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Kim JH, Lee SK, Kim EH, Kim JY. Acute left iliofemoral vein thrombosis: Comparison between simple and bony May-Thurner syndrome in CT venography. Vascular 2023; 31:1230-1239. [PMID: 35762344 DOI: 10.1177/17085381221111010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the etiology of May-Thurner syndrome (MTS) with acute iliofemoral deep vein thrombosis (DVT) regarding imaging findings and clinical features. METHODS We retrospectively analyzed 57 patients with acute left iliofemoral DVT from 2015 to 2020. The diameter of left common iliac vein (LCIV) at the maximal compression site and its percent compression regarding the average diameter of the uncompressed iliac vein were recorded in central and distal portions of the LCIV according to the location in the quadrant of lumbar vertebral body. Compression was categorized into simple and bony MTS; Simple MTS as LCIV compressed by the right common iliac artery (RCIA) versus Bony MTS as LCIV by lower lumbar degenerative changes regardless of RCIA compression. Initial computed tomographic venography (CTV) regarding chronic change of LCIV such as fibrotic atrophy or cordlike obliteration, extent of thrombus, and lumbar degenerative changes were evaluated. Therapeutic effect after initial therapy was assessed in follow-up CTVs after 3-6 months. RESULTS All patients showed LCIV compression with 19 simple MTS (mean age, 42.8 ± 14.1 years [23-67 years]; 12 females; symptom for 4.4 ± 5.5 days) and 38 bony MTS (mean age, 73.0 ± 10.2 years [49-85 years]; 26 females; symptom for 5.5 ± 4.8 days). There was significant difference in age (p < .001) and no significant difference in sex or symptom duration between two groups (p = .691 and 0.415, respectively). All simple MTS showed compression only in the central LCIV and half of bony MTS showed compression in both central and distal LCIV (p < .001). Among the lumbar degenerative changes, symmetric anterolateral osteophyte (p < .001) and asymmetric osteophyte (p < .001) were significantly associated with bony MTS, but not scoliosis (p = .799), compared to simple MTS. Although there was no significant difference in chronic change of LCIV, thrombosis extent, and therapeutic effect between two groups (p > .05), chronic change of LCIV showed significant difference between single and dual compression (23.7% vs. 57.9%, p = .024) and residual thrombus after initial therapy was occurred in 21.1% of single compression and 47.4% in dual compression with non-significant trend (p = .082). CONCLUSION Bony MTS related to lumbar degenerative changes with acute iliofemoral DVT occurs in older patients, presenting more than one stenosis at LCIV, inducing more chronic change with possibly weaker therapeutic effect than simple MTS.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eu Hyun Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim JH, Lee SK, Kim JY. Iliac vein compression syndrome by lumbar degenerative changes is associated with deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:5833-5842. [PMID: 36799994 DOI: 10.1007/s00402-023-04811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION This study aimed to identify whether iliac vein compression syndrome(IVCS) is associated with deep vein thrombosis(DVT) after total knee arthroplasty(TKA) and whether lower lumbar degenerative changes were risk factors for IVCS. MATERIALS AND METHODS A total of 259 consecutive patients who underwent TKA from January 2019 to March 2022 was retrospectively reviewed. Preoperative plain radiographs of lumbar spines and CT venography (CTV) for DVT diagnosis at postoperative 7 days were performed in all patients. Imaging findings of lower lumbar degenerative changes were analyzed on plain radiograph including lateral osteophytes, scoliosis, lateralolisthesis, retrolisthesis, anterolisthesis, and lower lumbar lordosis angle (LLLA). Percent compression at the left common iliac vein (LCIV) and right common iliac vein (RCIV) as well as DVT were evaluated on CTV. Moreover, IVCS was defined as greater than 50% of compression of the iliac vein on CTV. RESULTS DVT occurred in 79 patients (30.5%) after TKA. The overall occurrence of DVT was significantly higher in patients with IVCS of LCIV (52.8%) than those without (18.8%, P < 0.001). When DVT was further subdivided, compared to non-IVCS, IVCS of LCIV was significantly associated with bilateral DVT (P < 0.001, both), especially distal DVT (P < 0.001, both), and IVCS of RCIV was significantly associated with right-side DVT (P = 0.031), especially popliteal (P = 0.008) and distal DVT(P = 0.011). Female patients (OR: 3.945, P = 0.039), presence of left osteophyte (OR: 2.348, P = 0.006), and higher LLLA (OR: 1.082, P < 0.001) were significantly associated with IVCS of LCIV, and presence of right osteophyte (OR: 3.494, P = 0.017) was significantly associated with IVCS of RCIV. CONCLUSION IVCS was significantly associated with DVT after TKA and lumbar degenerative changes with lateral osteophytes and hyperlordosis were significant risk factors for IVCS.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 05278, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea.
