Suspected deep venous thrombosis: is US of both legs necessary? [ comment]

Naidich, James B.; Torre, J.R. Infante de la; Pellerito, John S.; Smalberg, I S; Kase, Daniel J.; Crystal, K S

doi:10.1148/radiology.200.2.8685337

Cited by 45 publications

(18 citation statements)

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“…Opinions differ on the matter of systematic ultrasound screening for bilateral DVT in patients with DVT suspected in a single limb: for many ultrasonographers, proximal testing of the symptomatic leg is sufficient [13,14], whereas others consider that both limbs should be systematically explored [15] and a third group suggests bilateral screening only in non‐ambulatory patients [16]. However, a recent review in ‘Circulation’ stated that a complete color flow venous duplex examination has become the standard of care for assessment of DVT [17].…”

Section: Introductionmentioning

confidence: 99%

Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study

Seinturier

Bosson

Colonna

et al. 2005

Journal of Thrombosis and Haemostasis

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See also Cohen AT, Wolozinsky M. The significance of distal vein thrombosis and bilateral disease. This issue, pp 1360-1.Summary. Clinical outcomes of patients diagnosed with venous thromboembolic disease (VTED) have rarely been assessed on large series of patients from single institutions. This was work based on our practice to routinely screen all suspected pulmonary embolism (PE) and deep venous thrombosis (DVT) patients with bilateral proximal and distal venous US was designed to evaluate survival, recurrence and cancer occurrence in patients diagnosed with symptomatic or asymptomatic DVT and to assess their relationship with the site of the DVT (proximal vs. distal, bilateral vs. unilateral). Our study is based on the cross-matching of the VTED register of the Grenoble University Hospital with the local Cancer Register and community mortality data. Survival analyses were performed with the Kaplan-Meier method; prognostic variables were tested using the log-rank test. A total of 1913 patients with a DVT of the lower limbs from 1993 to 1998 were included (57% women; mean age, 69 years). Of these, 1018 patients were diagnosed with proximal DVT (156 bilateral) and 895 distal DVT (112 bilateral). PE was associated in 760 patients. Patients with PE and no detected DVT were not included. At 2 years, adjusted survival rates were 80% in patients with unilateraldistal DVT, 67% in bilateral-distal, 72% in unilateral-proximal and 65% in bilateral-proximal DVT patients. The cumulated VTED recurrence rates were 7.7% in unilateral-distal DVT, 13.3% when DVT was bilateral-distal, 14% when unilateralproximal and 13.2% when bilateral-proximal. The rate of new cancer was 6.4% in unilateral-distal DVT, 10.8% when it was bilateral-distal, 6.5% when unilateral-proximal and 6.1% when bilateral-proximal.Based on a large series of unselected patients, our results show that the site of the DVT and principally the bilaterality provides important prognostic information that may be used in the setting up of medical strategies.

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Section: Introductionmentioning

confidence: 99%

Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study

Seinturier

Bosson

Colonna

et al. 2005

Journal of Thrombosis and Haemostasis

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“…This is somewhat higher than rates of 15 to 18% reported from other ultrasound facilities 8,9 but similar to a rate of 25% reported in a facility with a high-risk population. 14 No sex difference in DVT rates was seen. Among all cases of DVT diagnosed, 84% occurred in patients with unilateral symptoms whereas 16% occurred in patients with bilateral symptoms.…”

Section: Discussionmentioning

confidence: 91%

Lower extremity deep venous thrombosis in cancer patients: correlation of presenting symptoms with venous sonographic findings.

Loud

Klippenstein²

1998

Journal of Ultrasound in Medicine

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ancer patients are at increased risk for the development of DVT. The clinical sequelae of DVT in this population are significant. In addition to the prolonged discomfort and swelling associated with chronic DVT, the presence of acute femoropopliteal DVT poses a grave risk of thromboembolic complications. Pulmonary embolism is a frequent cause of death among cancer patients. 1 Early diagnosis and treatment of DVT is vital to decrease these complications.Lower extremity deep venous sonography using compression and Doppler techniques is a quick, noninvasive, and accurate test with sensitivities of 89 to 95% and specificities of 92 to 100% in the diagnosis of acute femoropopliteal DVT. 2-5 For these reasons ultrasonography has now become the primary diagnostic imaging modality for suspected DVT in most clinical settings, largely replacing venography with its associated discomfort and risks associated with administration of contrast agents, including contrast agent-induced phlebitis. The clinical utility of lower extremity venous ultrasonography in the setting of bilateral leg edema and in the evaluation of suspected pulmonary embolism has, however, been a subject of debate in the recent literature.

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“…More recent data have suggested an excellent outcome with US performed serially over 1 wk for suspected DVT, using a limited examination (also see S YMPTOMATIC A CUTE P ROXIMAL D EEP V ENOUS T HROMBOSIS , below ). In addition to controversy over the limited examination, the issue of unilateral versus bilateral studies in the setting of unilateral symptoms is debated (50)(51)(52). The unilateral examination has been reported to decrease scanning time and cost, without a decrease in diagnostic yield (51).…”

Section: Compression Ultrasound With Venous Imagingmentioning

confidence: 99%

The Diagnostic Approach to Acute Venous Thromboembolism

Vf¹,

Carroll²,

Bl³

et al. 1999

Am J Respir Crit Care Med

289

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Suspected deep venous thrombosis: is US of both legs necessary? [ comment]

Abstract: The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates that both categories of patients need to be evaluated with bilateral US.

Cited by 45 publications

References 0 publications

Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study

Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study

Lower extremity deep venous thrombosis in cancer patients: correlation of presenting symptoms with venous sonographic findings.

The Diagnostic Approach to Acute Venous Thromboembolism

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