Calf Deep Venous Thrombosis Research Articles

Colour Doppler flow imaging ultrasonography versus venography as screening method for asymptomatic postoperative deep venous thrombosis

Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.

Utility of leg ultrasonography in suspected symptomatic isolated calf deep venous thrombosis

To evaluate the utility of duplex ultrasonography in patients with suspected symptomatic, isolated calf deep venous thrombosis. Thirty patients with clinically suspected isolated calf deep venous thrombosis were examined with both duplex ultrasonography and contrast venography and the results were compared. Venography detected 7 cases of isolated calf deep venous thrombosis, all of which were also detected by ultrasonography. Ultrasound identified an additional 3 cases of soleal vein thrombosis, but venography did not visualize these veins. Of the 20 negative ultrasound studies, 11 were technically inadequate; however, no false-negative ultrasound studies were noted. Compression ultrasonography may be reliable for the evaluation of patients with suspected symptomatic infrapopliteal deep venous thrombosis. Its apparent superiority to contrast venography in visualizing muscular calf veins warrants further study; however, the high rate of technical inadequacy in ultrasound studies observed here, if confirmed in larger studies, may limit the usefulness of ultrasound in this setting.

DEEP VENOUS THROMBOSIS FOLLOWING LUMBAR LAMINOTOMY AND LAMINECTOMY

Sixty consecutive patients undergoing lumbar laminotomy or laminectomy underwent preoperative and postoperative compression ultrasonography of the lower extremities to detect acute deep venous thrombosis (DVT). Compression stockings were the only method of prophylaxis. Three patients (5%) developed postoperative calf DVT. Despite continued treatment with only compression stockings, serial scanning failed to detect propagation of the thrombus proximal to the knee in any patient. The average age of patients who developed DVT, 62 years, was significantly greater (P < .05) than the age of patients who did not, 45 years. There were no statistically significant differences in DVT rates when compared by: sex, addition of one- or two-level fusion, length of procedure, or number of days of bedrest.

Recurrence and Late Sequelae after First-Time Deep Vein Thrombosis: Relationship to Initial Signs

Objective: To investigate the relation between initial symptoms and long-term sequelae in first-time deep venous thrombosis (DVT). Design: Follow-up study of patients 6 years after an episode of suspected symptomatic DVT. Setting: Vascular laboratory, University Hospital of Lund. Patients: 66 patients, 19 with femoral DVT, 20 with calf DVT and 27 with normal phlebograms at initial investigation. Main outcome measures: Symptoms and signs of chronic venous insufficiency (CVI), foot volumetry and measurement of plasminogen activator inhibitor 1 (PAI-1) activity. Initial clinical signs and results at phlebography were compared with findings at follow-up. Results: Of patients with DVT, 11 (28%) had been treated for a recurrent DVT during follow-up. No relation was found between initial signs of DVT and late signs of CVI. Patients with DVT had significantly more signs of CVI but symptoms did not differ between the groups. Mean levels of PAI-1 activity were similar in the three groups, and patients with recurrent DVT did not differ. Refilling flow was related to the clinical CVI-score, and expelled volume was inversely related to the extension of DVT at phlebography. Conclusion: The recurrence rate is high in first-time DVT, but symptoms are mostly mild as long as after 6 years. There is a poor correlation between symptoms of CVI and objective findings. The late development of CVI cannot be predicted from the clinical signs in the acute phase. Levels of PAI-1 do not correlate with the degree of CVI.

Insensitivity of Color Doppler Flow Imaging for Detection of Acute Calf Deep Venous Thrombosis in Asymptomatic Postoperative Patients

Although color Doppler flow imaging (CDFI) has been shown to accurately depict calf vein thrombosis in symptomatic patients, this technique has not been proved accurate for detection of calf vein thrombosis in a population restricted to asymptomatic postoperative patients. To evaluate the accuracy of CDFI in asymptomatic postoperative patients, both CDFI and contrast venography were performed on 78 limbs of 76 patients without symptoms of deep venous thrombosis (DVT) who had undergone either hip or knee replacement. CDFI and venographic examination were interpreted blindly with respect to the results of the other modality or clinical findings. Venography was the standard for comparison of results. Fifty-six percent of CDFI examinations of the calf vein were technically adequate. The remaining studies were compromised technically by limb swelling and/or obesity. For the technically adequate CDFI studies, calf vein thrombosis was detected in eight of 10 patients. Calculated sensitivity in this cohort was 80%, and specificity was 97%. The sensitivity of CDFI for acute calf DVT in all patients, regardless of image quality, was 42%. These observations suggest that state-of-the-art CDFI is not an accurate examination for acute calf vein DVT in asymptomatic postoperative patients. CDFI is associated with a high rate of technically compromised studies and relatively low sensitivity in studies that are deemed technically satisfactory. These observations do not preclude the use of CDFI in postoperative patients for detection of thrombus extension into the popliteal vein or for detecting thrombosis of more proximal lower extremity veins.

Duplex scanning in post-operative surgical patients.

The technique of duplex scanning for the diagnosis of deep venous thrombosis (DVT) has been developed in 3 stages. Initially B-mode imaging with compression was used. Subsequently interrogation of the venous lumen using the Doppler facility was introduced and finally the latter became simple and efficient with the introduction of colour flow imaging. Sensitivities and specificities in excess of 90% have been produced for thrombosis proximal to the calf by all methods in symptomatic patients. Colour flow imaging has given the best results for calf DVT in symptomatic patients with 86% sensitivity and 91% specificity. Before the introduction of colour flow imaging the accuracy for the detection of old thrombi in asymptomatic patients was poor. With the introduction of colour, sensitivities and specificities in excess of 90% have been obtained for proximal DVT; for calf DVT, sensitivity of 79% and specificity of 97% have been reported by 2 studies. If further studies substantiate these recent results duplex scanning will become the non-invasive method to be used in screening asymptomatic patients.

