Deep Venous Thrombosis (Leg)
Pathway Home
Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with suspected lower limb deep venous thrombosis.
Date reviewed: September 2017
Date of next review: April 2023
Published: December 2017
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Leg Deep Vein Thrombosis Image 1a and 1b (Doppler Ultrasound): Acute thrombosis is indicated by the distended and hypoechoic lumen of the common femoral and external iliac veins with no flow. |
| 1b |  |
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Teaching Points
Teaching Points
- Clinical prediction rules (e.g. Wells Criteria) may be used to categorise patients into low, medium or high risk
- Low risk and negative serum D-Dimer effectively excludes DVT
- Medium and high risk patients should undergo Doppler ultrasound without D-Dimer estimation
- Ultrasound is highly sensitive for proximal lower limb deep vein thrombosis
- US is less sensitive for deep calf vein thrombosis and for iliac vein thrombosis
- After a negative Doppler ultrasound, follow-up US in patients with high clinical suspicion may be indicated to exclude a calf thrombosis that is propagating proximally
References
References
Date of literature search: September 2017
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345(8961):1326-30. (Level II evidence). View the reference
- Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227-35. (Level II evidence). View the reference
- Perrier A, Desmarais S, Miron MJ, de Moerloose P, Lepage R, Slosman D, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353(9148):190-5. (Level II evidence). View the reference
- Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-8. (Level II evidence). View the reference
- Min SK, Kim YH, Joh JH, Kang JM, Park UJ, Kim HK, et al. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines Vasc Specialist Int. 2016;32(3):77-104. (Guidelines). View the reference
- Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005;5:6. (Level II evidence). View the reference
- Kitchen L, Lawrence M, Speicher M, Frumkin K. Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm. West J Emerg Med. 2016;17(4):384-90. (Review article). View the reference
- Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med. 1998;128(8):663-77. (Review article). View the reference
- Tapson VF, Carroll BA, Davidson BL, Elliott CG, Fedullo PF, Hales CA, et al. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med. 1999;160(3):1043-66. (Guidelines). View the reference
- Keeling DM, Mackie IJ, Moody A, Watson HG. The diagnosis of deep vein thrombosis in symptomatic outpatients and the potential for clinical assessment and D-dimer assays to reduce the need for diagnostic imaging. Br J Haematol. 2004;124(1):15-25. (Review article). View the reference
- Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review Ann Intern Med. 2004;140(8):589-602. (Level I evidence). View the reference
- Sule AA, Chin TJ, Handa P, Earnest A. Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation? The International Journal of Angiology : Official Publication of the International College of Angiology, Inc. 2009;18(2):83-7. (Level IV evidence). View the reference
- Goodacre S, Sampson FC, Sutton AJ, Mason S, Morris F. Variation in the diagnostic performance of D-dimer for suspected deep vein thrombosis. Qjm. 2005;98(7):513-27. (Review article). View the reference
- Freyburger G, Trillaud H, Labrouche S, Gauthier P, Javorschi S, Bernard P, et al. D-dimer strategy in thrombosis exclusion--a gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism: 8 DD methods compared. Thromb Haemost. 1998;79(1):32-7. (Level II evidence). View the reference
- Owaidah T, AlGhasham N, AlGhamdi S, AlKhafaji D, B AL, Zeitouni M, et al. Evaluation of the usefulness of a D dimer test in combination with clinical pretest probability score in the prediction and exclusion of Venous Thromboembolism by medical residents. Thromb J. 2014;12(1):28. (Level III evidence). View the reference
- Ho WK, Hankey GJ, Lee CH, Eikelboom JW. Venous thromboembolism: diagnosis and management of deep venous thrombosis. Med J Aust. 2005;182(9):476-81. (Review article). View the reference
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