open access

Vol 26, No 2 (2020)
Review papers
Published online: 2020-09-25
Get Citation

Management of isolated distal deep vein thrombosis. A persistent conundrum?

Nalaka Gunawansa, Thilina Gunawardena
DOI: 10.5603/AA.2020.0011
·
Acta Angiologica 2020;26(2):65-71.

open access

Vol 26, No 2 (2020)
Review papers
Published online: 2020-09-25

Abstract

Isolated distal deep vein thrombosis (IDDVT) accounts for approximately 50% of all patients diagnosed with
DVT. While the definitive management of patients with proximal deep vein thrombosis is fairly well defined,
IDDVT remains shrouded uncertainty. The great majority of patients with IDDVT may remain with little or no
symptoms and have spontaneous resolution of the thrombi. However, a small but significant fraction may show
proximal thrombus extension and may proceed to cause pulmonary embolism or late deep venous reflux.
Identification of this subgroup of patients with IDDVT who have a greater propensity for thrombus extension or
further sequelae remains the cornerstone of individualized management for optimal results.

Abstract

Isolated distal deep vein thrombosis (IDDVT) accounts for approximately 50% of all patients diagnosed with
DVT. While the definitive management of patients with proximal deep vein thrombosis is fairly well defined,
IDDVT remains shrouded uncertainty. The great majority of patients with IDDVT may remain with little or no
symptoms and have spontaneous resolution of the thrombi. However, a small but significant fraction may show
proximal thrombus extension and may proceed to cause pulmonary embolism or late deep venous reflux.
Identification of this subgroup of patients with IDDVT who have a greater propensity for thrombus extension or
further sequelae remains the cornerstone of individualized management for optimal results.

Get Citation

Keywords

deep vein thrombosis, pulmonary embolism, calf vein thrombus, venous thromboembolism

About this article
Title

Management of isolated distal deep vein thrombosis. A persistent conundrum?

Journal

Acta Angiologica

Issue

Vol 26, No 2 (2020)

Pages

65-71

Published online

2020-09-25

DOI

10.5603/AA.2020.0011

Bibliographic record

Acta Angiologica 2020;26(2):65-71.

Keywords

deep vein thrombosis
pulmonary embolism
calf vein thrombus
venous thromboembolism

