Pitfalls in lower extremity venous duplex scanning

Wright, D. J.; Shepard, Alexander D.; McPharlin, Michalene; Ernst, Calvin B.

doi:10.1016/0741-5214(90)90213-t

Cited by 50 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar observations have also been reported by others [1,17]. In our study the inter-observer agreement of these measurements in patients appeared to be good (κ l 0.77), despite the fact that 30 % of the distal femoral vein segments in healthy individuals were not compressible and therefore might have caused misinterpretation of compressibility in patients.…”

Section: Discussionsupporting

confidence: 91%

Venous duplex scanning of the leg: range, variability and reproducibility

Haenen¹,

Langen²,

Janssen³

et al. 1999

Clinical Science

View full text Add to dashboard Cite

Despite the many studies on venous haemodynamics using duplex, only a few evaluated the normal values, variability and reproducibility. Therefore, the range and variability of venous diameter, compressibility, flow and reflux were measured. To obtain normal values, 42 healthy individuals (42 limbs, 714 vein segments) with no history of venous disease were scanned by duplex. To determine the reproducibility the intra-observer variability was measured in 11 healthy individuals (187 vein segments) and the inter-observer variability in 15 healthy individuals (255 vein segments) and 13 patients (169 vein segments) previously diagnosed with deep venous thrombosis. Of the 714 normal vein segments, 708 (99%) were traceable, including the crural veins. Of the traceable vein segments, 675 (95%) were compressible and in 696 (98%) flow was present. Of the 42 common femoral vein segments, in 25 (60%) the reflux duration exceeded 1.0 s, but in the other proximal vein segments the reflux duration was less than 1.0 s (95% confidence interval 3.0-10.0). With the exception of the distal long saphenous vein, in the distal vein segments the reflux duration was less than 0.5 s (95% confidence interval 3.5-8.2). The coefficient of variation of the diameter measurements ranged from 14 to 50% and that of the reflux measurements from 28 to 60%. The kappa-coefficient of the inter-observer variability in the classification of compressibility measurements in the patients was 0. 77 and that of the reflux measurements was 0.86. This study shows that almost all veins were compressible in healthy individuals, except the distal femoral veins. In healthy individuals the duration of reflux of the proximal veins was less than 1.0 s and in the distal veins it was less than 0.5 s. The inter-observer variability of the reflux and compressibility measurements in the patients was good.

show abstract

Section: Discussionsupporting

confidence: 91%

Venous duplex scanning of the leg: range, variability and reproducibility

Haenen¹,

Langen²,

Janssen³

et al. 1999

Clinical Science

View full text Add to dashboard Cite

show abstract

“…68,69 CURRENT CONTROVERSIES What has been briefly described above is considered the standard examination in most vascular laboratories. A reverse Trendelenburg or erect position as well as use Augmentation should be tried for any non-visualized segment.…”

Section: Pathophysiology and Anatomymentioning

confidence: 99%

Sonography for Deep Venous Thrombosis

Andrews

Fleischer²

2005

Ultrasound Quarterly

View full text Add to dashboard Cite

Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly.

show abstract

“…There are some duplex ultrasonography criteria, such as the degree of vein occlusion and the echogenicity of the thrombus, that may help to differentiate acute from chronic clots [ 4 ]. However, there is not enough evidence to state that such criteria are reliable and replicable tools to assess thrombus age.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Elastography to Assess Age of Deep Vein Thrombosis: A Systematic Review

et al. 2023

View full text Add to dashboard Cite

Background and aims: Deep-vein thrombosis (DVT) is a widely diffused condition, and its accurate staging has major clinical and therapeutic implications. Ultrasound elastography (UE) is a rapidly evolving imaging technique that allows quantification of elastic tissue properties and could play a crucial role in determining thrombus age. The aim of this review is to find clinical evidence regarding the application of UE in the evaluation of DVT and its usefulness in differentiating thrombosis age. Methods: A literature search of clinical studies was performed to identify the ability of UE of discriminate acute, subacute, and chronic DVT. Heterogeneity and publication bias were calculated. In accordance with the study protocol, a qualitative analysis of the evidence was planned. The results were summarized with a comprehensive summary table of study characteristics and baseline characteristics of participant patients. Results: Nine studies matched the predetermined eligibility requirements for this systematic review regarding the risk of bias; the greatest criticalities were found within the domains of patient selection and index test. Based on the quality assessment, two publications were excluded from the qualitative synthesis because of the presence of significant applicability concerns. Among the seven studies that were considered eligible for qualitative synthesis, four evaluated strain elastography and three evaluated shear-wave elastography. Despite significant differences concerning study design, thrombus age definitions, and patient characteristics, nearly all studies demonstrated an increase in thrombus stiffness according to DVT age. Conclusions: UE could play a key role in routine ultrasound examination of DVT. The measurement of thrombus stiffness has a high biological plausibility and its use is supported by the finding of a correlation between the stiffness and the progression of the DVT age.

show abstract

Pitfalls in lower extremity venous duplex scanning

Cited by 50 publications

References 13 publications

Venous duplex scanning of the leg: range, variability and reproducibility

Venous duplex scanning of the leg: range, variability and reproducibility

Sonography for Deep Venous Thrombosis

Ultrasound Elastography to Assess Age of Deep Vein Thrombosis: A Systematic Review

Contact Info

Product

Resources

About