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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 t...

The efficacy of small doses of peri-operative subcutaneous heparin in preventing deep venous thrombosis has been studied in a controlled clinical trial involving 251 patients undergoing major operations. The results indicate that the regimen of sodium heparin used was safe. It reduced the frequency of postoperative deep venous thrombosis from 24% in the control group to 0·8% in the test group as detected by the 125 I-fibrinogen test. In addition it reduced the frequency of the dangerous extensive thrombi often responsible for pulmonary emboli from 7.4% to nil

A venographic technique for studying stasis in the deep veins of the legs of conscious patients is described. A second technique involving the clearance of radioactive material from the veins has been developed for use during operation. The results of the two methods correlate closely. There is considerable stasis of the blood, particularly in the soleal veins, in conscious patients with the legs horizontal, and it is prolonged considerably during surgery. Using these new techniques the effectiveness of various methods said to prevent stasis has been assessed.

In a study of 52 patients admitted into the coronary intensive care unit the incidence of deep-vein thrombosis was measured with the (125)I-fibrinogen test. Of these patients 31 were eventually confirmed to be suffering from acute myocardial infarction. This preliminary study showed that in patients with a confirmed infarct who were not treated with anticoagulants the incidence of deep-vein thrombosis was 38% and in those treated it was 5.5%. In patients who were "severely ill" from whatever the cause there was a high incidence of deep-vein thrombosis (68%).

The effectiveness of subcutaneous heparin in the prophylaxis of deep-vein thrombosis was investigated in 53 consecutive patients over the age of 50 undergoing repair of inguinal hernia. Deep-vein thrombosis was detected by means of the 125 I-fibrinogen test in 7 (26%) of the 27 control patients, while this was significantly reduced (4%) in the 26 similar patients who received heparin before and after surgery.

The most effective electrical stimulus to the calf muscles which prevents stasis in the soleal veins during operation was determined. This was subsequently used in a clinical trial and was shown to produce a 92% relative reduction in the incidence of deep vein thrombosis as determined by the (125)I-fibrinogen test.

A new apparatus for the detection of deep-vein thrombosis, using the 125 I-Iabelled fibrinogen test, is described. Forty patients were studied and results with the new method (ratemeter) and the older method (requiring radioactive counting and calculations) were compared. Counts with the two methods correlated well, and both methods detected deep-vein thrombosis in the six patients in whom this complication developed. There were no false-positives. It is suggested that the 125 I-labelled fibrinogen test with the ratemeter is a suitable method for the routine screening of at-risk patients.

In a study of 50 patients who had undergone prostatectomy the incidence of deep-vein thrombosis was measured, using the 125I-fibrinogen test. Of these, 12 (24 per cent) developed deep-vein thrombosis. This preliminary study showed that in patients who had had a transurethral resection the incidence of deep-vein thrombosis was 6·8 per cent, while in patients who had had a retropubic prostatectomy it was 47·6 per cent.