Thank you very much for your reply.

From: UVM Flownet [[log in to unmask]] on behalf of Bill Johnson [[log in to unmask]]
Sent: Monday, December 06, 2010 3:41 PM
To: [log in to unmask]
Subject: Superficial vs. deep

Bill Johnson, Port Townsend, WA

Carol wrote;
“Bill et all, (Not the Bill you asked, I am another Bill)
I have a question.  I've had a couple pts recently with superficial thrombosis extending into a perforator (beneath the fascia) but not into a tibial vein.  I say this is DVT, my medical director does not think so.  Who is right?  Thank you
Carol Wise, RN, RVT, RDCS Technical Director, Vascular Laboratory”

I think perforators fall into one of those “in-between” categories.  Neither fish nor fowl as it were.  The fascia is usually the boundary between the “deep” and the “superficial” (“superficial femoral vein” notwithstanding, and hopefully not standing anymore.)  I think the accepted definition of a deep vein is that it is adjacent to a deep artery.  I believe your medical director is correct.  I also believe that a patient with thrombus in a perforator should have serial exams to assure that this does not propagate into the deep system which should significantly affect treatment decisions.

I do not think it unlikely that superficial thrombosis cannot be a source for embolus, but the issue is the size of the vein and therefore the size of the potential embolus.  Emboli occur more frequently than we would like to know.  I have worked with surgeons that would readily ligate the great saphenous vein if thrombus was visualized near the sapheno-femoral junction.  I never thought that was over-reacting.
"deep vein,  one of the many systemic veins that accompany the arteries, usually enclosed in a sheath that wraps both the vein and the associated artery."

There are many other references in the same vein.  ;-)
Not sure if this includes perforators although I have often seen small arteries associated with them.  And thrombus within the perforators is not  uncommon.

Not trying to split hairs here, the issue should be patient care.  Your concern is obviously based on that.
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