Comerota A J, Katz M L, Greenwald L L, Leefmans E, Czeredarczuk M, White J V
Section of Vascular Surgery, Temple University School of Medicine, Philadelphia, PA 19140.
J Vasc Surg. 1990 Jan;11(1):53-9; discussion 59-61. doi: 10.1067/mva.1990.16342.
Noninvasive diagnosis of deep venous thrombosis has traditionally relied on detection of alterations in venous hemodynamics. Although phleborheography is among the most sensitive tests, it is inadequate for diagnosing infrapopliteal and nonocclusive proximal thrombi and for surveillance of patients at high risk for deep venous thrombosis. Venous duplex imaging is a new technique being rapidly accepted, however, without the same critical analysis given to previous diagnostic modalities. The purpose of this study is to evaluate the diagnostic acumen of venous duplex imaging compared to phleborheography and ascending phlebography in two distinct patient groups, and to determine whether patient selection, and thus the location or magnitude of thrombi have significant influence on these diagnostic tests. One hundred ten extremities in 103 patients were prospectively evaluated with venous duplex imaging, phleborheography, and ascending phlebography within the same 24-hour period. Patients were categorized into one of two groups: Diagnostic--patients evaluated because of clinical suspicion of acute deep venous thrombosis; and Surveillance--patients at high risk of postoperative deep venous thrombosis after total joint replacement, but not symptomatic. Patients in the diagnostic group had a greater frequency of deep venous thrombosis (p less than 0.001) and significantly more occluding above-knee thrombi (p = 0.054) compared to those in the surveillance group. Phleborheography detected 73% (27/37) of above-knee thrombi in the diagnostic group compared to 29% (2/7) in the surveillance group (p = 0.036). This difference was not noted with venous duplex imaging, which detected 100% of above-knee thrombi in both diagnostic and surveillance groups and 78% (7/9) of all below-knee thrombi.(ABSTRACT TRUNCATED AT 250 WORDS)
传统上，深静脉血栓形成的无创诊断依赖于静脉血流动力学改变的检测。尽管静脉血流描记术是最敏感的检测方法之一，但它对于诊断腘静脉以下和非闭塞性近端血栓以及监测深静脉血栓形成高危患者并不充分。静脉双重超声成像作为一项新技术正在迅速得到认可，然而，却没有对先前的诊断方法进行同样严格的分析。本研究的目的是在两个不同的患者组中评估静脉双重超声成像与静脉血流描记术及上行性静脉造影相比的诊断敏锐度，并确定患者的选择，以及血栓的位置或大小是否对这些诊断检测有显著影响。在同一24小时内，对103例患者的110条肢体进行了静脉双重超声成像、静脉血流描记术和上行性静脉造影的前瞻性评估。患者被分为两组之一：诊断组——因临床怀疑急性深静脉血栓形成而接受评估的患者；监测组——全关节置换术后深静脉血栓形成高危但无症状的患者。与监测组相比，诊断组患者深静脉血栓形成的发生率更高（p<0.001），膝上闭塞性血栓明显更多（p = 0.054）。静脉血流描记术在诊断组中检测到73%（27/37）的膝上血栓，而在监测组中为29%（2/7）（p = 0.036）。静脉双重超声成像未发现这种差异，其在诊断组和监测组中均检测到100%的膝上血栓以及78%（7/9）的所有膝下血栓。（摘要截短于250词）