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea
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Sato T, Yoshimura N, Horii Y, Yamazaki M, Sato K, Kumagai K, Ishikawa H. Low Tube Voltage Computed Tomography Venography for Patients With Deep Vein Thrombosis of the Lower Extremities - A Comparison With Venous Ultrasonography. Circ J 2021; 85:369-376. [PMID: 33441495 DOI: 10.1253/circj.cj-20-0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low tube voltage computed tomography venography (CTV) can be expected to increase imaging contrast and decrease radiation exposure by using iterative reconstruction (IR). This study evaluated the diagnostic ability of low tube voltage CTV with IR for deep vein thrombosis (DVT), compared to ultrasonography (US).Methods and Results:Two experienced radiologists retrospectively reevaluated the CTV data of 55 of 318 consecutive patients suspected of having DVT or pulmonary embolism between December 2015 and April 2017. The 55 patients had undergone both low tube voltage CTV and US (within 1 day before or after CTV). The lower extremity veins were divided into 10 segments. The DVT forms were categorized into 3 types: complete, concentric, and eccentric. We analyzed the 534 overall segments (16 segments excluded in US) measured using both CTV and US. The sensitivity-specificity was overall 73.3-90.0%, for femoropopliteal, it was 90.0-93.2%, and for the calf, it was 71.1-87.2%. The diagnostic accuracy between the 'eccentric only' and 'others' groups focusing on DVT forms was compared, and significant differences were revealed, especially in the muscular vein. CONCLUSIONS The DVT diagnostic ability above the knee was comparable between low tube voltage CTV with IR and conventional CTV, and the radiation dose was reduced. It was suggested that eccentric DVT measured by CTV tend to be a false-positive, especially in the calf muscular vein.
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Affiliation(s)
- Tatsuhiko Sato
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Norihiko Yoshimura
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Yosuke Horii
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Motohiko Yamazaki
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Ken Sato
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazuki Kumagai
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
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Masi Z, Gussman K, Hazelton JP, Gefen R. Evaluation of the diagnostic value of a venous phase in CT angiography of the extremities in the setting of trauma: is vein imaging in vain? Emerg Radiol 2017; 24:335-340. [PMID: 28150047 DOI: 10.1007/s10140-017-1480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE This study examined the value of including a venous phase in addition to the initial arterial phase in the CT angiography evaluation of extremity trauma. METHODS CT studies from 157 patients (average age 38 years, age range 18-89 years, male 83%, female 17%) were obtained for trauma to the upper or lower extremity with both arterial and venous phases and retrospectively reviewed. The detection rate and type of vascular injury were evaluated by using the arterial phase alone and compared to the detection rate when interpreting the arterial and venous phases together. RESULTS Arterial injury was identified in 35 cases (22%), and venous injury was identified in seven cases (5%). Four cases of discrepant diagnoses were identified between image interpretation of the arterial phase alone and interpretation using both phases, all of which were venous injuries that were visible only on the venous phase. None of the four cases of venous injury required a change in surgical management. Overall, no significant difference in diagnosis between the two methods of image interpretation (arterial phase alone, arterial and venous phases) was discovered (p > 0.125; CI 95%). CONCLUSIONS The use of a venous phase in the CT angiography evaluation of extremity trauma does not add significant arterial diagnostic or clinical management value despite its potential of increasing the diagnostic detection rate of venous injury.
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Affiliation(s)
- Zachary Masi
- Department of Radiology, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Kathryn Gussman
- Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Joshua P Hazelton
- Department of Surgery, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Ron Gefen
- Department of Radiology, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA.
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Validity of a New Quantitative Evaluation Method that Uses the Depth of the Surface Imprint as an Indicator for Pitting Edema. PLoS One 2017; 12:e0170810. [PMID: 28129366 PMCID: PMC5271403 DOI: 10.1371/journal.pone.0170810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
Abstract
This study examined the validity of a practical evaluation method for pitting edema by comparing it to other methods, including circumference measurements and ultrasound image measurements. Fifty-one patients (102 legs) from a convalescent ward in Maruyama Hospital were recruited for study 1, and 47 patients (94 legs) from a convalescent ward in Morinaga Hospital were recruited for study 2. The relationship between the depth of the surface imprint and circumferential measurements, as well as the relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue on an ultrasonogram, were analyzed using a Spearman correlation coefficient by rank. There was no significant relationship between the surface imprint depth and circumferential measurements. However, there was a significant relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue as measured on an ultrasonogram (correlation coefficient 0.736). Our findings suggest that our novel evaluation method for pitting edema, based on a measurement of the surface imprint depth, is both valid and useful.
