Modern Approach to Diagnosis in Patients with Suspected Deep Vein Thrombosis

Wells, Philip S.; Anderson, David R.

doi:10.1159/000054107

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…Various studies have shown a high rate of limb salvage in these patients, who present with phlegmasia cerulea dolens. [13] Surgical thrombectomy is usually the last resort in patients with a high risk of hemorrhagic complications. However, results with surgical management are not satisfactory and incomplete thrombus removal, recurrent DVT and an increased incidence of systemic complications are known.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management in venous disease

D’Souza¹,

Kapoor²,

Bedi³

2008

Indian J Radiol Imaging

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Background:Deep vein thrombosis (DVT) and pulmonary embolism (PE) are under-recognized entities and can be often difficult to diagnose. Occasionally, clinical symptoms, such as pain and swelling, are non-specific or absent. If left untreated, the thrombus can get dislodged and migrate to cause life-threatening pulmonary embolism.Materials and Methods:Twenty patients presenting with limb edema and local increase in temperature were screened with color Doppler. Of the 20 cases, three were treated for upper limb venous disease and 17 were treated for lower limb disease. Cases detected to be positive for DVT were taken up for diagnostic venography using DSA. On confirmation, these patients were offered endovascular management viz. percutaneous recanalization by thromboaspiration or thrombolysis or a combination of both. Patients with residual stenosis or vessel occlusion were treated with balloon angioplasty/stent placement. The patients were assessed with a color Doppler study at 6, 12, 24, and 36 months.Results:Of the 20 cases, four patients underwent thromboaspiration, eight underwent thrombolysis, eight were treated with angioplasty, and seven patients required stent placement. Technical success was achieved in 95% (19 of 20) of the cases treated with thrombolysis and/or venous stent placement. One patient had complete occlusion of the vein preventing passage of catheter and thromboaspiration. Three patients were treated for upper limb disease and on follow-up studies, all three remained patent while of the 16 patients treated for lower limb disease, 13 remained patent giving a success rate of 81.25%. No complications occurred in any of the patients. Two patients developed a stent thrombus at 48 and 72 h respectively, both of which were recanalized by balloon angioplasty.Conclusions:In venous thrombosis, color Doppler helps in the detection and morphological analysis of disease, while venography confirms and assists in managing venous thrombosis using interventions. Endovascular interventional management includes percutaneous recanalization by thromboaspiration or thrombolysis or a combination of both. Patients with residual stenosis or vessel occlusion vessel can be further treated with balloon angioplasty/stent placement.

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Section: Discussionmentioning

confidence: 99%

Endovascular management in venous disease

D’Souza¹,

Kapoor²,

Bedi³

2008

Indian J Radiol Imaging

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“…Like DVT, clinical signs and symptoms of PE are both insensitive and nonspecific. To increase clinical accuracy in diagnosing PE, Wells developed a clinical estimation tool for establishing a patient's risk of PE on the basis of clinical signs and symptoms that is summarized in Table 3 [59‐63]. Once again, it would be rare for an acute inpatient rehabilitation patient to have a score of less than 2 and be in the low probability category.…”

Section: Vte Confirmationmentioning

confidence: 99%

Venous Thromboembolic Events in the Rehabilitation Setting

Kelly

Yoder

Tang

et al. 2010

PM&R

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Venous thromboembolism (VTE) is a disease entity that encompasses both deep venous thrombosis and pulmonary embolism. During the past decade there have been significant advances in the understanding of prophylaxis and treatment of VTE. There is an extensive research base from which conclusions can be drawn, but the heterogeneity within the rehabilitation patient population makes the development of rigid VTE protocols challenging and overwhelming for the busy clinician. Given the prevalence of this condition and its associated morbidity and mortality, we review the evidence for the prevention, identification, and optimal treatment of VTE in the rehabilitation population. Our goal is to highlight studies that have the most clinical applicability for the care of VTE patients from a physiatrist's perspective. At times, information about acute care protocols is included in our discussion because these situations are encountered during the consultation process that identifies patients for rehabilitation needs.

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“…38,43,44 The combination of clinical probability and the inclusion of plasma D-dimer measurement by a rapid ELISA method before US is probably the better strategy for the clinical suspicion of symptomatic DVT. 45 For the diagnosis of isolated symptomatic distal DVT, a meta-analysis of methodologically good quality studies reported the sensitivity of US to be only 73%. 46 In asymptomatic patients the sensitivity of both compression US and color Doppler US for the diagnosis of DVT is much lower than in symptomatic patients.…”

Section: Lower Limb Venous Compression Ultrasonography In Dvtmentioning

confidence: 99%

Looking for Deep Vein Thrombosis in Suspected Pulmonary Embolism

Emmerich

2001

Seminars in Vascular Medicine

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Pulmonary embolism (PE) and deep vein thrombosis are two facets of the same disease, that is, venous thromboembolism (VTE). In patients with angiographically proven PE, the prevalence of proximal deep vein thrombosis by venography is around 70%. The sensitivity of compression ultrasonography (US) for the diagnosis of acute VTE in patients with a suspicion of PE is between 40 and 60%, with a high specificity (96 to 100%). Taking into account the 20 to 30% prevalence of PE in a population consulting for suspicion of this disease, the first line use of compression US will allow the diagnosis of acute VTE in half of patients with confirmed PE, that is, in 10 to 15% of patients addressed for suspicion of PE. In outpatients, the first line use of D-dimers which will exclude acute VTE in one-third of the initial population will slightly increase the reliability of compression US as a first imaging test. New tools of looking for deep vein thrombosis, such as computed tomographic venography coupled with computed tomographic pulmonary angiography, could become an interesting approach in the diagnostic strategy of PE, but require adequate evaluation in prospective studies.

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Modern Approach to Diagnosis in Patients with Suspected Deep Vein Thrombosis

Cited by 4 publications

References 42 publications

Endovascular management in venous disease

Endovascular management in venous disease

Venous Thromboembolic Events in the Rehabilitation Setting

Looking for Deep Vein Thrombosis in Suspected Pulmonary Embolism

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