Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
Minneapolis Heart Institute Foundation, Minneapolis, Minn.
J Vasc Surg Venous Lymphat Disord. 2021 Jul;9(4):1062-1070.e6. doi: 10.1016/j.jvsv.2021.01.018. Epub 2021 Feb 9.
Although distal deep vein thrombosis (DDVT) has been more frequently diagnosed with the availability of better ultrasound imaging quality, the data on the best method to manage DDVT have been conflicting. The aim of the present review was to summarize the current and evidence-based recommendations for the diagnosis and management of DDVT and to provide a summary of the most recent societal guideline recommendations.
A literature review of DDVT was performed. The PubMed databases were queried for articles on the epidemiology, risk factors, diagnosis, and management of DDVT.
The prevalence of isolated DDVT has been reported in a broad range. The reported risk factors include older age, active malignancy, a low degree of mobility, acute infection, and atrial fibrillation. With more evidence, anticoagulation therapy was found to be associated with a reduced risk of recurrent venous thromboembolism (VTE) and/or thrombus propagation compared with conservative management. However, anticoagulation was associated with an increased risk of bleeding in a number of studies. The rate of VTE recurrence ranged from 7% to 23% during a follow-up period ranging from 3 months to 8 years. The significant risk factors for VTE recurrence included cancer, older age, an unprovoked event, and inpatient status.
Few studies have addressed the diagnosis and management of DDVT. Further research is needed to standardize the best approach to diagnose and treat DDVT.
尽管随着超声成像质量的提高,远端深静脉血栓(DDVT)的诊断更为常见,但有关 DDVT 最佳治疗方法的数据却存在争议。本综述旨在总结 DDVT 的诊断和管理的最新循证推荐,并概述最新的社会指南建议。
对 DDVT 的文献进行了回顾。在 PubMed 数据库中检索了关于 DDVT 的流行病学、危险因素、诊断和治疗的文章。
孤立性 DDVT 的患病率报告范围较广。报告的危险因素包括年龄较大、活动性恶性肿瘤、活动度低、急性感染和心房颤动。随着更多证据的出现,抗凝治疗与复发性静脉血栓栓塞症(VTE)和/或血栓延伸的风险降低相关,而与保守治疗相比。然而,在一些研究中,抗凝治疗与出血风险增加相关。在 3 个月至 8 年的随访期间,VTE 复发率为 7%至 23%。VTE 复发的显著危险因素包括癌症、年龄较大、无诱因事件和住院状态。
很少有研究涉及 DDVT 的诊断和管理。需要进一步的研究来标准化诊断和治疗 DDVT 的最佳方法。