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Zhang T, He X, Li H, Xu S. Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel. BMC Musculoskelet Disord 2016; 17:49. [PMID: 26832740 PMCID: PMC4736612 DOI: 10.1186/s12891-016-0902-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been no consensus regarding what is the optimal means of treating lumbosacral segment tuberculosis. The aim of this study was to evaluate the clinical outcomes of our newly developed one-stage anterior debridement and fusion combined with dual screw-rod construct anterior instrument underneath the iliac vessels for lumbosacral spinal tuberculosis. METHODS We retrospectively reviewed 22 patients with lumbosacral spinal tuberculosis who underwent one-stage anterior debridement and fusion combined with dual screw-rod anterior instrument underneath the iliac vessels between January 2004 and June 2013. We assessed the visual analogue scale (VAS), erythrocyte sedimentation rates (ESR), neurological performance, kyphotic angles, fusion rates, and computed tomographic angiography (CTA) before and after surgery. RESULTS All patients were followed-up for a mean of 46.59 months. There were no instances of spinal tuberculosis recurrence. The mean VAS scores and ESR decreased significantly from the preoperative levels both postoperatively and at the final follow-up (all P <0.001). The mean kyphotic angle significantly increased from the mean preoperative angle both postoperatively and at the final follow-up (both P <0.001). All patients had bone fusion at a mean of five months after surgery. No postoperative vascular complications were observed. CONCLUSIONS Our findings suggest that anterior radical debridement, fusion combined with dual screw-rod anterior instrument underneath the iliac vessels can be an effective and safe treatment option for lumbosacral segment tuberculosis.
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Affiliation(s)
- Ting Zhang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an, 710004, Shaanxi, P.R China
| | - Xijing He
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an, 710004, Shaanxi, P.R China.
| | - Haopeng Li
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an, 710004, Shaanxi, P.R China
| | - Siyue Xu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an, 710004, Shaanxi, P.R China
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Abstract
Objectives To determine the frequency of left common iliac vein (CIV) compression by the right common iliac artery (CIA) based on CT scan images. Methods CT scan images were reviewed and the diameter of CIV was measured at the area of minimal diameter and compared to the distal adjacent segment and the contralateral CIV at the same level. Medical records were reviewed for symptoms, deep vein thrombosis (DVT) and risk factors that might be associated with DVT. Data were analyzed with SPSS program using both Chi square and t test. A p < 0.05 was considered statistically significant. Linear regression (R2) was used to evaluate correlation. Results A total of 300 complete records were reviewed. The mean age was 51.89 years, with 126 (42%) males. Comparison between the two groups (>70% vs <70%) showed similar clinical factors such as history of DVT, surgery, immobilization, malignancy, limb trauma, pregnancy, obesity, CHF, and smoking. There were more females with CIV compression of 70% or more than males (19.5% vs 11.1% P < .049). Conclusion Diameter stenosis more than 70% was present in 30.6% of cases with higher incidence in females. The presence of stenosis was not associated with the presence of clinical symptoms.
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Comparison of characteristic CT findings of lymphedema, cellulitis, and generalized edema in lower leg swelling. Int J Cardiovasc Imaging 2013; 29 Suppl 2:135-43. [PMID: 24293042 DOI: 10.1007/s10554-013-0332-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
To determine the different computed tomography (CT) findings of lymphedema, cellulitis, and generalized edema in the lower leg. CT images of 44 patients with confirmed lymphedema (n = 19), cellulitis (n = 11), or generalized edema (n = 14) were retrospectively reviewed. The following characteristics were evaluated: extent of edema, laterality, skin thickening, honeycombing, taller than wide appearance, muscle edema, conglomeration of septum of fat lobule, fluid collection, fascial enhancement, inguinal lymph node (LN) enlargement, medullary fat obliteration of inguinal LN, trunk subcutaneous edema, and bone marrow edema. Fisher's exact test with Bonferroni correction was used for multiple comparisons. Honeycombing and taller than wide appearance of fat lobules were more common in lymphedema (P < 0.01). Fat obliteration of inguinal LN and inguinal LN enlargement at the affected side were more common in cellulitis (P < 0.01). Bone marrow and subcutaneous edema of the trunk were more common in generalized edema (P < 0.01). Honeycombing is commonly seen in lymphedema, but is not a specific finding. Inguinal LN enlargement is a specific sign of cellulitis. Truncal edema and bone marrow edema were specific findings of generalized edema.
