Thursday, March 23, 2017

Isolated distal DVT

An online community of practice for Canadian EM physicians
CanadiEM - By David Wonnacott - March 21, 2017
"Clinical Question:
Should we be doing whole-leg ultrasounds to look for isolated distal DVTs (IDDVT), and if we find them, how should we manage them?
Isolated distal DVTs are a controversial clinical entity. The distinction between proximal and distal DVTs is usually made at the level of the trifurcation of the popliteal vein, located at or just below the popliteal fossa.1 While there’s a robust literature and consensus around diagnosing and treating proximal DVTs to reduce the risk of pulmonary embolism, recurrence, and clot extension, the evidence around IDDVT is much murkier. Major guidelines differ significantly in management suggestions, and the objective of this article is to discuss some of the controversies and approaches to IDDVT management. The most commonly used guideline for VTE diagnosis and management in North America is the American Academy of Chest Physicians antithrombotic guidelines, which most recently published recommendations about IDDVT in 2012 and 2016.23 On the other side of the Atlantic, the UK National Institute for Health and Clinical Excellence (NICE) guidelines of 2012 and 2015 are more commonly used.45 Let’s consider how each of these guidelines would inform our management of this case regarding a possible diagnosis of isolated distal DVT."