Tang Yuanyuan, Luo Zan, Ye Xiangming
The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Sci Prog. 2025 Jul-Sep;108(3):368504251364934. doi: 10.1177/00368504251364934. Epub 2025 Sep 16.
Isolated distal deep vein thrombosis (IDDVT), a subtype of lower extremity deep vein thrombosis (DVT), is a common yet preventable complication in clinical practice. Based on thrombus location, IDDVT can be categorized into axial venous thrombosis (involving the anterior tibial, posterior tibial, and peroneal veins) and intermuscular venous thrombosis (affecting the venous plexus of the gastrocnemius and soleus muscles). IDDVT is recognized as a potential source of embolic events and is associated with poor prognosis. Current evidence indicates that the Wells score is not applicable for IDDVT diagnosis, which primarily relies on D-dimer testing and lower extremity venous ultrasonography. There remains a lack of standardized treatment protocols for IDDVT. The American College of Chest Physicians (ACCP) guidelines recommend a 3-month anticoagulation regimen for patients with significant symptoms or high risk of thrombus extension, prioritizing direct oral anticoagulants; however, the supporting evidence is of low quality. Significant anatomical and physiological differences exist between axial and intermuscular venous thrombosis. Axial venous thrombosis demonstrates higher rates of thrombus extension, recurrence, and pulmonary embolism compared to intermuscular venous thrombosis. Nevertheless, whether anticoagulation therapy is warranted for both types remains controversial. This narrative review systematically elucidates the epidemiological characteristics, risk factors, clinical manifestations, and clinical management of IDDVT. It focuses on the diagnosis and management of IDDVT based on current guideline recommendations and the latest evidence, with the aim of providing a reference for clinical practitioners.
孤立性远端深静脉血栓形成（IDDVT）是下肢深静脉血栓形成（DVT）的一种亚型，是临床实践中常见但可预防的并发症。根据血栓位置，IDDVT可分为轴性静脉血栓形成（累及胫前静脉、胫后静脉和腓静脉）和肌间静脉血栓形成（影响腓肠肌和比目鱼肌的静脉丛）。IDDVT被认为是栓子事件的潜在来源，且与预后不良相关。目前的证据表明，Wells评分不适用于IDDVT的诊断，其诊断主要依靠D-二聚体检测和下肢静脉超声检查。对于IDDVT，目前仍缺乏标准化的治疗方案。美国胸科医师学会（ACCP）指南建议，对于有明显症状或血栓扩展高风险的患者，采用3个月的抗凝方案，优先选择直接口服抗凝剂；然而，支持证据的质量较低。轴性静脉血栓形成和肌间静脉血栓形成在解剖学和生理学上存在显著差异。与肌间静脉血栓形成相比，轴性静脉血栓形成的血栓扩展、复发和肺栓塞发生率更高。尽管如此，两种类型是否都需要抗凝治疗仍存在争议。本叙述性综述系统阐述了IDDVT的流行病学特征、危险因素、临床表现和临床管理。它基于当前的指南建议和最新证据，重点关注IDDVT的诊断和管理，旨在为临床医生提供参考。
