[Acute venous disorders: deep vein thrombosis and superficial vein thrombosis of the lower extremity : Diagnosis and treatment in dermatology practice].

backgroundDeep vein thrombosis (DVT) is associated with potentially serious complications such as pulmonary embolism (PE) and postthrombotic syndrome. Superficial vein thrombosis (SVT) is also clinically relevant, as concomitant DVT and/or PE may already be present at initial diagnosis or may develop during follow-up.

objectiveWhich diagnostic and therapeutic steps are most relevant for dermatologists in clinical practice?

methodsOverview of the German S2k guideline and selected literature, supplemented by two case vignettes.

resultsDVT diagnostics are guided by clinical pretest probability (Wells score). In patients with low probability, a negative D‑dimer test can rule out DVT. In patients with high probability or a positive D‑dimer test, duplex compression ultrasonography is indicated. In confirmed DVT, prompt therapeutic anticoagulation is required, preferably with direct oral anticoagulants, usually for ≥ 3 months depending on provocation status and risk of recurrence. In SVT, thrombus length and proximity to the deep venous junction determine management. SVT ≥ 5 cm, marked symptoms, or relevant risk factors warrant 45 days of anticoagulation (e.g., fondaparinux 2.5 mg s.c. once daily). SVT < 3 cm from the junction or with progression into the deep venous system requires therapeutic-dose anticoagulation analogous to DVT. Short-segment distal SVT can often be managed symptomatically.

conclusionStructured risk stratification, focused diagnostic work-up, and guideline-concordant therapy are essential to prevent thromboembolic complications.