Compression ultrasonography detected proximal deep venous thrombosis but not isolated iliac and calf deep venous thrombosis

DiagnosisMarch 1, 1992Compression ultrasonography detected proximal deep venous thrombosis but not isolated iliac and calf deep venous thrombosisJack Hirsh, MDJack Hirsh, MDHamilton Civic Hospitals, Hamilton, Ontario, Canada (J.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1992-116-2-054 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationPedersen OM, Aslaksen A, Vik-Mo H, Bassoe AM. Compression ultrasonography in hospitalized patients with suspected deep venous thrombosis. Arch Intern Med. 1991 Nov;151:2217-20.References1 Lensing AW, Prandoni P, Brandjes D, et al. N Engl J Med. 1989;320:342-5. Google Scholar2 Borris LC, Christiansen HM, Lassen MR, et al. Thromb Haemost. 1989;61:363-5. Google Scholar Author, Article, and Disclosure InformationAffiliations: Hamilton Civic Hospitals, Hamilton, Ontario, Canada (J.H.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails March 1, 1992Volume 116, Issue 2Page: 54KeywordsBlood flowDeep vein thrombosisKneesOutpatientsPelvisSpecificityThrombosisUltrasound imagingVeins ePublished: 9 March 2020 Issue Published: March 1, 1992 Copyright & PermissionsCopyright © 1992 by American College of Physicians. All Rights Reserved.Loading ...

99mTc plasmin in 394 consecutive patients with suspected deep venous thrombosis

Three hundred and ninety four consecutive out-patients with suspected deep venous thrombosis (DVT) were investigated with the 99mTc-plasmin test and physical examination and 307 of them with phlebography. Fresh thrombi were present in 124 patients and the plasmin test was pathological in 118 of these (sensitivity 95%). The thrombi that were missed were all located below the knee and measured less than 10 cm on the phlebographic films. The predictive values of negative and positive tests were 91% and 49%, respectively. The predictive value of a positive test was higher with an increasing number of measuring points with a pathological uptake. To get the final result, a single series of measurements 5 min after injection was sufficient. If clinical signs of inflammation were present. the plasmin test was usually pathological. Median time for the plasmin test to become normal during anticoagulant therapy was 14 days for calf DVT and 6 months for proximal DVT. The plasmin test was found to be useful as a screening test in patients without extensive signs of inflammation in the legs. It has a high sensitivity even in patients with long-standing symptoms.

Calf Deep Venous Thrombosis

To determine the natural history of calf deep venous thrombosis (C-DVT), an analytic review of the 20 relevant English-language papers published since 1942 was performed. Remarkably little methodologically sound research on this subject was found. However, available evidence suggests that C-DVT propagates to the thigh in up to 20% of cases and that propagation invariably occurs before embolization. No fatal emboli were reported in patients presenting with isolated C-DVT. Traditional anticoagulation treatment with heparin sodium and warfarin sodium of symptomatic patients with C-DVT appears to prevent extension, embolization, and early recurrence. There is no convincing evidence that C-DVT leads to chronic venous insufficiency or whether the risks of anticoagulation exceed the risks of no treatment. As an option to anticoagulation, physicians may choose to follow patients with C-DVT with serial impedance plethysmography, treating only if there is evidence of proximal extension.

Calf deep venous thrombosis. A wolf in sheep's clothing?

Calf deep venous thrombosis. A wolf in sheep's clothing?

Progress in the diagnosis of deep venous thrombosis: The efficacy of real-time B-mode ultrasonic imaging

Seventy-six limbs with clinically suspected acute deep venous thrombosis (DVT) were evaluated by means of ultrasonic imaging (UI) to define the ability of this technique to detect acute and chronic venous obstruction and to determine the origin and distribution of venous thrombi. UI was compared with ascending contrast phlebography in 46 limbs and was found to be 100% accurate in detecting both acute and chronic venous thrombosis. Overall, acute DVT was present in 63 of 76 limbs (83%) studied. Acute DVT was found in 24% and recurrent acute DVT in 76%. Our results indicate that although the calf veins are the most common site of involvement (89%), thrombi may frequently arise simultaneously in multiple anatomic sites. All limbs with recurrent acute DVT had evidence of previous calf thrombi but only 13% had previous proximal disease. This suggests that asymptomatic calf DVT is common and the prevalence of recurrent acute DVT is significantly greater than previously believed. We found UI is a practical, accurate, non-invasive method for investigating the pathogenesis of venous disease.

Noninvasive diagnosis of clinically suspected deep venous thrombosis.

One hundred ten patients with clinically suspected deep venous thrombosis (DVT) were investigated by both venography and noninvasive testing (segmental air plethysmography and Doppler ultrasonography). The noninvasive tests were normal in all limbs that were normal by venography. The tests detected proximal venous thrombi (popliteal, femoral, or iliac) in 47 of the 50 limbs (94%) with venographically documented thrombi, but in only six of 16 limbs (37%) with calf DVT. Severe extrinsic compression could not be distinguished from acute DVT, but remote DVT usually could be distinguished from acute DVT. An abnormal noninvasive test is a usefiil finding on which therapeutic decisions can be based. A negative noninvasive test will not exclude calf vein thrombi or nonocclusive proximal vein thrombi.