Thrombosis isolated distalI80.0

Isolated distal thrombosis affects the deep veins of the lower leg (Vv. tibial anterior, tibial posterior, fibular) as well as the muscle veins (Gatsrocnemicus veins, soleus veins). The so-called trifurcation or popliteal level is not reached during thrombosis.

Often clinically dumb, but often punctual pain in the lower leg, engraved when walking. Often no typical signs of thrombosis such as swelling, overheating or discoloration.

The diagnosis is usually made within the framework of a sonographic thrombosis exclusion.

The therapy is usually analogous to deep thrombosis of proximal sections. A full anticoagulation is performed. Usually for 3 months - even in the case of isolated distal recurrent thrombosis. There is no higher level of evidence of therapy.
It has not yet been sufficiently investigated whether certain patient groups with distal DVT benefit from a longer or shorter treatment duration or from a reduced anticoagulation dose. If a risk factor has been identified and persists (e.g. antiphospholipid syndrome, active tumor disease), prolonged anticoagulation beyond 3 months may be appropriate.
On the other hand, if there is an increased risk of bleeding or if the thrombus load is very low, a shorter treatment period should be considered, if necessary with a reduced anticoagulation dose and then under sonographic control.
Compression therapy can be adapted to the patient's symptoms right from the start.

Prognosis more favourable than in proximal deep vein thrombosis: fewer recurrences and less often a postthrombotic syndrome (PTS).

1. - Guideline venous thrombosis and pulmonary embolism: diagnosis and therapy http://www.awmf.org/uploads/tx_szleitlinien/065-002l_S2k_VTE_2016-01.pdf