Management of isolated distal deep vein thrombosis. A persistent conundrum?

Isolated distal deep vein thrombosis (IDDVT) accounts for approximately 50% of all patients diagnosed with DVT. While the definitive management of patients with proximal deep vein thrombosis is fairly well defined, IDDVT remains shrouded uncertainty. The great majority of patients with IDDVT may remain with little or no symptoms and have spontaneous resolution of the thrombi. However, a small but significant fraction may show proximal thrombus extension and may proceed to cause pulmonary embolism or late deep venous reflux. Identification of this subgroup of patients with IDDVT who have a greater propensity for thrombus extension or further sequelae remains the cornerstone of individualized management for optimal results.