Li Chong, Maldonado Thomas S, Jacobowitz Glenn R, Kabnick Lowell S, Barfield Michael, Rockman Caron B, Berland Todd L, Cayne Neal S, Sadek Mikel
Division of Vascular Surgery, Department of Surgery, 12297New York University Langone Medical Center, New York, NY, USA.
5638Morristown Medical Center, Morristown, NJ, USA.
Vasc Endovascular Surg. 2020 Nov;54(8):681-686. doi: 10.1177/1538574420946569. Epub 2020 Aug 3.
Patients who present acutely with a femoral deep vein thrombosis (DVT) diagnosed by ultrasound are often treated with anticoagulation and instructed to follow-up electively. This study sought to assess whether obtaining axial imaging of the central venous system results in the identification of additional iliocaval pathology warranting treatment.
This study was a retrospective review of a prospectively maintained registry from November 2014 through April 2017 with follow-up through March 2020. Consecutive patients with a diagnosis of femoral DVT diagnosed by ultrasound were evaluated; those who underwent axial imaging of the iliocaval system (Group A) were compared to those who did not undergo imaging of the central veins (Group B). The primary outcome was the performance of any percutaneous central venous intervention. Secondary outcomes included the extent of DVT identified on duplex and after axial imaging, follow-up duplex patency and persistence of severe symptoms.
Eighty patients presented with an ultrasound diagnosis of a femoral vein DVT. Mean follow-up was 551 ± 502 days. Group A comprised 24 patients (30%) and Group B comprised 56 patients (70%). Baseline demographics did not differ significantly between the 2 groups. After duplex imaging, Group A exhibited an increased prevalence of DVT in the common femoral vein. After central imaging, Group A exhibited an increased prevalence of DVT in the iliocaval veins. The number of patients who underwent invasive treatment differed significantly between the 2 groups, Group A 16/24 (67%) vs. Group B 9/56 (16%), P < 0.0001. The number of patients that demonstrated duplex patency and had persistent symptoms on follow-up did not differ significantly.
Patients with an ultrasound diagnosis of femoral DVT may have additional iliocaval pathology warranting intervention. Well-selected imaging of the central veins may reveal a more complete picture, potentially altering management.
对于经超声诊断为急性股深静脉血栓形成（DVT）的患者，通常采用抗凝治疗并指导其进行择期随访。本研究旨在评估对中心静脉系统进行轴向成像是否能发现需要治疗的其他髂股静脉病变。
本研究是一项对2014年11月至2017年4月前瞻性维护的登记册进行的回顾性研究，随访至2020年3月。对经超声诊断为股DVT的连续患者进行评估；将接受髂股静脉系统轴向成像的患者（A组）与未接受中心静脉成像的患者（B组）进行比较。主要结局是任何经皮中心静脉干预的实施情况。次要结局包括在双功超声检查时以及轴向成像后发现的DVT范围、随访时双功超声检查的通畅情况以及严重症状的持续存在情况。
80例患者经超声诊断为股静脉DVT。平均随访时间为551±502天。A组包括24例患者（30%），B组包括56例患者（70%）。两组的基线人口统计学特征无显著差异。双功超声成像后，A组股总静脉DVT的患病率增加。中心成像后，A组髂股静脉DVT的患病率增加。两组接受侵入性治疗的患者数量有显著差异，A组为16/24（67%），B组为9/56（16%），P<0.0001。双功超声检查通畅且随访时有持续症状的患者数量无显著差异。
经超声诊断为股DVT的患者可能存在需要干预的其他髂股静脉病变。对中心静脉进行精心选择的成像可能会揭示更完整的情况，从而可能改变治疗方案。
