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Kim, Min, Kang, Kim, Bae, Choi, Park, Chang, Park, Kim, Park, Kim, Yim, Jeon, Joh, Park, and Yoon: Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines
Interventional Radiology
Review Article

Journal of the Korean Society of Radiology 2016; 75(4): 233-262.

Published online: 29 September 2016

DOI: https://doi.org/10.3348/jksr.2016.75.4.233

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Young Hwan Kim, MD1, Seung-Kee Min, MD2, Jin Mo Kang, MD3, Hyung-Kee Kim, MD4, Jae Ik Bae, MD5, Sun Young Choi, MD6, Sang Jun Park, MD7, Jeong-Hwan Chang, MD8, Ui Jun Park, MD9, Chang Won Kim, MD10, Sung Il Park, MD11, Jang Yong Kim, MD12, Nam Yeol Yim, MD13, Yong Sun Jeon, MD14, Jin Hyun Joh, MD15, Ki Hyuk Park, MD16, Hyun-Ki Yoon, MD17

1Department of Radiology, Keimyung University College of Medicine, Daegu, Korea.

2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

3Department of Surgery, Gachon University College of Medicine, Incheon, Korea.

4Department of Surgery, Kyungpook National University College of Medicine, Daegu, Korea.

5Mint Radiologic Clinic, Seongnam, Korea.

6Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea.

7Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea.

8Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.

9Department of Surgery, Keimyung University College of Medicine, Daegu, Korea.

10Department of Radiology, Pusan National University College of Medicine, Busan, Korea.

11Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

12Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

13Department of Radiology, Chonnam National University College of Medicine, Gwangju, Korea.

14Department of Radiology, Inha University College of Medicine, Incheon, Korea.

15Department of Surgery, Kyunghee University College of Medicine, Seoul, Korea.

16Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea.

17Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Young Hwan Kim, MD. Department of Radiology, Keimyung University College of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel. 82-53-250-7770, Fax. 82-53-250-7766, yhkim68@dsmc.or.kr

Received 24 May 2016       Revised 21 June 2016       Accepted 27 June 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lower extremity deep vein thrombosis is a serious medical condition that results in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Proper diagnosis and treatment are warranted to improve symptoms and limb salvage. Early thrombus clearance rapidly resolves symptoms related to venous obstruction and can restore valve function; hence, it reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views about the indications and procedure methods among medical institutions and operators. Therefore, we intend to provide evidence based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goal of these guidelines is to ensure better diagnosis and treatment, to serve as a guide to the clinician, and consequently, to contribute to public health care.

Keywords: Guideline, Deep Vein Thrombosis, Diagnosis and Treatment

Figures and Tables

Table 1

Classification of Recommendations

jksr-75-233-i001
Class Description
I Conditions for which there is evidence for and/or general agreement that a given procedure or treatment is beneficial, useful, and effective
II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
IIa Weight of evidence/opinion is in favor of usefulness/efficacy
IIb Usefulness/efficacy is less well established by evidence/opinion
III Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and is some cases may be harmful
Table 2

Levels of Evidence

jksr-75-233-i002
Level Description
A Data derived from multiple randomized clinical trials or meta-analysis
B Data derived from a single randomized clinical trial or nonrandomized studies
C Only consensus opinion of experts, case studies, or standard of care
Table 3

Wells Score Criteria for Assessment of Suspected DVT

jksr-75-233-i003
Criteria Score (Points)
1. Active cancer (treatment ongoing or within the last 6 months or palliative) 1
2. Calf swelling > 3 cm compared to the other calf (measured 10 cm below the tibial tuberosity) 1
3. Collateral superficial veins (non-varicose) 1
4. Pitting edema (greater in the symptomatic leg) 1
5. Swelling of the entire leg 1
6. Localized tenderness along the distribution of the deep venous system 1
7. Paralysis, paresis, or recent plaster castimmobilization of the lower extremities 1
8. Recently bedridden > 3 days, or major surgery in the previous 4 weeks 1
9. Alternative diagnosis at least as likely as DVT -2
Interpretation: for evaluation (low vs. moderate vs. high)
Score of 0 or less Low probability of deep vein thrombosis
Score of 1 or 2 Moderate probability of deep vein thrombosis
Score of 3 or higher High probability of deep vein thrombosis

DVT = deep vein thrombosis

Table 4

Revised Wells Score Criteria for Assessment of Suspected DVT

jksr-75-233-i004
Criteria Score (Points)
1. Active cancer (treatment ongoing or within the last 6 months or palliative) 1
2. Calf swelling > 3 cm compared to asymptomatic calf (measured 10 cm below the tibial tuberosity) 1
3. Collateral superficial veins (non-varicose) 1
4. Pitting edema (greater in the symptomatic leg) 1
5. Swelling of the entire leg 1
6. Localized tenderness along the distribution of the deep venous system 1
7. Paralysis, paresis, or recent plaster cast immobilization of the lower extremities 1
8. Recently bedridden for ≥ 3 days, or major surgery requiring a regional or general anesthetic in the previous 12 weeks 1
9. Previously documented deep vein thrombosis 1
10. Alternative diagnosis at least as likely as DVT -2
Interpretation: for dichotomized evaluation (likely vs. unlikely)
Score of 2 or higher Deep vein thrombosis is ‘likely’
Score of less than 2 Deep vein thrombosis is ‘unlikely’

DVT = deep vein thrombosis

Notes

This Guideline has been published jointly by invitation and consent in both the Vascular Specialist International and the Journal of the Korean Society of Radiology.

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