Management of Isolated Calf Deep Vein Thrombosis: Is Treatment or Follow-Up Warranted

Abstract

Objectives: There is no consensus regarding the management of isolated calf deep vein thrombosis (DVT). The aim of this study is to determine the proper management of isolated soleal, gastrocnemius, peroneal, and posterior tibial vein thrombosis in an outpatient population. We further aim to identify the results of management of below the knee DVT (BKDVT) with serial ultrasound imaging during a 30-day period vs anticoagulation. Methods: A retrospective review was conducted for records from January 2009 to December 2010 to identify patients with BKDVT. Trauma and inpatients were excluded from the study. Univariate and multivariate analyses were conducted as well as descriptive statistics of the data. Results: The study included 225 outpatients with isolated BKDVT. The cohort consisted of 41% male, predominantly Caucasian (88%) patients, who were a mean age of 64 years. Thrombus was present most frequently in the soleal vein (40.3%), followed by the gastrocnemius (25%), peroneal (23.5%), and the posterior tibial vein (11.3%). Anticoagulation was used to treat 30.7% of initially diagnosed BKDVTs. No statistically significant difference was noted in the rate of proximal propagation (P .27), or pulmonary embolism (P .70) with or without anticoagulation. A decrease of new thrombus in additional calf veins was seen with anticoagulation, 1.4% vs 14.1% without anticoagulation (P .01). Conclusions: In an outpatient population, serial ultrasound imaging is adequate management for BKDVT. There is no significant reduction in the rate of pulmonary embolism or proximal propagation for patients managed with anticoagulation vs serial duplex ultrasound imaging for isolated calf DVT. Owing to the formation of new thrombus, serial ultrasound imaging is warranted in an outpatient population.