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Arnoldussen CWKP, de Graaf R, Wittens CHA, de Haan MW. Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. Phlebology 2013; 28 Suppl 1:169-75. [PMID: 23482555 DOI: 10.1177/0268355513477785] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For the treatment of chronic venous disease (CVD) of the lower extremity, identification of the underlying venous pathologies is essential. Traditionally, the pathologies to detect with imaging have been centred on insufficiency and reflux of the superficial, perforator and deep veins of the leg. More recently, stenosis and obstruction of the deep veins of the pelvis and abdomen (i.e. inferior vena cava, common and external iliac veins) have been identified as significant underlying pathologies in CVD. Accurate detection of stenotic and/or occlusive venous disease expands the treatment options for patients with CVD. In most cases, imaging of venous disease is performed with duplex ultrasound. In this article we discuss the existing evidence and potential value of computed tomographic venography and magnetic resonance venography to contribute in accurately identifying chronic venous disease, in particular chronic venous obstruction.
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Affiliation(s)
- C W K P Arnoldussen
- Department of Radiology and Interventional Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Uhl JF. Three-dimensional modelling of the venous system by direct multislice helical computed tomography venography: technique, indications and results. Phlebology 2013; 27:270-88. [PMID: 23155152 DOI: 10.1258/phleb.2012.012j07] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of multislice helical computed tomography venography (CTV) is to provide a precise, global and three-dimensional (3D) anatomical depiction of the venous network of the lower limbs. A multislice and multidetector spiral CT acquisition of the lower limbs with contrast injection of the dorsal foot produces about 1000 slices in 30 seconds. Dedicated volume-rendering software can compute a realistic and interactive 3D model of the venous system in realtime. This new tool furnishes an accurate 3D representation of the whole venous system of the lower limb with a realistic 3D model of the limbs, providing a road map of the varicose networks complementary to the duplex ultrasound (DUS). CTV allows a complete morphological study of the deep veins, including the detection of anatomical variations and proximal venous obstruction, not easily detectable by DUS. In the case of deep vein thrombosis, it has been shown to be a good diagnostic tool, well correlated with sonography. It also demonstrates, in some cases, haemodynamic patterns which are not available by DUS, particularly for perforator veins and congenital vascular malformations. The use of virtual reality techniques enables a complete anatomical study of both deep and superficial veins including a virtual dissection of the limbs. CTV is also a great educational tool to learn anatomy of the venous system and a powerful research tool to improve our knowledge of venous anatomy.
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Affiliation(s)
- J F Uhl
- Varicose Vein Surgical Center, 113 Avenue Victor Hugo, 75116 Paris, France.
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Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Kløw NE. Determinants of Early and Long-term Efficacy of Catheter-directed Thrombolysis in Proximal Deep Vein Thrombosis. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2012.09.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yukizawa Y, Inaba Y, Watanabe SI, Yajima S, Kobayashi N, Ishida T, Iwamoto N, Hyonmin C, Nakamura M, Saito T. Plasma accumulation of fondaparinux 2.5 mg in patients after total hip arthroplasty. J Thromb Thrombolysis 2012; 34:526-32. [DOI: 10.1007/s11239-012-0773-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eliahou R, Sosna J, Bloom AI. Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 2012; 32:E33-49. [PMID: 22236908 DOI: 10.1148/rg.321115011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
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Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Lohr JM, McLafferty RB, Murad MH, Padberg F, Pappas P, Raffetto JD, Wakefield TW. Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2012; 55:1449-62. [DOI: 10.1016/j.jvs.2011.12.081] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 12/08/2011] [Accepted: 12/27/2011] [Indexed: 11/26/2022]
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15
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Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e351S-e418S. [PMID: 22315267 DOI: 10.1378/chest.11-2299] [Citation(s) in RCA: 404] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Objective testing for DVT is crucial because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. This guideline focuses on the identification of optimal strategies for the diagnosis of DVT in ambulatory adults. METHODS The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. RESULTS We suggest that clinical assessment of pretest probability of DVT, rather than performing the same tests in all patients, should guide the diagnostic process for a first lower extremity DVT (Grade 2B). In patients with a low pretest probability of first lower extremity DVT, we recommend initial testing with D-dimer or ultrasound (US) of the proximal veins over no diagnostic testing (Grade 1B), venography (Grade 1B), or whole-leg US (Grade 2B). In patients with moderate pretest probability, we recommend initial testing with a highly sensitive D-dimer, proximal compression US, or whole-leg US rather than no testing (Grade 1B) or venography (Grade 1B). In patients with a high pretest probability, we recommend proximal compression or whole-leg US over no testing (Grade 1B) or venography (Grade 1B). CONCLUSIONS Favored strategies for diagnosis of first DVT combine use of pretest probability assessment, D-dimer, and US. There is lower-quality evidence available to guide diagnosis of recurrent DVT, upper extremity DVT, and DVT during pregnancy.
