Point-of-Care Ultrasound for a Deep Venous Thrombosis

Abstract

Patients presenting to the emergency department with lower extremity symptoms suggestive of venous thromboembolic disease require a diagnostic evaluation. Although contrast venography was the diagnostic standard, this has largely been replaced by duplex ultrasound as the first-line imaging modality. This review presents a summary of the literature on the evolution and performance of B-mode point-of-care compression ultrasound as an alternative to duplex ultrasound evaluation. The 2-point compression and 2-region compression techniques are described. The limitations of point-of-care ultrasound of the lower extremity as a diagnostic modality for this disease entity, the role of a D-dimer assay in the emergency department evaluation and future directions for this diagnostic modality are discussed.

Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function

“…25 Point-of care US performed by emergency physicians using limited CUS has shown good performance (96.1% sensitivity, 96.8% specificity) 26 and may be useful if vascular laboratories are not available 24/7, provided its integration in a validated diagnostic strategy. 27 In patients with clinically suspected recurrent DVT: comparison of test results with baseline imaging at discontinuation of anticoagulation can safely rule out diagnosis of recurrence. 28 A 2-or 4-mm [29][30][31] increase in vein diameter between two measurements at the common femoral and popliteal veins, after full compression, is the most validated US criterion.…”

The utility of on‐site ultrasound screening in population at high risk for deep venous thrombosis in temporary housing after the great East Japan Earthquake

“…The use of ultrasonography in the prehospital setting has been found to be a feasible and useful tool for triage, diagnosis, and treatment planning . Point‐of‐care ultrasound of the lower extremity for suspected DVT is now becoming increasingly common in the emergency room . Thus, we focused on the use of ultrasonography to diagnose DVT in a displaced population in temporary housing with disuse syndrome caused by the loss of family and community support and the lack of mobility and supportive aids.…”

“…15,16 Point-of-care ultrasound of the lower extremity for suspected DVT is now becoming increasingly common in the emergency room. 17 Thus, we focused on the use of ultrasonography to diagnose DVT in a displaced population in temporary housing with disuse syndrome caused by the loss of family and community support and the lack of mobility and supportive aids. Separation during displacement leaves older people particularly disadvantaged.…”

Pattern Analysis of Lower Extremity Venous Thrombosis: Implications for Point of Care Ultrasound (POCUS) Protocols

“…The full VDU protocol was performed by credentialed vascular technologists (ARDMS RVT) and used high-resolution duplex scanning of the deep venous system from the iliac veins to the calf veins bilaterally, using gray-scale (B-mode) and color flow, spectral analysis, and manuevres of compression and augmentation, as outlined in standards published by the Society for Vascular Ultrasound (SVU) 7 and Intersocietal Accreditation Commission (IAC). 6 The simplified protocols, described in the emergency medicine literature 3,8–10 included “two-point” (common femoral vein and popliteal vein) and “three-point” (common femoral vein, femoral vein in the thigh, and popliteal vein) compression and “two-area” [(1) common femoral vein, proximal femoral vein, and saphenofemoral junction (SFJ) and (2) proximal and distal popliteal vein and the small saphenous-popliteal junction (SSP)] assessment. The potential findings from POCUS protocols were mapped to the actual distribution of disease on full VDU and correlations were identified.…”