Deep vein thrombosis: significant limitations of noninvasive tests.

Ramchandani, Parvati; Soulen, Renate L.; Fedullo, Lisa M.; Gaines, Victor D.

doi:10.1148/radiology.156.1.4001421

Cited by 43 publications

(5 citation statements)

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“…Phlebography remains superior to the non-invasive methods (2,6,12,24,25,27) and is the only method that enables direct visualization of the whole venous system. It causes limited discomfort and risk to the patient when using modern contrast media (3) and it forms the 'gold standard'.…”

Section: Discussionmentioning

confidence: 99%

Phlebographic Findings in Venous Thrombosis following Total Hip Replacement

Kälebo¹,

Anthmyr²,

Eriksson³

et al. 1990

Acta Radiol

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The specific appearance of venous thrombosis following total hip replacement was analysed by reviewing 45 positive phlebograms from 122 patients participating in a concurrent trial against thromboembolism. Almost all thrombi were asymptomatic and non-occlusive. Forty-four per cent of the thrombi were excusively confined to the calf. The muscular veins were the most common location, followed by the fibular and posterior tibial veins. Ipsilateral thrombi predominated over thrombi in the non-operated leg. Thirty-six per cent were located in the ipsilateral thigh and the major part was found in the proximal part of the femoral veins. Nearly all were related to valve cusps, free-floating and were of small size. In 20 per cent, thrombi were found in both the calf and the thigh. Neither contralateral thigh thrombi, nor pelvic thrombi were found. Of 25 patients with pulmonary embolism, all but 3 asymptomatic, 64 per cent had thigh thrombi. A multifocallocation of thrombi was present but two major types of thrombosis were distinguished; calf vein thrombosis probably due to venous stasis and femoral thrombosis caused by the local surgical trauma.

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Section: Discussionmentioning

confidence: 99%

Phlebographic Findings in Venous Thrombosis following Total Hip Replacement

Kälebo¹,

Anthmyr²,

Eriksson³

et al. 1990

Acta Radiol

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“…Gosselin 159 Mayer 157 Mayer 157 Kilroy 72 Brenner Lee 149 Gosselin 146 Bozic 71 Wells 128 Brenner 126 Janssen 123 Fiessinger 119 Jacq 117 Wildburger 112 Wells 110 Mauron 108 Lennox 70 Aschwanden 105 Wells 67 Carter 101 Farrell 99 van der Graaf 97 Permpikul 93 Anderson 92 Gosselin 90 Harper 88 Dryjski 64 Shields 61 ten Wolde 83 Pazzagli 209 Liapis 207 Elbaum 206 Richards 52 Nicholas Cooperman 36 Foti 204 Sandler 54 Vacarro 56 Wells 128 Dmochowski 203 Hull 202 Hull 201 Benedict 200 Flanigan 199 Toy 198 Peters 197 O'Donnell 196 Ramchandani 195 Jonker 194 Dauzat…”

Section: Acknowledgementsmentioning

confidence: 99%

Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis

Goodacre

Sampson²,

Stevenson³

et al. 2006

Health Technol Assess

147

119

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Diagnostic algorithms based on a combination of Wells score, D-dimer and ultrasound (with repeat if negative) are feasible at most UK hospitals and are among the most cost-effective. Use of repeat scanning depends on the threshold for willingness to pay for health gain. Further diagnostic testing for patients with a low Wells score and negative D-dimer is unlikely to represent a cost-effective use of resources. Recommendations for research include the evaluation of the costs and outcomes of using the optimal diagnostic algorithms in routine practice, the development and evaluation of algorithms appropriate for specific groups of patients with suspected DVT, such as intravenous drug abusers, pregnant patients and those with previous DVT, the evaluation of the role of plethysmography: interaction with other diagnostic tests, outcome of low-risk patients with negative plethysmography and measurement of the costs of providing plethysmography, and methodological research into the incorporation of meta-analytic data into decision-analytic modelling.

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“…tests (frequency of DVT: 9.3%) and the other plethysmography alone (frequency: 1.9%). Depending on the patient population, however, a significant proportion of proximal thrombi can also be missed [58], especially nonocclusive ones [59].…”

Section: Visualization Of Venous Blood Flow or Valve Motion 4 Visuali...mentioning

confidence: 99%

Diagnosis of deep vein thrombosis

Bergqvist

Bergentz

1990

World j. surg.

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A wide range of clinical symptoms and signs are observed with venous thrombosis. Nonetheless, clinical diagnosis has been found to be unreliable and accurate diagnostic methods must be used before potent therapy such as anticoagulation is instituted, since the complications of treatment themselves can be life-threatening. Phlebography is still the basic reference for evaluation of deep venous disease. While it is felt to be the most accurate, there are still limitations relative to difficulty in separating acute from chronic disease, and in obtaining adequate contrast in certain veins such as calf muscles and in the larger intraabdominal veins. Moreover, it is an uncomfortable invasive test, not without complications of its own. The 125I-fibrinogen uptake test is an excellent test for screening for forming thrombi. The sensitivity of this test is high, particularly in the detection of small calf vein thrombi. The primary drawbacks of this technique are that it is falsely positive in cases where there has been bleeding, inflammation, gross edema, arthritis, or leg ulceration. It is not accurate above mid-thigh because of the high blood flow at the level of the groin and pelvis. Radioactive labeled plasmin which will adhere to the surface of recently formed thrombi can also be used for diagnosis. The limitations are a very short half-life of the radioactive label so that repeated investigation of a patient cannot be performed unless new injections are given. The diagnostic accuracy is comparable to that of radioactive labeled fibrinogen and has the same advantages and disadvantages. Plethysmographic techniques have been used with various modifications.(ABSTRACT TRUNCATED AT 250 WORDS)

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Deep vein thrombosis: significant limitations of noninvasive tests.

Cited by 43 publications

References 0 publications

Phlebographic Findings in Venous Thrombosis following Total Hip Replacement

Phlebographic Findings in Venous Thrombosis following Total Hip Replacement

Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis

Diagnosis of deep vein thrombosis

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