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DOI: 10.1055/s-0038-1656360
Detection of Asymptomatic Deep Vein Thrombosis by Real-Time B-Mode Ultrasonography in Hip Surgery Patients
Publication History
Received 31 January 1992
Accepted after revision 16 April 1992
Publication Date:
04 July 2018 (online)
Summary
The aim of this study was to prospectively evaluate the accuracy of real-time B-mode ultrasonography in the diagnosis of asymptomatic proximal deep vein thrombosis (DVT) in hip surgery patients. Venography was adopted as the gold standard. We studied 100 consecutive patients undergoing hip surgery: 60 patients for hip fracture and 40 patients for elective hip replacement. Bilateral real-time B-mode ultrasonography was performed prior to bilateral venography. The two diagnostic procedures were performed on the same day by different investigators unaware of the assigned prophylatic regimen for DVT Compressibility of the vein segment was adopted as the single criterion for DVT. Venography was performed and judged by radiologists unaware of the ultrasonography results. In 13 limbs venography was either impossible to perform or not adequate for judgement. Ultrasonography and an adequate venography was obtained in 187 limbs. A venography proven DVT was observed in 49 limbs (26.2%) and a proximal DVT in 21 limbs (11.2%). All the patients were asymptomatic for DVT. The sensitivity and specificity of real time B-mode ultrasonography for proximal DVT were 57% (95% confidence interval: C. I. 36–80) and 99% (C. I. 99–100), respectively and the positive and negative predictive values were 93% (C.I. 73–100) and 95% (C.I. 91–97), respectively. The sensitivity and specificity for overall DVT were 25% (C.I. 11–38) and 99% (C.I. 97–100), respectively and the positive and negative predictive values were 92% (C. I. 73–100) and 79% (C.I. 76–85), respectively. Our data indicate that realtime B-mode ultrasonography for its high specificity could make venography unnecessary in patients with positive results. However, because of its low sensitivity it cannot be used for the screening of DVT in asymptomatic patients, nor can it replace venography for outcome measurements in clinical trials on DVT prophylaxis.
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References
- 1 Haeger K. Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms. Angiology 1969; 20: 219-220
- 2 Cranley JJ, Canos AJ, Sull WJ. The diagnosis of deep venous thrombosis: fallibility of clinical symptoms and signs. Arch Surg 1976; 111: 34-36
- 3 Hull RD, Seeker-Walker RH, Hirsh J. In: Diagnosis of Deep Vein Thrombosis. Thrombosis and Haemostasis: Basic Principles and Clinical Practice. Colman RW, Hirsh J, Marder VJ, Salzman EW. (eds) Lippincott, Philadelphia, PA: 1987. pp 1220-1238
- 4 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
- 5 Lea Thomas M. Routine and special phlebography in the evaluation of venous problems. Venous disorders Bergan JJ, Yao JST. WB Saunders, Philadelphia, PA: 1991: 123-36
- 6 Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Büller HR, Turpie AG, Powers P, Kinch D, Dodd PE, Gill GJ, Leclerc JR, Gent M. Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis. Ann Intern Med 1985; 102: 21-28
- 7 Huisman MV, Büller HR, ten Cate JW, Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. N Engl J Med 1986; 314: 823-828
- 8 Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, ten Cate JW, Huisman MV, Büller HR. Detection of deep-vein thrombosis by real time B-mode ultrasonography. N Engl J Med 1989; 320: 342-345
- 9 Lensing AWA, Levi M, Büller HR, Prandoni P, Vigo M, Agnelli G, Lupattelli L, Huisman MV, ten Cate JW. Diagnosis of deep-vein thrombosis using an objective Doppler method. Ann Intern Med 1990; 113: 09-13
- 10 Cruickshank MK, Levine MN, Hirsh J, Turpie AGG, Powers P, Jay R, Gent M. An evaluation of impedance plethysmography and 125I-fibrinogen leg scanning in patients following hip surgery. Thromb Haemostas 1989; 62: 830-834
- 11 Borris LC, Christiansen HM, Lassen MR, Olsen AD, Schøtt P. Comparison of real-time B-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thromb Haemostas 1989; 61: 363-365
- 12 Woolson ST, McCrory DW, Walter JF, Maloney WJ, Watt JM, Cahill PD. B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement. J Bone J Surg 1990; 72A: 983-987
- 13 Ginsberg JS, Brill-Edwards P, Panju A, Bona R, Demers C. Compression ultrasonography and impedance plethysmography for the detection of venous thrombosis in patients who have undergone major hip or knee surgery. Thromb Haemostas 1991; 65: 1173
- 14 Barnes RW, Nix ML, Barnes CL, Lavender RC, Golden WE, Harmon BH, Ferris EJ, Nelson CL. Perioperative asymptomatic venous thrombosis: Role of duplex scanning versus venography. J Vasc Surg 1989; 9: 251-260
- 15 Comerota AJ, Katz ML, Greenwald LL, Leefmans E, Czeredarczuk M, White JV. Venous duplex imaging: Should it replace hemodynamic tests for deep venous thrombosis?. J Vasc Surg 1990; 11: 53-61
- 16 Cronan JJ, Froehlich JA, Dorfman GS. Image-directed Doppler ultrasound: A screening technique for patients at high risk to develop deep vein thrombosis. J Clin Ultrasound 1991; 19: 133-138
- 17 Büller HR, Lensing AWA, Hirsh J, ten Cate JW. Deep vein thrombosis: new non-invasive diagnostic test. Thromb Haemostas 1991; 66: 133-137
- 18 Appelman PT, De Jong TE, Lampmann LE. et al Deep venous thrombosis of the leg: US findings. Radiology 1987; 163: 743-746
- 19 Sackett D, Haynes R, Tugwell P. In: Clinical Epidemiology a Basic Science for Clinical Medicine. Little, Brown and Company: Boston, IL: 1985. 1st ed, pp 059-138
- 20 Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 1988; 318: 1162-1173
- 21 Agnelli G, Longetti M, Cosmi b, Lupattelli L, Barzi F, Levi M, Nenci GG. Diagnostic accuracy of the computerized impedance plethysmography (C. I. P. 8/32) in the diagnosis of symptomatic deep vein thrombosis: a venography controlled study. Angiology 1990; 41: 559-564
- 22 Agnelli G, Cosmi B, Ranucci V, Renga C, Mosca S, Lupattelli L, Di Filippo P, Rinonapoli E, Nenci GG. Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery: a venography controlled study. Arch Intern Med 1991; 151: 2167-2171
- 23 Raghavendra BN, Horii SC, Hilton S, Subramanyam BR, Rosen RJ, Lam S. Deep venous thrombosis: Detection by probe compression of the veins. J Ultrasound Med 1986; 5: 89-95
- 24 Cronan JJ, Dorfman GS, Scola FH. Deep venous thrombosis: US assessment using vein compression. Radiology 1987; 162: 191-194