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Affiliation(s)
- Shannon M Bates
- Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
| | - Roman Jaeschke
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Scott M Stevens
- Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Steven Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew D Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Clive Kearon
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Holger J Schunemann
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Stephen G Pauker
- Department of Medicine, Tufts New England Medical Center, Boston, MA
| | | | - Gordon H Guyatt
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- Lawrence V Hofmann
- Division of Interventional Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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17
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Meetoo D. In too deep: understanding, detecting and managing DVT. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2010; 19:1021-7. [PMID: 20852464 DOI: 10.12968/bjon.2010.19.16.78188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious health and social care problem of the developed world, affecting 1 in 1000 adults every year, and with an annual financial overhead of approximately £640 million. The nature of DVT means that often the condition can go unrecognized until the thrombus becomes an embolus. The pathogenesis of DVT continues to be based on Virchow's triad, which attributes VTE to 'hypercoagulability', 'stasis' and 'intimal injury'. The diagnosis of DVT is often the result of a number of tests performed either sequentially or in combination before mechanical and/or chemical treatment is embarked on. Creating public awareness of DVT and PE is the best way to prevent this condition. Nurses are in an ideal position to discuss the importance of lifestyle changes and other related measures to prevent DVT.
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Affiliation(s)
- Danny Meetoo
- School of Nursing and Midwifery, University of Salford
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May-Thurner Syndrome Complicated by Acute Iliofemoral Vein Thrombosis: Helical CT Venography for Evaluation of Long-Term Stent Patency and Changes in the Iliac Vein. AJR Am J Roentgenol 2010; 195:751-7. [DOI: 10.2214/ajr.09.2793] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Multidetector computed tomography venography: optimum dose of contrast material. Jpn J Radiol 2010; 28:335-9. [PMID: 20585920 DOI: 10.1007/s11604-010-0428-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to determine the optimum dose of contrast material for evaluating veins in the lower limbs. MATERIALS AND METHODS A total of 134 patients who underwent multidetector computed tomography (MDCT) due to suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) were included in this study. One hundred milliliters of iopamidol 100 ml, with 370 mg I/ml was administered. The degree of contrast enhancement of veins in the lower limbs was classified on a 4-point scale (grade 1, poor --> 4, excellent). Regions of interest (ROIs) were positioned in the femoral vein and the popliteal vein to measure CT numbers in these veins. Correlations between the CT number in each ROI and body weight were examined. RESULTS The mean +/- SD body weights of patients by contrast-enhancement grade were as follows: grade 1, 86.3 +/- 10.2 kg; grade 2, 72.6 +/- 10.7 kg; grade 3, 59.7 +/- 8.7 kg; grade 4, 51.3 +/- 7.9 kg. Negative correlations were found between body weight and CT number for both the femoral vein and the popliteal vein. Grade 3 or better contrast enhancement was obtained in 79 of 81 patients (97.5%) weighing <60 kg. CONCLUSION For patients weighing <60 kg, 100 ml of contrast material (370 mg I/ml) is considered sufficient for evaluating veins in the lower limbs.
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Kim SH, Chung SW, Kim CW. The Efficacy of Endovascular Treatment for Deep Vein Thrombosis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seon-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University
| | - Sung Woon Chung
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University
| | - Chang Won Kim
- Department of Radiology, School of Medicine, Pusan National University
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Abstract
In this article, we discuss the approach for diagnosing deep vein thrombosis (DVT) in different patient populations. Clinical features and probability assessment guide further diagnostic tests. D-dimer testing is used as screening test; however, duplex ultrasound remains the primary confirmatory test. Computed tomography and magnetic resonance imaging are used only in select patient populations, such as when ultrasound results are equivocal, in patients suspected of central venous DVT, or as a part of combined protocol for diagnosis of pulmonary embolism. Contrast phlebography and plethysmography do not have much of a role during routine diagnosis of DVT.
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Affiliation(s)
- Bhanusupriya Somarouthu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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22
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The Role of Venoscintigraphy in the Image Diagnostics of Lower Limb Venous System. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Abstract
Abstract
Background
Deep vein thrombosis of the leg affects 1–2 per cent of the population with an annual incidence of 0·5–1 per 1000. It presents with non-specific symptoms and signs making clinical diagnosis difficult. Techniques to image and diagnose this condition are advancing rapidly.
Methods and results
A literature review from 1980 to 2007 was undertaken using PubMed, The Cochrane Library, Medline and Embase. The most frequently used diagnostic test is duplex ultrasonography which is accurate above the knee and has a low cost, but is limited by inaccuracy when assessing the pelvic and distal veins and in diagnosing a new thrombosis in the post-thrombotic limb. Magnetic resonance imaging (MRI) and sonographic elasticity imaging are more recent techniques that have shown promise in overcoming these limitations. However, their availability is currently restricted because they are expensive. Computed tomography (CT) is sensitive, specific and provides good imaging of the pelvis. It has the advantage that it can be performed at the same time as CT pulmonary angiography.
