Pitfalls in lower extremity venous duplex scanning

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

doi:10.1067/mva.1990.18519

Cited by 16 publications

(19 citation statements)

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“…This is probably due to the deep course of this vein segment as it enters Hunter's canal. Similar observations have also been reported by others [1,17]. Flow was present in all of these noncompressible distal femoral vein segments.…”

Section: Discussionsupporting

confidence: 86%

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

et al. 1999

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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.

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Section: Discussionsupporting

confidence: 86%

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

et al. 1999

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“…Finally, there are still questions about the significance of small, distal thrombi, especially the asymptomatic ones. Therefore, the standard is changing towards venous Doppler ultrasonography, which can be repeated, is non-invasive and is highly sensitive to symptomatic thrombi of the lower extremities and asymptomatic, proximal DVT [1, 2, 22], even though ultrasound has a lower sensitivity than venography [10, 13]. We found no DVTs by venography in 17 patients eight days after surgery.…”

Section: Discussionmentioning

confidence: 90%

“…Without proper prophylaxis, hip prosthesis surgery and abdominal cancer surgery have a 70% and 30% risk of venous thromboembolism (VTE) respectively [1, 2]. The use of pre- and postoperative low molecular weight heparin (LMWH) has reduced the incidence of symptomatic VTE to around 3%, with an incidence of fatal pulmonary embolus of 0.2 - 0.7% [3].…”

Section: Introductionmentioning

confidence: 99%

Low Risk of Thromboembolic Complications After Fast-Track Abdominal Surgery With Thrombosis-Prophylaxis Only During Hospital Stay

2011

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BackgroundSubcutaneous low molecular weight heparin (LMWH) reduces the risk of thromboembolic complications after abdominal surgery. With enhanced recovery after surgery (ERAS), median hospital stay after abdominal surgery may be as short as 3 - 4 days. The aim of our study was to investigate whether thrombosis prophylaxis during the short hospital stay was sufficient to maintain a low frequency of thromboembolic complications.MethodsNinety-eight patients, median age 67 years, were enrolled in a prospective two-center observational study of colorectal resections following the ERAS principles. Seventy-seven patients (78.6%) were resected for colonic cancer, the rest for benign colonic diseases. Fifty percent of the patients were discharged from hospital within three days after surgery. Follow-up examinations took place at 8 and 30 days after surgery with clinical examination for thromboembolism. The patients enrolled at one of the centers were also scheduled for a routine venography at day 8. Seventeen of these were evaluated.ResultsClinical follow-up at day 8 of 72 patients (73.5%) revealed no venous thromboembolism (VTE), and the 17 venograms did not show any thromboses. Clinical follow-up at day 30 of 74 patients (75.5%) showed no deep venous thrombosis (DVT), whereas pulmonary embolus (PE) was suspected and verified in one patient (1.3%) with pulmonary metastases and pneumonia.ConclusionsProphylaxis until full mobilization seems to be sufficient following major surgery in patients treated with the principles of ERAS who remain in hospital for 3 - 4 days.

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“…2,12,14 As color flow duplex ultrasonography (CFDU) scan has evolved to become the imaging method of choice for investigating CVT, CVT isolated to the veins draining the gastrocnemius and soleal muscles is being recognized with greater frequency. 3,5,7,9,15,16 CFDU has been reported to have a diagnostic sensitivity of 94% to 100%, specificity of 91% to 100%, positive predictive value of 80%, and negative predictive value of 94% for detection of thrombus at the level of the tibial and peroneal veins. 3,4,7,9,13,16,17 In a prospective study of 5250 patients with suspected deep vein thrombosis (DVT), acute DVT was documented with CFDU in 14% of patients, with 4.8% of patients having thrombi isolated to the veins of the calf.…”

mentioning

confidence: 98%

“…3,5,7,9,15,16 CFDU has been reported to have a diagnostic sensitivity of 94% to 100%, specificity of 91% to 100%, positive predictive value of 80%, and negative predictive value of 94% for detection of thrombus at the level of the tibial and peroneal veins. 3,4,7,9,13,16,17 In a prospective study of 5250 patients with suspected deep vein thrombosis (DVT), acute DVT was documented with CFDU in 14% of patients, with 4.8% of patients having thrombi isolated to the veins of the calf. Forty percent of these isolated CVTs were limited to the veins draining the gastrocnemius and soleal muscles.…”

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confidence: 98%

Early follow-up and treatment recommendations for isolated calf deep venous thrombosis

Singh

Yakoub

Giangola

et al. 2012

Journal of Vascular Surgery

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ICVT can be safely observed in asymptomatic patients without therapeutic anticoagulation. In our study, patients who have had orthopedic procedures, those with malignancy, and those that were immobile seemed to have a higher incidence of clot propagation. In this group, we recommend full anticoagulation until the patient is ambulatory or the follow-up duplex scan is negative. Our data also suggest that a follow-up duplex scan is not beneficial when performed within 72 hours or after 3 months.

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Pitfalls in lower extremity venous duplex scanning

Cited by 16 publications

References 0 publications

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

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

Low Risk of Thromboembolic Complications After Fast-Track Abdominal Surgery With Thrombosis-Prophylaxis Only During Hospital Stay

Early follow-up and treatment recommendations for isolated calf deep venous thrombosis

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