Utility of lower-extremity duplex sonography in patients with venous thromboembolism

Abstract

Purpose We evaluated the utility of venous duplex ultrasonography (VDUS) of the lower extremities in patients with pulmonary embolism (PE) and studied the distribution of venous thrombi in deep vein thrombosis (DVT) patients with and without PE. Methods We retrospectively reviewed medical records of all inpatients with a final diagnosis of PE or DVT between 1989 and 2000. Results Venous thrombosis was detected by VDUS in 229 patients (191 without PE and 38 with PE). The left leg only was involved in 50% of patients (p < 0.05), the right leg only in 33%, and both legs in 17%. The overall distribution of veins affected by DVT was: popliteal vein, 77%; superficial femoral vein, 76%; common femoral vein, 65%; posterior tibial vein, 23%; external iliac vein, 21%; common iliac vein, 9%; great saphenous vein, 7%; and inferior vena cava, 2%. A single venous site was involved in 22% of patients. External iliac vein thrombosis was more frequent in patients with DVT only (24%) than with PE and DVT (5%) (p < 0.05). The venous obstruction was partial in 14% of patients. VDUS of the asymptomatic leg was positive in 14% of patients with unilateral symptoms of DVT, all of whom also had DVT in the symptomatic leg. VDUS was positive for DVT in 90% of patients with PE and concomitant pain or edema of the leg, compared to only 20% of PE patients with no symptoms of DVT. Conclusions Sonography should be the first diagnostic test for patients suspected of having PE with any sign or symptom related to DVT. VDUS of the asymptomatic leg is unnecessary in the diagnosis and management of DVT. Omitting the superficial femoral vein examination would lead to some decrease in the sensitivity of VDUS. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:92–98, 2001.

Predominance of left‐sided deep vein thrombosis and body weight

“…Our study confirms the findings of a few cohort studies that have reported on the left-to-right ratio of DVT [9,10]. To our knowledge there are no studies that investigated whether BMI further increases this imbalanced distribution.…”

“…This finding may explain the strong tendency of left‐ over right‐sided thrombosis observed in pregnant women, in whom 80–90% of deep venous thromboses occur in the left leg [7,8]. Some cohort studies among DVT patients also reported a higher incidence of thrombosis in the left than in the right leg, of approximately 60 vs. 40% [9,10].…”

Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

“…Likewise, although contrast venography is considered the criterion standard for DVT, VDUS has become the ''standard of care.'' [4][5][6]13,14 Second, a study of consecutive patients would have eliminated possible selection bias, although the two previous prospective studies were also limited by convenience samples. It may be that those patients whom an EP-sonographer feels comfortable examining with US can be adequately assessed.…”

“…Contrast venography is the criterion standard for diagnosing DVT, but it is invasive and has been replaced by venous duplex ultrasonography (VDUS) as the initial diagnostic test. [4][5][6] Recently, some centers have begun using computed tomography (CT) venography, with comparable results. [7][8][9] Although most emergency departments (EDs) are able to obtain VDUS during business hours, this often requires patients' being gone from the ED for several hours.…”

Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?

“…Blebea found that 75% of laboratories routinely perform unilateral scans for DVT 10 . The policy of only scanning the symptomatic limb in patients who present with unilateral symptoms is supported by many published studies 11−18 . Other investigators disagree with this policy, finding that a significant number of patients had DVT located in the asymptomatic contralateral limb 19−21 .…”