Conclusion
MRI has some specific advantages over duplex ultrasonography, but requires refinement before it can be used clinically. Venography or CT venography should be considered when duplex scanning is inadequate.
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Affiliation(s)
- J H Orbell
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - A Smith
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - K G Burnand
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - M Waltham
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
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Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis. Clin Radiol 2007; 63:299-304. [PMID: 18275870 DOI: 10.1016/j.crad.2007.09.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 09/24/2007] [Indexed: 11/21/2022]
Abstract
AIM To estimate the sensitivity and specificity of computed tomography (CT) for the diagnosis of deep vein thrombosis (DVT) in patients with suspected DVT and pulmonary embolus (PE). MATERIALS AND METHODS A search of the medical literature and citation lists was undertaken, and selected studies comparing CT to a reference standard in patients with suspected DVT or PE were retrieved. Data were analysed by random effects meta-analysis. RESULTS Thirteen articles were included in the meta-analysis. Most compared CT to ultrasound in patients with clinically suspected PE. The sensitivity ranged from 71-100%, while specificity ranged from 93-100%. The pooled estimate of sensitivity was 95.9% (95% CI 93 to 97.8%) and the pooled estimate of specificity was 95.2% (93.6 to 96.5%). However, pooled estimates should be interpreted with caution as these were subject to significant heterogeneity (p=0.025 and p<0.001, respectively). Most studies only appeared to report proximal DVT. Too few data were available to estimate sensitivity for distal DVT. CONCLUSIONS CT has a similar sensitivity and specificity to ultrasound in patients with suspected PE where investigation of suspected DVT is required. There is insufficient research to determine the diagnostic accuracy of CT in patients with suspected DVT alone.
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Park EA, Lee W, Lee MW, Choi SI, Jae HJ, Chung JW, Park JH. Chronic-Stage Deep Vein Thrombosis of the Lower Extremities. J Comput Assist Tomogr 2007; 31:649-56. [PMID: 17882048 DOI: 10.1097/rct.0b013e31803151d9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the computed tomographic (CT) findings of chronic deep vein thrombosis (DVT) and its evolution from acute DVT. METHODS Fifty-one consecutive patients with 52 legs confirmed as acute DVT by CT venography underwent follow-up computed tomography more than 2 months later. Follow-up CT findings were assessed retrospectively by consensus between 2 radiologists. The frequencies of CT findings were analyzed for affected venous segments: common iliac, external iliac, femoral, popliteal, and calf veins. RESULTS Twelve legs (23%) were completely normalized on follow-up computed tomography, but 40 legs (77%) showed abnormal findings as follows: luminal obliteration (n = 16), decreased caliber (n = 30), residual thrombi (n = 3), fibrotic bands (n = 28), ipsilateral muscle enlargement (n = 28), ipsilateral subcutaneous edema (n = 11), and superficial collateral vein development (n = 23). The external iliac vein (26/40, 65%) was the most commonly affected site followed in decreasing order by femoral (29/50, 58%), common iliac (9/18, 50%), popliteal (22/47, 47%), and calf veins (9/43, 21%). Trends were observed whereby luminal obliteration affected iliac veins and fibrotic bands affected femoropopliteal veins. CONCLUSIONS Luminal obliteration, decreased caliber, fibrotic bands, ipsilateral muscle enlargement, and superficial collateral vein development are common CT findings in chronic DVT of the lower extremity.
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Affiliation(s)
- Eun-Ah Park
- Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, Korea
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26
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Dodd JD. Evidence-based Practice in Radiology: Steps 3 and 4—Appraise and Apply Diagnostic Radiology Literature. Radiology 2007; 242:342-54. [PMID: 17255406 DOI: 10.1148/radiol.2422051679] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several paradigms for evidence-based practice (EBP) exist. One model proposes that specialist academic centers should primarily construct valid guidelines for various topics in medicine (top-down model). An alternative model integrates "the best research evidence with clinical expertise and patient values" (bottom-up model). Whereas the former model inherently implies a central specialized process, the latter implies that practitioners working in nonspecialist centers can learn and implement a standardized set of tools with which to ask a question, search and appraise the literature, and then apply best current evidence in a local setting. This article focuses on appraising the literature and applying retrieved results and is part of a series on EBP in radiology. This article describes a clinical scenario in which a new respirologist at a hospital requests indirect computed tomographic (CT) venography as part of a work-up of a patient with a high pretest probability for pulmonary embolism and a positive d-dimer test result. Many controversies surround the technique of indirect CT venography, and difficult topics such as this are ideally suited to the tools of EBP. This article will describe how to approach such a scenario.
