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Duplex ultrasonography is a useful and accurate method for assessment of the IVC before vena cava filter placement.

The purpose of this study was to determine whether those with lower extremity acute venous thrombosis have fever. During a recent 14.5-month period, 1847 patients undergoing lower extremity venous duplex scanning also had their oral temperature measured using a digital thermometer at the time of duplex examination. Patients were 57.8 ± 17.3 years of age (range, 14 to 99). Temperature was 98.5 ± 1.1° F. Twenty-three patients had acute inferior vena cava thrombosis, 60 had acute iliac vein thrombosis, 138 had acute femoral venous thrombosis, and 131 had acute popliteal venous thrombosis. Calf vein thromboses were present in 102 patients, and 43 patients had superficial venous thrombosis. A total of 228 patients had acute lower extremity venous thrombosis in one or more of these venous segments. Temperature with acute lower extremity venous thrombosis was 98.7 ± 1.05° F versus 98.5 ± 1.10° F in those with no acute thrombosis. Although small, this temperature difference was statistically significant ( P < 0.02). Acute deep venous thrombosis (DVT) was defined as acute popliteal or more proximal femoral, iliac, or vena cava thrombosis. The temperature for the 175 patients with acute DVT was 98.7 ± 1.10° F versus 98.5 ± 1.10° F for those without DVT ( P < 0.035). There was no temperature that served to accurately differentiate those who did from those who did not have DVT. The frequency that patients with DVT had fever, defined as a temperature ≥100° F, was 9.1 per cent (16 of 175) with DVT versus 7.5 per cent (126 of 1678) without DVT (not significant). In the subgroup with a temperature ≥101° F, 4.6 per cent (8 of 175) with DVT had such a fever versus 3.4 per cent (57 of 1672) without DVT (not significant). Those undergoing venous duplex who were found to have acute lower extremity venous thrombosis, including acute DVT, had statistically higher temperatures, but such temperature differences were minimal. The incidence of fever, defined as a temperature ≥100° F or ≥101° F, was not different between those with and those without acute DVT. It appears that the presence of fever may not be a sensitive or specific indicator for the presence of underlying acute DVT.

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The purpose of this study was to define the incidence of and outcomes associated with isolated acute calf vein thrombosis (CVT). From 11/95 through 6/97, 3096 patients underwent lower extremity venous duplex testing in a hospital-based vascular laboratory in which bilateral tibial and peroneal vein imaging were standard components of the venous duplex examination. CVT was present in 118 patients (3.8%), and 339 patients (10.9%) had acute proximal deep venous thrombosis (PDVT). Patients with CVT were 56.4 ± 17.2 years of age (range, 18–92). Approximately 25 per cent with CVT had cancer (n = 30). Of the 18 patients with CVT who underwent ventilation-perfusion (V/Q) lung scanning, 56 per cent (n = 10) had high-probability scans. Venous duplex reports for those with CVT recommended follow-up venous duplex examination, which was done in 60 per cent (n = 71) of patients. Of the 71 patients with CVT who underwent follow-up testing, 15.5 per cent (n = 11) progressed to PDVT. The incidence of progression to deep venous thrombosis was 25 per cent (9 of 36) in those receiving anticoagulants at the time of initial venous duplex examination versus 5.7 per cent (2 of 35) in those not receiving anticoagulants (P = 0.046). With progression to PDVT, patients were more likely to have cancer (35% versus 7.8%; P = 0.009), more likely to have high-probability V/Q scans (36% versus 6.7%; P = 0.017), and more likely to die (27% versus 1.7%; P = 0.011) during follow-up. CVT was less common than proximal deep vein thrombosis and was also associated with pulmonary embolism. Progression of CVT was an adverse clinical event associated with greater chance of pulmonary embolism and death.

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