Vol.:(0123456789) 1 3 Journal of Thrombosis and Thrombolysis https://doi.org/10.1007/s11239-018-1708-0 Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer F. Dentali 1  · S. Barco 2  · S. Pegoraro 1  · M. N. D. Di Minno 3  · D. Mastroiacovo 4  · F. Pomero 5  · C. Lodigiani 6  · F. Bagna 1  · M. Sartori 7  · G. Barillari 8  · N. Mumoli 9  · M. Napolitano 10  · S. M. Passamonti 11  · R. Benedetti 12  · W. Ageno 1  · M. Di Nisio 13 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the frst months of antico- agulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30 Kg/m 2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events. Keywords Distal deep vein thrombosis · Residual vein obstruction · Compression ultrasound · Venous thromboembolism · Recurrence * F. Dentali fdentali@libero.it 1 Department of Clinical and Experimental Medicine, Insubria University, Viale Borri 57, 21100 Varese, Italy 2 Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany 3 Unit of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy 4 Angiology Unit, Avezzano Hospital, Avezzano, AQ, Italy 5 Department of Internal Medicine, S. Croce e Carle General Hospital, Cuneo, Italy 6 Thrombosis Center, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy 7 Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy 8 Center for Haemorrhagic and Thrombotic Disorders, Udine General and University Hospital, Udine, Italy 9 Department of Internal Medicine, Ospedale Giuseppe Fornaroli, Magenta, Italy 10 Haemophilia and Thrombosis Center, Haematology Department, University of Palermo, Palermo, Italy 11 A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy 12 Haemostasis and Thrombosis Center, Department of Internal Medicine, Hospital of Piacenza, Piacenza, Italy 13 Department of Medicine and Ageing Sciences, University “G. D’Annunzio” of Chieti-Pescara, Chieti, Italy