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Affiliation(s)
- Jonathan D Dodd
- Department of Radiology, Massachusetts General Hospital, Boston, Mass, USA.
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Lim KE, Hsu WC, Hsu YY, Chu PH, Ng CJ. Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients. Clin Imaging 2005; 28:439-44. [PMID: 15531146 DOI: 10.1016/s0899-7071(03)00319-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the accuracy of indirect mutidetector row computed tomographic (MDCT) venography with lower extremity venous sonography for the diagnosis of femoropopliteal deep venous thrombosis (DVT), and to determine the frequency and location of DVT at MDCT venography. MATERIALS AND METHODS Twenty-six consecutive patients suspected of having pulmonary embolism (PE) underwent both combined MDCT venography and MDCT pulmonary angiography and lower extremity venous sonography. Indirect MDCT venography was acquired from the upper calves to the mid-abdomen following MDCT pulmonary angiography. The CT venographic findings were compared with those of sonography for the diagnosis of femoropopliteal DVT. All CT scans were also reviewed for the frequency and location of DVT. RESULTS Indirect MDCT venography disclosed DVT in 19 patients, and 12 of whom also had PE. Seventeen patients with thrombosis in the femoropopliteal veins were identified in both indirect MDCT venography and sonography. The sensitivity and specificity of indirect MDCT venography for femoropopliteal DVT, as compared with sonography, were both 100%. In one patient DVT in the superficial femoral vein was detected using only indirect MDCT venography. MDCT venography also showed superior extension of femoropopliteal DVT to the inferior vena cava and iliac veins in four patients and thrombosis isolated to the inferior vena cava and common iliac vein thrombosis in one patient. CONCLUSIONS Indirect MDCT venography is as accurate as sonography in the diagnosis of femoropopliteal DVT. MDCT venography can further reveal thrombus in large pelvis veins and the inferior vena cava, an important advantage over sonographic screening for DVT.
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Affiliation(s)
- Kun-Eng Lim
- Department of Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC.
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Oguzkurt L, Tercan F, Pourbagher MA, Kizilkilic O, Turkoz R, Boyvat F. Computed tomography findings in 10 cases of iliac vein compression (May-Thurner) syndrome. Eur J Radiol 2004; 55:421-5. [PMID: 16129251 DOI: 10.1016/j.ejrad.2004.11.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 11/08/2004] [Accepted: 11/10/2004] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present the computed tomography (CT) findings for the iliac veins of 10 patients who had left-sided lower extremity deep vein thrombosis due to iliac vein compression syndrome. MATERIALS AND METHODS The CT findings for 10 cases of left-sided acute or chronic deep vein thrombosis caused by iliac vein compression syndrome were retrospectively evaluated. The patients were five women and five men (mean age+/-S.D., 49.9+/-15.6 years). In each patient with iliac vein compression syndrome, the diagnosis of the compression was established by venography performed during endovascular treatment. Diameter of the left common iliac vein was also measured in 14 control subjects without any lower extremity venous disease for comparison. RESULTS In all 10 cases, CT images in the transverse plane demonstrated the left common iliac vein being compressed by the overlying right common iliac artery. The mean diameter at the origin of the left common iliac vein (3.5 mm) in patients group was much smaller than the mean diameter of the same vein (11.5 mm) in the control group (p<0.01). The mean percent stenosis of the left common iliac vein due to compression by the artery was 68%. CONCLUSION Pelvic CT images in the transverse plane are useful for detecting iliac vein compression by the overlying right common iliac artery in patients with left-sided deep vein thrombosis. Radiologists should be aware of this imaging finding of iliac vein compression by the artery where the inferior vena cava bifurcates into the common iliac veins.
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Affiliation(s)
- Levent Oguzkurt
- Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana, Turkey.
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Edmonds MJR, Crichton TJH, Runciman WB, Pradhan M. Evidence-based risk factors for postoperative deep vein thrombosis. ANZ J Surg 2004; 74:1082-97. [PMID: 15574153 DOI: 10.1111/j.1445-1433.2004.03258.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a common postoperative complication that is associated with significant morbidity and mortality. Thromboprophylaxis has been shown to be underused. In the absence of prophylaxis, rates as high as 50% have been reported following orthopaedic surgery, and 25% following general surgery. Many risk factors have been suggested but there is often little evidence to support these claims. METHODS A systematic review was performed to determine the evidence base behind each suggested risk factor, and, where sufficient data were available, a random-effects meta-analysis was performed. RESULTS There is evidence to support a significant association between increased age, obesity, a past history of thromboembolism, varicose veins, the oral contraceptive pill, malignancy, Factor V Leiden gene mutation, general anaesthesia and orthopaedic surgery, with higher rates of postoperative DVT, although there remain some variables within the study designs that may lead to overestimation of effect. There is no evidence to support the suggested risk factors of hormone replacement therapy, gender, ethnicity or race, chemotherapy, other thrombophilias, cardiovascular factors, smoking and blood type. CONCLUSIONS An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use.
