Duplex Ultrasound Examination of the Acutely Painful and Swollen Leg

Somjen, George M.; Donlan, J.; Hurse, J.; Bartholomew, John R.; Weir, E. K.; Johnston, Andrew H.; Royle, John P.

doi:10.1111/j.1524-4725.1996.tb00337.x

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…It may also be a decisive factor in the presence of clinically difficult differential diagnosis with cellulitis, panniculitis, erythema nodosum, insect bites, and lymphangiitis. 12,19,[47][48][49]…”

Section: Diagnosismentioning

confidence: 99%

“…A renewed interest for this disease has arisen in the last decade by the evidence for a significant and previously unsuspected association with deep vein thrombosis (DVT) and pulmonary embolism (PE), which often are clinically occult. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Recent studies have shown the risk of venous thromboembolic complications in patients with isolated SVT by the direct propagation of superficial thrombosis to the deep vein system or the development of DVT in noncontiguous sites with a subsequent real risk of PE. 13,15,[19][20][21] These data have challenged the traditional belief that SVT is always a benign and trivial disease, and have encouraged new clinical research in this field.…”

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confidence: 99%

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Superficial Vein Thrombosis: Risk Factors, Diagnosis, and Treatment

Marchiori¹,

Mosena²,

Prandoni³

2006

Semin Thromb Hemost

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Superficial vein thrombosis (SVT) is a very common disease even though its incidence has never been assessed properly. Until recently, the literature on this topic has been relatively poor, old, and with numerous methodologic drawbacks, probably because this disease was considered benign and trivial. However, the recent recognition of a frequent association with concomitant venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) and the risk of subsequent VTE complications in patients with isolated SVT has revived interest and has encouraged new clinical research. SVT and VTE share many common predisposing risk factors. Even if varicose veins represent the main cause of SVT, several underlying conditions (e.g., malignancy, thrombophilia, autoimmune diseases) should be sought, especially in idiopathic, migrant, or recurrent SVT of nonvaricose vein patients. The diagnosis is made in a clinical setting but ultrasonography is useful to identify concomitant asymptomatic DVT. Many medical and surgical treatments have been suggested to relieve local symptoms and signs, prevent recurrences, and limit the VTE risk of SVT, but the evidence coming from the limited number of prospective randomized studies does not allow strong recommendations on the optimal treatment of SVT.

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Section: Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

Superficial Vein Thrombosis: Risk Factors, Diagnosis, and Treatment

Marchiori¹,

Mosena²,

Prandoni³

2006

Semin Thromb Hemost

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“…Complete US needed to be repeated in only very few patients (1.4%) because of inadequate tests. study (27) evaluating 106 limbs without venous thrombosis, the most frequent ultrasound findings were incompetent leg veins or soft tissue masses (Baker's cyst and calf hematoma).…”

Section: Discussionmentioning

confidence: 99%

A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs

Elias¹,

Mallard²,

Elias³

et al. 2003

Thromb Haemost

119

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SummaryIn patients clinically suspected of deep-vein thrombosis (DVT) of the lower limbs, it is safe to withhold anticoagulant therapy after a negative ultrasound (US) limited to the popliteal and the femoral veins, provided that this can either be repeated or combined with other diagnostic procedures. To assess the safety of withholding anticoagulants after a single negative complete US, we performed a multicenter, prospective, cohort study including consecutive ambulatory outpatients from institutional and private practice settings, with a clinically suspected first episode of DVT. Patients fulfilling the inclusion criteria were enrolled after careful clinical assessment. A complete US examination of the proximal and the distal veins was performed according to a standardized and detailed protocol. Anticoagulant therapy was administered in patients with proximal or isolated distal DVT and withheld in those with negative results. The main outcome measure was the occurrence of objectively documented clinical thromboembolic events during a three-month follow-up after a negative US.Out of 623 patients,401 (64.4%) had a baseline negative US, were not anticoagulated and could be followed-up for three months. Two patients presented a calf DVT within three months. The incidence of venous thromboembolic events, including distal DVT, was 0.5% [95% confidence interval: 0.1-1.8]. No proximal DVT, or non-fatal or fatal pulmonary embolism occurred (incidence: 0.0% [95% confidence interval: 0.0-0.9]).In conclusion, it is safe to withhold anticoagulant therapy in patients with clinically suspected DVT after a single, negative, complete US. Integrating this method within diagnostic strategies for DVT could improve management and be more acceptable for patients and physicians.

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“…Extension of superficial thrombophlebitis to the deep venous system occurs through the proximal long and short saphenous veins to the common femoral and popliteal veins, respectively, and through the perforating veins. [3][4][5]8,13 The use of duplex scanning for diagnosis is controversial. Some argue that it should be performed to establish the diagnosis and to evaluate the deep venous system with a follow-up scan to assess resolution of the condition and the status of the deep veins.…”

Section: Definition and Diagnosismentioning

confidence: 99%

Superficial Thrombophlebitis and Low-Molecular-Weight Heparins

Kalodiki

Nicolaides

2002

Angiology

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The current status of superficial thrombophlebitis, including incidence, diagnosis, and management, are reviewed. Treatment options are assessed in the light of data from the main studies reported in the literature. These include compression, ambulation, and nonsteroidal antiinflammatory agents and surgical management with high saphenous ligation (with or without saphenous vein stripping) with or without anticoagulants, ranging from aspirin, unfractionated heparin, warfarin, and low-molecular-weight heparin (LMWH). The advantage of the surgical approach is that by ligation with or without stripping of the superficial veins the underlying pathesis (i.e., varicose veins) is also eradicated. In the presence of deep venous thrombosis (DVT), surgery could be combined with anticoagulants. The extensive current literature for DVT treatment shows that the LMWHs are at least as effective and safe as the unfractionated heparins. On this basis, one could reasonably recommend LMWH for the treatment of superficial thrombophlebitis with involvement of the deep veins. Pentasaccharide, a drug that has been recently explored for the prophylaxis and treatment of DVT could be another option. However, there are as yet no data for recommended dosages or duration of treatment for the latter two options.

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Duplex Ultrasound Examination of the Acutely Painful and Swollen Leg

Cited by 6 publications

References 9 publications

Superficial Vein Thrombosis: Risk Factors, Diagnosis, and Treatment

Superficial Vein Thrombosis: Risk Factors, Diagnosis, and Treatment

A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs

Superficial Thrombophlebitis and Low-Molecular-Weight Heparins

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