ACR appropriateness Criteria® on suspected lower extremity deep vein thrombosis

Vincent B. Ho, Peter H. Van Geertruyden, E. Kent Yucel, Frank J. Rybicki, Richard A. Baum, Benoit Desjardins, Scott D. Flamm, W. Dennis Foley, Michael R. Jaff, Scott A. Koss, Leena Mammen, M. Ashraf Mansour, Emile R. Mohler, Vamsidhar R. Narra, Matthew P. Schenker

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations

Abstract

Lower extremity deep vein thrombosis (DVT) is a common clinical concern, with an incidence that increases with advanced age. DVT typically begins below the knee but may extend proximally and result in pulmonary embolism. Pulmonary embolism can occur in 50% to 60% of patients with untreated DVT and can be fatal. Although clinical examination and plasma d-dimer blood evaluation can often predict the presence of DVT, imaging remains critical for the diagnostic confirmation and treatment planning of DVT. Patients with above-the-knee or proximal DVT have a high risk for pulmonary embolism and are recommended to receive anticoagulation therapy. On the other hand, patients with below-the-knee or distal DVT rarely experience pulmonary embolism, and anticoagulation therapy in these patients remains controversial. However, one sixth of patients with distal DVT may experience extension of their thrombus above the knee and therefore are recommended to undergo serial imaging assessment at 1 week to exclude proximal DVT extension if anticoagulation therapy is not initiated. Ultrasound is the preferred imaging method for evaluation of patients with newly suspected lower extremity DVT. Magnetic resonance and CT venography can be especially helpful for the evaluation of suspected DVT in the pelvis and thigh. Contrast x-ray venography, the historic gold standard for DVT assessment, is now less commonly performed and primarily reserved for patients with more complex presentations such as those with suspected recurrent acute DVT.

Original languageEnglish
Pages (from-to)383-387
Number of pages5
JournalJournal of the American College of Radiology
Volume8
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • Appropriateness Criteria®
  • computed tomography
  • magnetic resonance imaging
  • phlebography
  • ultrasonography
  • vein thrombosis

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