Authors

Nalaka Gunawansa
Thilina Gunawardena

References (36)
  1. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis. 2016; 41(1): 3–14.
  2. https://www cdc gov/ncbddd/dvt/data. Data and Statistics on Venous Thromboembolism | CDC.
  3. Wei M, Zhu J, Yi X, et al. The prevalence of isolated calf deep vein thrombosis in patients with pulmonary embolism. Int Angiol. 2013; 32(5): 465–470.
  4. Mattos MA, Melendres G, Sumner DS, et al. Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study. J Vasc Surg. 1996; 24(5): 738–744.
  5. Sapp B, Craddock G, Sapp J. Patterns and Distribution of Deep Vein Thrombus in the Lower Extremity. Journal for Vascular Ultrasound. 2018; 39(2): 71–77.
  6. Wells PS, Ginsberg JS, Anderson DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998; 129(12): 997–1005.
  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(2): 129–139.
  8. Sartori M, Cosmi B, Legnani C, et al. The Wells rule and D-dimer for the diagnosis of isolated distal deep vein thrombosis. J Thromb Haemost. 2012; 10(11): 2264–2269.
  9. Di Nisio M, Squizzato A, Rutjes AWS, et al. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost. 2007; 5(2): 296–304.
  10. Goodacre S, Sampson F, Thomas S, et al. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005; 5: 6.
  11. Zhang Y, Xia H, Wang Y, et al. The rate of missed diagnosis of lower-limb DVT by ultrasound amounts to 50% or so in patients without symptoms of DVT: A meta-analysis. Medicine (Baltimore). 2019; 98(37): e17103.
  12. Heit J, Petterson T, Farmer S, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 35-year population-based study. Blood. 2006; 108(11): 1488–1488.
  13. Needleman L, Cronan J, Lilly M, et al. Ultrasound for lower extremity deep venous thrombosis. Circulation. 2018; 137(14): 1505–1515.
  14. Kearon C, Kearon C. Natural history of venous thromboembolism. Circulation. 2003; 107(23 Suppl 1): I22–I30.
  15. Sevestre MA, Quashié C, Genty C, et al. Clinical presentation and mortality in pulmonary embolism: The Optimev study. Journal des Maladies Vasculaires. 2010; 35(4): 242–249.
  16. Galanaud JP, Quenet S, Rivron-Guillot K, et al. RIETE INVESTIGATORS. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost. 2009; 7(12): 2028–2034.
  17. Fleck D, Albadawi H, Wallace A, et al. Below-knee deep vein thrombosis (DVT): diagnostic and treatment patterns. Cardiovasc Diagn Ther. 2017; 7(Suppl 3): S134–S139.
  18. Garry J, Duke A, Labropoulos N. Systematic review of the complications following isolated calf deep vein thrombosis. Br J Surg. 2016; 103(7): 789–796.
  19. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016; 149(2): 315–352.
  20. Galanaud JP, Sevestre MA, Genty C, et al. OPTIMEV-SFMV investigators. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost. 2014; 12(4): 436–443.
  21. Sartori M, Migliaccio L, Favaretto E, et al. Two years outcome of isolated distal deep vein thrombosis. Thromb Res. 2014; 134(1): 36–40.
  22. Barco S, Corti M, Trinchero A, et al. Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost. 2017; 15(7): 1436–1442.
  23. Galanaud JP, Monreal M, Kahn SR, et al. Epidemiology of the post-thrombotic syndrome. Thromb Res. 2018(164): 100–109.
  24. Meissner MH, Caps MT, Bergelin RO, et al. Early outcome after isolated calf vein thrombosis. J Vasc Surg. 1997; 26(5): 749–756.
  25. Saarinen JP, Domonyi K, Zeitlin R, et al. Postthrombotic syndrome after isolated calf deep venous thrombosis: the role of popliteal reflux. J Vasc Surg. 2002; 36(5): 959–964.
  26. McLafferty RB, Moneta GL, Passman MA, et al. Late clinical and hemodynamic sequelae of isolated calf vein thrombosis. J Vasc Surg. 1998; 27(1): 50–6; discussion 56.
  27. Galanaud JP, Righini M, Le Collen L, et al. Long-term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS-PTS study. J Thromb Haemost. 2020; 18(4): 857–864.
  28. 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(6 Suppl): 454S–545S.
  29. Kahn SR, Shapiro S, Wells PS, et al. SOX trial investigators. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 2014; 383(9920): 880–888.
  30. Palareti G. How I Treat isolated distal DVT. Blood. 2015; 123: 1802–1810.
  31. Pinede L, Ninet J, Duhaut P, et al. Investigators of the "Durée Optimale du Traitement AntiVitamines K" (DOTAVK) Study. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation. 2001; 103(20): 2453–2460.
  32. Ferrara F, Meli F, Amato C, et al. Optimal duration of treatment in surgical patients with calf venous thrombosis involving one or more veins. Angiology. 2006; 57(4): 418–423.
  33. Franco L, Giustozzi M, Agnelli G, et al. Anticoagulation in patients with isolated distal deep vein thrombosis: a meta-analysis. J Thromb Haemost. 2017; 15(6): 1142–1154.
  34. Schwarz T, Buschmann L, Beyer J, et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg. 2010; 52(5): 1246–1250.
  35. Righini M, Galanaud JP, Guenneguez H, et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol. 2016; 3(12): e556–e562.
  36. Kirkilesis G, Kakkos SK, Bicknell C, et al. Treatment of distal deep vein thrombosis. Cochrane Database Syst Rev. 2020; 4: CD013422.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl