosis: a venographic study

Abstract A venographic technique has been described which demonstrates the soleal veins in addition to the rest of the deep veins of the lower limb consistently in the presence or absence of thrombosis. In 127 consecutive patients, the soleal veins were demonstrated in all but three. In 97 surgical and medical patients with clinically suspected deep vein thrombosis, the presence of thrombi was confirmed by venography only in 51 (52 per cent); the remainder had normal deep veins. In nine patients the soleal veins were the only site of thrombosis. Only one patient was found with thrombosis proximally and normal soleal veins. In the remaining patients whenever there were thrombi proximally they were also present in the soleal and intervening veins. It is concluded that in the majority of patients thrombi start in the soleal veins in the calf. It has also been shown that the clinical diagnosis of deep vein thrombosis is unreliable and no patient should be given anticoagulant therapy without first confirming the diagnosis with venography.