ÎEither proximal CUS or whole-leg US is preferred over no testing (1-B for all comparisons) or venography (1-B for all comparisons).
▶ Whole-leg US may be preferred to proximal CUS in patients unable to return for serial testing and those with severe symptoms consistent with calf DVT.
ÎIf proximal CUS or whole-leg US is positive for proximal DVT, treat rather than confirm with venography (1-B).
ÎIn patients with a negative proximal CUS, additional testing with a highly sensitive D-dimer or whole-leg US or repeat proximal CUS in 1 week is preferred over no further testing (1-B for all comparisons) or venography (2-B for all comparisons).
ÎPatients with a single negative proximal CUS and positive D-dimer should undergo whole-leg US or repeat proximal CUS in 1 week rather than no further testing (1-B) or venography (2-B).
ÎIn patients with negative serial proximal CUS, a negative single proximal CUS and negative highly sensitive D-dimer, or a negative whole-leg US, no further testing is preferred over venography or additional US (1-B for negative serial proximal CUS and for negative single proximal CUS and highly sensitive D-dimer; 2-B for negative whole-leg US).
ÎIn patients with high PTP, moderately or highly sensitive D-dimer assays should NOT be used as stand-alone tests to rule out DVT (1-B).
▶ In patients with extensive unexplained leg swelling, if there is no DVT on proximal CUS or whole-leg US and D-dimer testing has not been performed or is positive, the iliac veins should be imaged to exclude isolated iliac DVT.
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