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Diagnosis of deep vein thrombosis recurrence: Ultrasound criteria

  • Mario Maufus
    Affiliations
    Department of Vascular Medicine, Grenoble-Alps University Hospital, CS 1027, 38043 Grenoble Cedex, France
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  • Antoine Elias
    Affiliations
    Department of Vascular Medicine, Sainte Musse Hospital, CS 31412, 83056 Toulon Cedex, France

    InnoVTE: French Investigation Network on Venous Thromboembolique Disease, France
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  • Marie-Thérèse Barrellier
    Affiliations
    Department of Vascular Medicine, Caen University Hospital, CS 30001, 14033 Caen Cedex 9, France
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  • Gilles Pernod
    Correspondence
    Corresponding author at: Department of Vascular Medicine, Grenoble-Alps University Hospital, CS 1027, 38043 Grenoble Cedex, France.
    Affiliations
    Department of Vascular Medicine, Grenoble-Alps University Hospital, CS 1027, 38043 Grenoble Cedex, France

    InnoVTE: French Investigation Network on Venous Thromboembolique Disease, France

    Grenoble-Alps University, Centre National de Recherche Scientifique (CNRS)/Techniques de l'Ingénieurie Médicale et de la Complexité (TIMC), Informatique, Mathématiques et Applications (IMAG) Unité Mixte de Recherche (UMR), 5525/Themas, Grenoble, France
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  • on behalf of the French Society for Vascular Medicine
Published:November 14, 2017DOI:https://doi.org/10.1016/j.thromres.2017.11.004

      Highlights

      • Lower limb deep venous thrombosis (DVT) recurrence represents a diagnostic challenge.
      • Ultrasound is the first choice examination when DVT is suspected.
      • This review highlights the validated criteria for DVT recurrence.
      • An increase in vein diameter between 2 and 4 mm requires further examination.
      • New diagnostic imaging techniques are currently under evaluation.

      Abstract

      Introduction

      Recurrent deep vein thrombosis (DVT) is often suspected in patients after anticoagulant drug withdrawal. The clinical signs can be confused with the onset of post-thrombotic syndrome. For these reasons, diagnosis of DVT recurrence must rely on an accurate method.

      Materials and methods

      In order to assess this challenging clinical issue, we performed an overview of the literature regarding ultrasound criteria for the diagnosis of recurrent DVT through a Medline search, which included articles published from January 1, 1980 to February 20, 2017.

      Results

      Eighty-eight publications were found based on the defined keywords, of which nine articles with a relevant abstract were selected. By searching the reference lists of these nine articles, we obtained another 27 relevant articles. A new non-compressible vein or an increase in the diameter of a previously thrombosed vein segment by >4 mm are sufficient to confirm the diagnosis of DVT recurrence. In contrast, an increase in diameter of <2 mm enables recurrence to be ruled out. An increase between 2 and 4 mm is deemed equivocal. Criteria based on echogenicity and Doppler venous blood flow are not reproducible. Other diagnostic imaging methods, mainly direct thrombus magnetic resonance imaging, are currently under evaluation.

      Conclusions

      Ultrasound remains the most useful test for the diagnosis of recurrent DVT. Further imaging tests need to be validated.

      Keywords

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