Deep Vein Thrombosis (DVT) occurs when clots form in the deep veins within the muscles of the leg

Diagnosing deep vein thrombosis

DVT: A challenge to diagnose

Signs of deep vein thrombosis (DVT) are only are only found in about half of patients1, and it is often difficult to differentiate from non-thrombotic disorders.

Symptoms (when they exist) include the following2:

  • Sudden swelling in affected limb
  • Limb pain/tenderness
  • Pain on dorsiflexion of the foot
  • Dilated superficial collateral veins
  • Cyanosis or pallor
  • Warm skin over area of thrombosis
  • Lack of distal pulses

DVT has many precipitating causes2, including:

  • Injury/trauma
  • Prolonged inactivity
  • Anticoagulation disorder
  • Surgery
  • Cancer
  • Contraceptives/ estrogen therapy
  • Severe infection

Importance of early diagnosis

Early detection provides physicians with a wider range of treatment options for their patients, including thrombus removal, which can only occur within up to <28 days of symptoms onset.3

Image shows a timeline for acute, subacute and chronic DVT, from 0-2 weeks to a year.
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Early diagnosis can help reduce DVT recurrence and post-thrombotic syndrome 

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Treatment window = two weeks4

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Patients with iliofemoral DVT (IFDVT) have a twofold increased risk of developing PTS5

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Venous stenting in conjunction with thrombus removal is safe and effective and has low incidence of PTS6

Diagnostic protocol for suspected DVT

This diagnostic protocol for suspected DVT was developed by the NICE (National Institute for Health and Care Excellence).

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References:

  • Chunilal SD, et al., “Does this patient have pulmonary embolism?” JAMA. 2003 Dec 3;290(21):2849-58.
  • Schreiber, D. Deep venous thrombosis and thrombophlebitis. October 2005.
  • Vedantham S, et al. Society of Interventional Radiology. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014 Sep;25(9):1317-25.
  • Foegh P, Jensen LP. Factors associated with long-term outcome in 191 patients with ilio-femoral DVT treated with catheter-directed thrombolysis. Eur J Vasc  Endovasc Surg. 2017;53(3):419-424.
  • Engelberger RP, Fahrni J, Willenberg T, et al. Fixed low-dose ultrasound-assisted catheter-directed thrombolysis followed by routine stenting of residual stenosis for acute ilio-femoral deep-vein thrombosis. Thromb Haemost. 2014;111(6):1153-60.
  • Ten Cate-Hoek AJ, Henke PK. The post thrombotic syndrome: Ignore it and it will come back to bite you. Blood Rev. 2016;30(2):131-7.
  • Diagnostic protocol: NICE National Institute for Health and Care Excellence. NICE Pathways. https://www.nice.org.uk/guidance/ng158/chapter/Recommendations Accessed August 29, 2024.

 

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