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Updated: Mar 27, 2026
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Analysis of 1,338 Patients with Acute Lower Limb Deep Venous Thrombosis (DVT) Supports the Inadequacy of the Term
M G R De Maeseneer1, N Bochanen2, G van Rooijen1
1Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
The term "proximal deep venous thrombosis" (DVT) is imprecise. This study advocates for replacing it with "iliofemoral" or "femoropopliteal" DVT to better guide treatment, especially for iliofemoral cases.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Thrombosis Research
Background:
- Deep venous thrombosis (DVT) is traditionally classified as distal or proximal.
- The term "proximal DVT" encompasses a wide range of thrombus locations and extents.
- Accurate anatomical characterization is crucial for effective DVT management.
Purpose of the Study:
- To analyze the anatomical site and extent of thrombus in a large cohort of acute deep venous thrombosis patients.
- To evaluate the utility of current DVT classification and propose refined terminology.
Main Methods:
- Retrospective analysis of 1,338 adult patients with unilateral DVT diagnosed via duplex ultrasound (1994-2012).
- DVT thrombus distribution was categorized into five segments: calf veins, popliteal vein, femoral vein, common femoral vein, and iliac veins/inferior vena cava.
- Analysis of thrombus extent within these defined segments.
Main Results:
- Out of 1,338 patients, 370 (28%) had DVT isolated to calf veins.
- In patients previously termed "proximal DVT" (n=968), thrombus involved a median of three segments.
- Iliofemoral DVT (segments 4/5) was present in 38% of the total cohort; 12% had iliofemoral DVT without calf vein involvement.
Conclusions:
- The current "proximal DVT" classification is anatomically diverse and should be abandoned.
- Proposed terms "iliofemoral DVT" and "femoropopliteal DVT" offer more precise anatomical description.
- Iliofemoral DVT, identified in 38% of patients, may be suitable for early clot removal interventions.
Objective/Background:
For decades acute lower limb deep venous thrombosis (DVT) has been subdivided into distal DVT (isolated to the calf veins) and proximal DVT (extending above calf vein level). The aim of this study was to analyse the anatomical site and extent of thrombus in a large cohort of patients with acute DVT.
Methods:
A retrospective analysis of all patients aged >18 years, presenting with unilateral DVT according to duplex ultrasound investigation was performed at the University Hospital of Antwerp, Belgium (1994-2012). The anatomical site and extent of thrombus was registered and subdivided into five segments: calf veins (segment 1), popliteal vein (segment 2), femoral vein (segment 3), common femoral vein (segment 4), and iliac veins, with or without inferior vena cava (segment 5).
Results:
The median age of the 1,338 patients (50% male) included was 62 years (range 18-98 years). Left sided DVT was predominant (57%). DVT was limited to one segment in 443 patients, of whom 370 had DVT isolated to the calf veins (28% of total cohort). In 968 patients with what was previously called "proximal DVT", the median number of affected segments was three (range 1-5 segments). In this group iliofemoral DVT (at least involving segment four and/or five) was present in 506 patients (38% of total cohort), whereas the remaining patients had femoropopliteal DVT (at least in segment two and/or three but not in four or five). Iliofemoral DVT without thrombus in segments one and two was present in 160 patients (12% of total cohort).
Conclusion:
This study illustrates the large diversity of thrombus distribution in patients previously described as having "proximal DVT". Therefore, this term should be abandoned and replaced with iliofemoral and femoropopliteal DVT. Patients with iliofemoral DVT (38%) could be considered for early clot removal; 12% of all patients with DVT would be ideal candidates for such intervention.
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