Diagnostik der venösen Thrombembolie - Ist der Goldstandard 'Phlebografie' bald überholt?

In den letzten 15 Jahren hat sich der diagnostische Ablauf zur Abklärung eines Verdachtes auf eine tiefe Beinvenenthrombose (TVT) oder eine Lungenembolie (LE) erheblich geändert. Obwohl die Phlebografie trotz ihres vergleichsweise hohen Risikopotenzials nach wie vor als Goldstandard gilt, kann durch Einsatz von Scoresystemen, D-Dimer-Bestimmung und Venenultraschall bei der Diagnose einer tiefen Beinvenenthrombose zumeist auf sie verzichtet werden. Gleiches gilt für die Abklärung der Lungenembolie: Die Kombination aus D-Dimer-Test und Beinvenenultraschall gefolgt von szintigrafischen oder computertomografischen Verfahren hat die Pulmonalisangiografie nahezu vollständig verdrängt. Die leitliniengerechte Kombination der verschiedenen Tests im Rahmen eines diagnostischen Stufenplanes versetzt den Klinikarzt also in die Lage, tiefe Venenthrombosen und Lungenembolien schnell und sicher zu diagnostizieren. Auf Großgeräteuntersuchungen kann dabei zumeist verzichtet werden.

Diagnostic strategies to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE) have changed significantly over the last 15 years. Whereas venography still is the gold standard for detecting DVT, the introduction of DVT-scores, d-dimer-testing and venous ultrasound made it replaceable in most cases for detecting venous thromboembolisms. The same is true for the diagnostic approach to pulmonary embolism: the combination of d-dimer-testing and venous ultrasound followed by szintigraphic or computertomographic lung scan almost replaced pulmonal angiography. This review focuses on different diagnostic strategies for clinicians in hospitals using practical approaches. Combination of these procedures in a graduated scheme - as postulated in guidelines - enables clinicians to diagnose deep vein thrombosis and pulmonary embolism fast and on a firm basis. Therefore the use of venography is not mandatory in most cases.

Key words

deep venous thrombosis - DVT - pulmonary embolism - pretest probability - d-dimer - venous ultrasound - venography

Publication History

Article published online:
23 August 2007

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