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Affiliation(s)
- Michael J R Edmonds
- Health Informatics Unit, University of Adelaide, Adelaide, South Australia 5000, Australia
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Chung JW, Yoon CJ, Jung SI, Kim HC, Lee W, Kim YI, Jae HJ, Park JH. Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol 2004; 15:249-56. [PMID: 15028809 DOI: 10.1097/01.rvi.0000109402.52762.8d] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the spectrum of underlying anatomic abnormalities in iliofemoral deep vein thrombosis (DVT) by spiral computed tomographic (CT) venography. MATERIALS AND METHODS During the past 4 years, 56 patients with acute iliofemoral DVT have been evaluated by CT venography at our institution. Forty-four patients had left-sided DVT, nine had right-sided DVT, and the remaining three had DVT in both extremities. CT venography was performed with use of 2.5-3.2-mm x-ray beam collimation and a 1.25-2.0-mm reconstruction interval. Spiral scans were initiated 5 minutes after intravenous contrast medium injection. The CT venograms were correlated with catheter venograms. In addition, with use of axial sections and their three-dimensional reconstructions, including multiplanar reformation and volume rendering, the presence or absence of central obstructing lesions and their causes were evaluated. RESULTS Among 44 patients with left-sided DVT, 37 had significant anatomic abnormalities in their iliofemoral veins or inferior vena cava (IVC). The most common lesion was left common iliac vein compression by the right common iliac artery (n = 27; exaggerated by a bony spur in nine and associated with extrinsic compression by the left internal iliac artery in two). Of the nine patients with right-sided DVT, six had significant anatomic abnormalities including encasement or extrinsic compression of their iliac veins by various causes (n = 3) and venous stricture without extrinsic lesions (n = 3). Among three patients with DVT in both extremities, two had anatomic abnormalities in the IVC. Therefore, 45 of 56 patients had anatomic abnormalities central to the thrombosed deep veins. CONCLUSION The majority of patients with acute iliofemoral DVT had underlying anatomic abnormalities. The presence of central stenosis or obstruction and their causes can be evaluated by spiral CT venography.
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Affiliation(s)
- Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, Korea.
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Jang T, Docherty M, Aubin C, Polites G. Resident-performed compression ultrasonography for the detection of proximal deep vein thrombosis: fast and accurate. Acad Emerg Med 2004; 11:319-22. [PMID: 15001419 DOI: 10.1111/j.1553-2712.2004.tb02220.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess whether emergency medicine residents (EMRs) could quickly perform accurate compression ultrasonography (CUS) for the detection of proximal lower extremity deep vein thromboses (PLEDVTs) with minimal training. METHODS A prospective, observational study using a convenience sample of patients presenting with signs and/or symptoms for PLEDVT. Vascular laboratory and department of radiology studies were considered the criterion standard. CUS of the femoral vessels was performed. Incompressibility or visualized thrombus was considered "positive." RESULTS Eight residents with limited ultrasound (US) experience and no prior experience with deep vein thrombosis (DVT) US volunteered to participate in this study, enrolling 72 patients. Their average scan time was 11.7 minutes (95% CI = 9.4 to 14). There were 23 true positives, 4 false positives, 45 true negatives, and 0 false negatives. The test characteristics for PLEDVT gave a sensitivity of 100% (95% CI = 82.2 to 100) and a specificity of 91.8% (95% CI = 79.5 to 97.4). CONCLUSION Emergency medicine residents with limited US experience were able to quickly perform CUS after minimal training for the detection of PLEDVT in a select group of patients.
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Affiliation(s)
- Timothy Jang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
Deep vein thrombosis is an important cause of morbidity and mortality worldwide, and its clinical diagnosis is unreliable. This article explains current screening and diagnostic methods as well as treatment
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Affiliation(s)
- Clive Tovey
- Prince Charles Hospital, Merthyr Tydfil, Mid Glamorgan CF47 9DT.
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Castaño J, Alpendre J, Pisco JM. Diagnóstico do embolismo pulmonar. REVISTA PORTUGUESA DE PNEUMOLOGIA 2003; 9:129-37. [PMID: 14685638 DOI: 10.1016/s0873-2159(15)30666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution.
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Affiliation(s)
- João Castaño
- Serviço Universitário de Radiologia do Hospital de Pulido Valente
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34
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Manninen HI. Time for more complete scoring of deep leg vein thrombosis. Acta Radiol 2002. [DOI: 10.1034/j.1600-0455.2002.430301.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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