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Letters |
Simi Valley Hospital Simi, CA 93065
Veterans Administration Sepulveda, CA 91343
WEB—This is a Web exclusive article.
The correct nomenclature for this vessel, which carries blood from the popliteal to the common femoral vein, is simply the femoral vein. It is a deep, not superficial, vein. This is a critical distinction. Deep vein thrombosis, at least of the proximal leg veins, frequently results in pulmonary embolism and requires anticoagulation. Superficial vein thrombosis does not. The high incidence of associated silent deep vein thrombosis with the latter, however, is generally not appreciated by most primary care physicians (i.e., family practitioners and general internists). Also overlooked by many of these physicians is the frequent progression to deep vein thrombosis of proximal saphenous vein thrombophlebitis.
Bundens et al. [1] reported that 75% of primary care physicians were unaware that the "superficial femoral vein" is, in fact, a deep vein. A subsequent survey in 2002 found that 59% of physicians continued to identify the "superficial femoral vein" as a superficial vein [3]. It is evident that the majority of clinicians, when presented with a sonography report reading "superficial femoral vein thrombosis" will fail to initiate the necessary treatment [1]. We conservatively estimate 190,000 newly diagnosed cases of proximal deep vein thrombosis each year in this country. The mortality rate associated with untreated asymptomatic proximal deep vein thrombosis is 12–13% [4].
The mislabeled "superficial femoral vein," is not an obscure vein of only rare clinical importance. On the contrary, it is the vein most frequently affected by deep vein thrombosis (74% of cases), and 22% of cases of acute deep vein thrombosis are isolated to this vessel alone [5]. If Hammond's [2] caution has not been widely adopted, and 93% of reports (as last surveyed) [1] continue to call this deep vein "superficial," the resulting unnecessary morbidity and mortality cannot be insignificant. We calculate an annual incidence of 41,000 cases of deep vein thrombosis isolated to the "superficial" femoral vein alone, with 38,130 cases reported with the "superficial" nomenclature. With 59% of primary care physicians not recognizing this vein as deep, 22,496 cases of deep vein thrombosis are untreated—translating into a yearly toll of 2,700 individuals. Among patients presenting with deep vein thrombosis, the rate of fatal pulmonary embolism is 0.4% during anticoagulant therapy and 0.3 per 100 patient-years after that therapy [6]. By this calculation, all but 11 of these 2,700 individuals would have survived were the vein correctly named in reports.
The percentage of radiologists still using the "superficial femoral vein" terminology is unknown. However, misleading language of fatal consequence should not be found in any radiology report.
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