Stricker H, dai-Do D, Mahler F
Angiologische Abteilung, Medizinische Universitätsklinik, Inselspital, Bern.
Ther Umsch. 1992 Dec;49(12):803-8.
The clinical diagnosis of deep venous thrombosis (DVT) is unreliable. Phlebography, an invasive method, has gained wide diffusion and is considered as gold standard, but it has several draw-backs such as elevated costs and x-ray exposure. For these reasons, other, non-invasive techniques for diagnosing DVT have been looked for. Among them, CW-Doppler, occlusion plethysmography and, more recently, colour-Duplex-sonography have gained most acceptance. While the first two methods are able to diagnose with sufficient sensitivity and specificity proximal DVT, they are unreliable for isolated calf vein thrombosis. The colour-Duplex-sonography, on the other hand, produces results similar to phlebography for proximal thrombosis and succeeds in detecting isolated calf vein thrombosis with sufficient accuracy. We propose therefore the following non-invasive proceeding when confronted with the question of DVT: The first investigation to be done is a (colour)-Duplex examination. If one lacks such an infrastructure, an investigation with CW-Doppler or occlusion plethysmography has to be performed. If the results are positive, the patient will be treated. Otherwise, the exam will be repeated after five to seven days for CW-Doppler and plethysmography. If now the result is positive, the patient will be treated, otherwise, as with a negative Duplex study, the suspicion of DVT will be dismissed.
深静脉血栓形成（DVT）的临床诊断并不可靠。静脉造影作为一种侵入性方法，已得到广泛应用并被视为金标准，但它存在一些缺点，如成本高昂和有X射线辐射。由于这些原因，人们一直在寻找其他非侵入性的DVT诊断技术。其中，连续波多普勒、阻塞性体积描记法，以及最近的彩色双功超声检查最受认可。虽然前两种方法能够以足够的敏感性和特异性诊断近端DVT，但对于孤立的小腿静脉血栓形成却不可靠。另一方面，彩色双功超声检查对于近端血栓形成的结果与静脉造影相似，并且能够以足够的准确性检测出孤立的小腿静脉血栓形成。因此，当面临DVT问题时，我们建议采用以下非侵入性程序：首先进行的检查是（彩色）双功超声检查。如果缺乏这样的设备，就必须进行连续波多普勒或阻塞性体积描记法检查。如果结果为阳性，患者将接受治疗。否则，对于连续波多普勒和体积描记法检查，将在五到七天后重复检查。如果此时结果为阳性，患者将接受治疗，否则与双功超声检查结果为阴性一样，DVT的怀疑将被排除。
