Diagnosis, investigation, and management of deep vein thrombosis

Introduction

Venous thromboembolic disease has an estimated annual incidence in developed countries of one in 1000 people.1 The disorder commonly manifests as deep vein thrombosis of the leg, but deep venous thrombosis may also occur in other veins (cerebral sinus, arms, retina, and mesentery).

The sequelae of deep vein thrombosis vary from complete resolution of the clot without any ill effects through to death due to pulmonary embolism. Morbidity due to deep vein thrombosis includes post-thrombotic syndrome, encompassing chronic venous hypertension causing limb pain, swelling, hyperpigmentation, dermatitis, ulcers, venous gangrene, and lipodermatosclerosis.

Pain or swelling of a lower limb is a common presenting complaint, and a wide differential diagnosis exists (box 1). No single investigation for the diagnosis of deep vein thrombosis has ideal properties (100% sensitivity and specificity, low cost, no risk), and often several tests are performed, either sequentially or in combination.

With the introduction of low molecular weight heparins it is now possible to treat deep vein thrombosis as an outpatient condition. This review describes the investigations used in the diagnosis of deep vein thrombosis of the lower limb and the further management of the condition. …