Diagnosis Suspected Recurrent LE DVT Figure 5. Suspected Recurrent LE DVT Suspected Recurrent LE DVT
Highly sensitive D-dimer
– No DVT (if not done initially)
High/Mod sensitive D-dimer
+ Treat * See Figure 7.
ÎInitial evaluation with proximal CUS or a highly sensitive D-dimer is preferred over venography, CT venography, or MRI (all 1-B).
Initial D-dimer testing with a high-sensitivity assay is preferable if prior US is not available for comparison.
ÎIf the highly sensitive D-dimer is positive, proceed to proximal CUS rather than venography, CT venography, or MRI (1-B for all comparisons).
ÎIf the initial proximal CUS is negative (normal or residual diameter increase of < 2 mm), use at least one further proximal CUS (day 7 ± 1) or, if not used initially, test with a moderately or highly sensitive D-dimer (followed by repeat CUS [day 7 ± 1] if positive) rather than avoiding further testing or venography (2-B).
▶ In patients with an abnormal proximal CUS at presentation that does not meet the criteria for the diagnosis of recurrence, an additional proximal CUS on day 2 ± 1 in addition to that on (day 7 ± 1) may be preferred.
▶ Patients who place a high value on an accurate diagnosis and a low value on avoiding the inconvenience and potential side effects of a venography are likely to choose venography over missed diagnosis (in the case of residual diameter increase of < 2 mm).
8 – No DVT OR
Repeat proximal CUS (day 6-8)
Treat + OR Proximal CUS – + Nondiagnostic*
