Division of Vascular Surgery, Northwestern Memorial Hospital, Chicago, Ill.
Division of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Ill.
J Vasc Surg Venous Lymphat Disord. 2018 Nov;6(6):724-729. doi: 10.1016/j.jvsv.2018.06.010.
Deep venous thrombosis isolated to the iliac veins is uncommon. Venous duplex ultrasound (DU) is widely accepted as the screening modality of choice for lower extremity deep venous thromboses. This investigation evaluated the accuracy and efficacy of DU in diagnosis of iliac vein thrombosis.
We conducted a single-center retrospective review of patients who were diagnosed with iliac vein thrombosis between January 1, 2006, and December 31, 2015. Patients included in our analysis needed to have both DU and cross-sectional imaging performed within a month of each other. The efficacy of DU in diagnosis of iliac vein thrombosis was determined using cross-sectional imaging as a standard for diagnosis.
In total, our query yielded 80 patients with a diagnosis of iliac vein thrombosis in the medical chart; 48 patients had both cross-sectional imaging and DU performed within 1 month of each other. There were 36 patients who had cross-sectional imaging positive for iliac vein thrombosis; only 10 (27.8%) of these patients were found to have iliac vein thrombosis by DU. Thus, 26 patients (72.2%) were not diagnosed accurately by DU. On the basis of our data, the sensitivity and positive predictive value of DU compared with cross-sectional imaging in diagnosis of iliac vein thrombosis were 27.8% and 76.9%, respectively. We did not identify any patient-specific factors that influenced the discrepancy between DU and cross-sectional imaging.
Our current protocol of lower extremity venous DU is not an effective tool in diagnosis of iliac vein thrombosis. All patients with clinically suspected iliac vein thrombosis should be evaluated with specific pelvic ultrasound protocols or cross-sectional imaging.
孤立于髂静脉的深静脉血栓并不常见。静脉双功能超声（DU）被广泛认为是下肢深静脉血栓形成的首选筛查方式。本研究评估了 DU 诊断髂静脉血栓的准确性和有效性。
我们对 2006 年 1 月 1 日至 2015 年 12 月 31 日期间被诊断为髂静脉血栓的患者进行了单中心回顾性研究。我们的分析纳入的患者需要在彼此一个月内同时进行 DU 和横断面成像。DU 诊断髂静脉血栓的有效性通过横断面成像作为诊断标准来确定。
在总共 80 例在病历中被诊断为髂静脉血栓的患者中，有 48 例在 1 个月内同时进行了横断面成像和 DU。有 36 例患者的横断面成像显示髂静脉血栓阳性；只有 10 例（27.8%）通过 DU 发现髂静脉血栓。因此，26 例（72.2%）患者的 DU 诊断不准确。根据我们的数据，与横断面成像相比，DU 诊断髂静脉血栓的敏感性和阳性预测值分别为 27.8%和 76.9%。我们没有发现任何影响 DU 与横断面成像之间差异的患者特定因素。
我们目前的下肢静脉 DU 方案不是诊断髂静脉血栓的有效工具。所有临床疑似髂静脉血栓的患者都应使用特定的骨盆超声方案或横断面成像进行评估。
