What is the diagnosis for a patient with bilateral lower extremity venous symptoms, including edema, with findings of non-visualized left peroneal vein, spontaneous phasic flow, and no evidence of deep vein thrombosis (DVT) or superficial thrombus?

From the Guidelines

The patient's venous ultrasound results indicate no evidence of deep vein thrombosis (DVT) or superficial thrombosis, and therefore, no specific treatment for DVT is needed. The study demonstrates normal blood flow patterns and compressible veins without any blood clots, which is consistent with the findings of a study published in the American Family Physician in 2019 1. The left peroneal vein was not visualized during the exam, but this is not necessarily concerning as the remaining venous structures appear normal. The absence of abnormal fluid collections further supports that there is no acute venous pathology. This study effectively rules out DVT as the cause of the patient's lower extremity edema, suggesting that other causes such as lymphedema, heart failure, kidney disease, or medication side effects should be considered. According to a study published in the American Family Physician in 2019, treatment options for varicose veins include conservative measures, lifestyle modifications, and interventional procedures 1. However, in this case, the patient's symptoms and ultrasound results do not indicate the need for varicose vein treatment. Instead, the underlying cause of the edema should still be investigated and addressed, and the patient's symptoms should be managed accordingly. It is essential to consider the patient's overall clinical presentation, medical history, and risk factors for venous disease, as outlined in the study published in the American Family Physician in 2019 1. The patient's symptoms, such as edema, should be evaluated in the context of their medical history and risk factors, and further testing or consultation with a specialist may be necessary to determine the underlying cause of their symptoms.

From the Research

Diagnosis and Findings

• The patient has a history of edema and presented with 4/15/25 VAS lower extremity venous bilateral symptoms.
• The left peroneal vein is not visualized, but spontaneous phasic flow with normal augmentation is noted, and no reflux is demonstrated.
• The veins are compressible without intraluminal thrombus, and no abnormal fluid collections are found.
• The impression is that there is no evidence for superficial thrombus or DVT in the lower extremities, as read by Dr. COX MD.

Treatment and Management

• The use of antiplatelet agents and anticoagulants in the treatment of arteriosclerosis is well established, based on many large randomized trials 2.
• Aspirin is indicated for primary prevention in patients at increased risk of developing symptomatic atherosclerotic vascular disease, and for patients with known vascular disease, antiplatelet therapy with aspirin is a well-established treatment 2, 3.
• However, the patient's condition is related to venous thromboembolism, and the evidence suggests that aspirin may have a beneficial effect on incidence and outcomes of VTE, with a significant 25% risk reduction of pulmonary embolism 4.

Future Directions

• Further studies are needed to determine the potential role of aspirin in the prevention of recurrent VTE, and to assess the efficacy of aspirin monotherapy for thromboprophylaxis in surgical patients 4.
• New opportunities have emerged for the development of bedside devices capable of bringing personalized medicine to patients being treated with antithrombotic drugs, to measure the pharmacodynamic activities of new therapies and to identify patients that fail to respond 5.