Duplex Ultrasound, Clinical Score, and D-Dimer to Rule in and Out Deep Venous Thrombosis (DVT) and Postthrombotic Syndrome (PTS): Bridging the Gap between DVT and PTS in the Primary Care and Hospital Setting

First episodes of DVT in adults and elderly are elicited in two-thirds of cases by risk factors, including varicose veins, cancer, pregnancy/postpartum, oral contraceptives below the age of 50 years, immobility or surgery. Pain and tenderness in the calf and popliteal fossa may occur resulting from conditions labeled as alternative diagnosis (AD) including Baker’s cyst, hematoma, or muscle tears or pulls. The requirement for a safe diagnostic strategy of deep vein thrombosis (DVT) should be based on an objective post-test incidence of venous thromboembolism (VTE) of less than 0.1% with a negative predictive value for exclusion of DVT of 99.90% during 3 months follow-up. Complete duplex ultrasonography (CDUS) does pick up AD not only Bakers cyste but also muscle hematomas, old DVT, and superficial vein thrombosis (SVT). AD with a negative CDUS include leg edema, varices erysipelas are picked up by physical examination. The sequential use of DUS, a sensitive D-dimer test and objective clinical score assessment is a safe costeffective non-invasive strategy to rule in and out DVT and AD in patients with suspected DVT.