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Approach to the diagnosis and therapy of lower extremity deep vein thrombosis

Author
Kenneth A Bauer, MD
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Deep vein thrombosis (DVT) and acute pulmonary embolism (PE) are two manifestations of the same disorder, venous thromboembolism (VTE). DVT of the lower extremity is subdivided into two categories:

Distal (calf) vein thrombosis, in which thrombi remain confined to the deep calf veins

Proximal vein thrombosis, in which thrombosis involves the popliteal, femoral, or iliac veins

Proximal vein thrombosis is of greater importance clinically, since it is more commonly associated with the development of pulmonary emboli. (See "Overview of the treatment of lower extremity deep vein thrombosis (DVT)", section on 'Introduction'.)

There are a number of questions that arise when a patient is suspected of having deep vein thrombosis (DVT) of the lower extremity. These include:

                                        

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 15 00:00:00 GMT 2014.
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References
Top
  1. Goodacre S. In the clinic. Deep venous thrombosis. Ann Intern Med 2008; 149:ITC3.
  2. Lechner D, Wiener C, Weltermann A, et al. Comparison between idiopathic deep vein thrombosis of the upper and lower extremity regarding risk factors and recurrence. J Thromb Haemost 2008; 6:1269.
  3. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008; 28:370.
  4. Cushman M, Tsai AW, White RH, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117:19.
  5. Bezemer ID, van der Meer FJ, Eikenboom JC, et al. The value of family history as a risk indicator for venous thrombosis. Arch Intern Med 2009; 169:610.
  6. Zöller B, Li X, Sundquist J, Sundquist K. Age- and gender-specific familial risks for venous thromboembolism: a nationwide epidemiological study based on hospitalizations in Sweden. Circulation 2011; 124:1012.
  7. Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med 2005; 143:129.
  8. Qaseem A, Snow V, Barry P, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med 2007; 146:454.
  9. Birdwell BG, Raskob GE, Whitsett TL, et al. The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med 1998; 128:1.
  10. Huisman MV, Büller HR, ten Cate JW, Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. The Amsterdam General Practitioner Study. N Engl J Med 1986; 314:823.
  11. Hull R, Hirsh J, Sackett DL, et al. Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis. Circulation 1981; 64:622.
  12. Gorman WP, Davis KR, Donnelly R. ABC of arterial and venous disease. Swollen lower limb-1: general assessment and deep vein thrombosis. BMJ 2000; 320:1453.
  13. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350:1795.
  14. Subramaniam RM, Chou T, Heath R, Allen R. Importance of pretest probability score and D-dimer assay before sonography for lower limb deep venous thrombosis. AJR Am J Roentgenol 2006; 186:206.
  15. van der Velde EF, Toll DB, Ten Cate-Hoek AJ, et al. Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients. Ann Fam Med 2011; 9:31.
  16. Tamariz LJ, Eng J, Segal JB, et al. Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: a systematic review. Am J Med 2004; 117:676.
  17. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:454S.
  18. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S.