Korean J Fam Pract.  2023 Jun;13(2):96-104. 10.21215/kjfp.2023.13.2.96.

Clinical Course of Advanced Cancer Patients with Lower-Extremity Edema and Elevated D-dimer Levels who Underwent Computed Tomography Venography

• Kim H
• Choi YS
• Kim SH
• Lee YJ
• Hwang SY

• KMID: 2543191
• DOI: http://doi.org/10.21215/kjfp.2023.13.2.96

Abstract

Background
Computed tomography (CT) venography is useful in determining the causes of lower-extremity edema in patients with cancer as it provides extensive anatomical information about reversible causes of edema, such as deep vein thrombosis (DVT) and extrinsic venous compression (EVC). D-dimer levels are routinely used to diagnose DVT in patients with cancer who have lower-extremity edema, although they are often elevated in patients with advanced cancer due to various causes, making it less clinically efficient. This study evaluated the clinical course of patients with advanced cancer with lower-extremity edema and elevated levels of D-dimer who underwent CT venography.
Methods
We retrospectively reviewed the medical records of 77 patients with advanced cancer who underwent CT venography due to lowerextremity edema and elevated D-dimer levels. We also examined the CT venography findings validated by radiologists and the patients’ clinical course.
Results
CT venography revealed that 33 patients (42.9%) had DVT, while 22 (28.6%) had EVC and soft-tissue edema. The DVT group had the highest mean D-dimer titer, although there was no significant difference among the groups. Anticoagulants were administered to 60.6% (n=20) of the patients with DVT, while 22.7% (n=5) of the patients with EVC underwent stent insertion.
Conclusion
EVC was diagnosed using CT venography in 28.6% of the patients with advanced cancer, lower-extremity edema, and elevated D-dimer levels. Our data suggest that diagnosing reversible causes of lower-extremity edema might improve patients’ quality of life through appropriate interventional treatment, even in a hospice or palliative care setting.

Keyword

Advanced Cancer; Lower Extremity Edema; Computed Tomography Venography; Extrinsic Vein Compression; Deep Vein Thrombosis