ÎPatients with suspected recurrent LE DVT and a negative highly sensitive D-dimer or negative proximal CUS and negative moderately or highly sensitive D-dimer or negative serial proximal CUS should undergo no
further testing for suspected recurrent DVT rather than venography (1-B).
ÎIf CUS of the proximal veins is positive, treat for DVT and perform no further testing rather than performing confirmatory venography (1-B) for the finding of a new noncompressible segment in the common femoral or popliteal vein, (2-B for a ≥ 4-mm increase in venous diameter during compression compared with that in the same venous segment on a previous result).
Patients with US abnormalities at presentation that do not include a new noncompressible segment 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 treatment (in the case of ≥ 4-mm increase in venous diameter).
ÎIn patients with suspected recurrent LE DVT and abnormal but nondiagnostic US results (eg, an increase in residual venous diameter of < 4 but ≥ 2 mm), proceed to further testing with venography, if available (1-B); serial proximal CUS (2-B) or testing with a moderately or highly sensitive D-dimer with serial proximal CUS as above if the test is positive (2-B), as opposed to other testing strategies or treatment.
ÎIn patients with suspected recurrent ipsilateral DVT and an abnormal US without a prior result for comparison, test further with venography, if available (1-B) or a highly sensitive D-dimer (2-B) rather than serial proximal CUS.
ÎIn patients with suspected recurrent ipsilateral DVT and an abnormal US without prior result for comparison and a negative highly sensitive D-dimer, no further testing is preferred over venography (2-C).
ÎIn patients with suspected recurrent ipsilateral DVT and an abnormal US without prior result for comparison and a positive highly sensitive D-dimer, use venography if available rather than empirical treatment of recurrence (2-C).
Patients who place a high value on avoiding the inconvenience and potential side effects of a venography are likely to choose treatment over venography.
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