Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Switzerland.
Semin Respir Crit Care Med. 2012 Apr;33(2):144-50. doi: 10.1055/s-0032-1311793. Epub 2012 May 30.
The diagnostic approach to deep vein thrombosis (DVT) has evolved during the last 3 decades. Contrast venography has been replaced by noninvasive tests. Compression ultrasonography (CUS) is currently the most widely used diagnostic test. Whereas CUS has a high accuracy for proximal DVT (thrombosis of the popliteal and more proximal veins), it has been shown to lack sensitivity and specificity for distal DVT. Ultrasonography can either be limited to the proximal veins and repeated within 1 week (serial limited CUS) or extended to both proximal and distal veins and performed on one occasion (single complete CUS). Both strategies are reliable diagnostic options for the management of patients with suspected DVT. The main limitation of proximal CUS is the need to repeat the test once in patients with initial negative findings. Conversely, complete CUS detects many distal DVTs for which systematic anticoagulation therapy is debatable and exposes patients to potentially unnecessary anticoagulation. Incorporation of D-dimer testing and clinical pretest probability assessment in the diagnostic algorithm is beneficial because it allows excluding DVT without the need for diagnostic imaging in about a third of patients.
深静脉血栓形成（DVT）的诊断方法在过去 30 年中发生了演变。对比静脉造影已被非侵入性检查所取代。目前，压缩超声（CUS）是最广泛使用的诊断测试。虽然 CUS 对近端 DVT（腘静脉和更近端静脉的血栓形成）具有较高的准确性，但对于远端 DVT 的敏感性和特异性较差。超声检查可以仅限于近端静脉并在 1 周内重复（连续有限 CUS），也可以扩展到近端和远端静脉并在一次检查中进行（单次完整 CUS）。这两种策略都是管理疑似 DVT 患者的可靠诊断选择。近端 CUS 的主要限制是需要在初始阴性结果的患者中重复测试一次。相反，完整的 CUS 检测到许多远端 DVT，对于这些 DVT，系统抗凝治疗是有争议的，并使患者面临潜在的不必要抗凝。将 D-二聚体检测和临床预测概率评估纳入诊断算法是有益的，因为它可以使大约三分之一的患者无需进行诊断性影像学检查即可排除 DVT。
