Comerota A J, Katz M L, Grossi R J, White J V, Czeredarczuk M, Bowman G, DeSai S, Vujic I
Department of Surgery, Temple University Hospital, Philadelphia, PA.
J Vasc Surg. 1988 Jan;7(1):40-9. doi: 10.1067/mva.1988.avs0070040.
This is a prospective analysis of 351 patients in two distinct groups undergoing ascending phlebography, impedance plethysmography (IPG), and/or phleborheography (PRG) within the same 24-hour period. One hundred twenty patients also had a 125I-fibrinogen uptake test (RFUT). The two patient groups consisted of the following: those patients evaluated because of suspicion of deep vein thrombosis (DVT) (diagnostic) and those patients at high risk for postoperative DVT (total joint replacement) who had routine noninvasive testing and ascending phlebography (surveillance). The overall sensitivities for IPG and PRG were significantly better in the diagnosis group (71% [69 of 97 patients] and 78% [82 of 105], respectively) compared with the surveillance group (20% [14 of 71] and 27% [17 of 63], respectively) (p less than 0.0001). The sensitivities for IPG and PRG detecting proximal (A/K) thrombi was 83% (68 of 82 patients) and 92% (79 of 86) in the diagnosis group compared with 32% (11 of 34) and 33% (9 of 27) in the surveillance group (p less than 0.0001). Although there was no difference in overall incidence of DVT between the diagnosis group (56%, 118 of 212 patients) and the surveillance group (55%, 76 of 139), the results can be explained by the difference in A/K thrombi (84% [99 of 118] and 47% [36 of 76]) (p less than 0.001) and occlusive A/K thrombi (84% [58 of 69] and 23% [7 of 31]) (p less than 0.0001), respectively. Of the patients with A/K thrombi, 97% (67 of 69) in the diagnosis group had hemodynamically detectable thrombi compared with only 48% (12 of 25) in the surveillance group (p less than 0.001). Combining the RFUT with the noninvasive studies for surveillance significantly improved the sensitivity for both A/K and distal thrombi. Patient selection also appears to have a significant influence on the results of the combination of IPG and RFUT when the current surveillance group is compared with similarly performed studies in a previously reported diagnosis group. The location and magnitude of thrombi in any patient population can be skewed depending on indications and timing of testing, thereby significantly affecting the sensitivity of noninvasive tests. IPG and PRG are reliable for evaluating patients with suspected DVT. However, patients with postoperative DVT have a high incidence of nonocclusive thrombi. Because noninvasive hemodynamic tests cannot identify accurately postoperative DVT, they cannot be used to generate epidemiologic data or as end points for studies evaluating efficacy of prophylaxis in patients undergoing total joint replacement, and anatomic studies of the deep venous system continue to be required.
这是一项前瞻性分析，对在同一24小时内接受上行静脉造影、阻抗体积描记法（IPG）和/或静脉血流描记法（PRG）的351例分属两个不同组别的患者进行研究。120例患者还进行了125I-纤维蛋白原摄取试验（RFUT）。两个患者组如下：因怀疑深静脉血栓形成（DVT）而接受评估的患者（诊断组）和接受常规无创检查及上行静脉造影的术后DVT高危患者（全关节置换）（监测组）。与监测组（分别为20%[71例中的14例]和27%[63例中的17例]）相比，IPG和PRG在诊断组中的总体敏感性显著更高（分别为71%[97例中的69例]和78%[105例中的82例]）（p<0.0001）。在诊断组中，IPG和PRG检测近端（A/K）血栓的敏感性分别为83%（82例中的68例）和92%（86例中的79例），而在监测组中分别为32%（34例中的11例）和33%（27例中的9例）（p<0.0001）。尽管诊断组（56%，212例中的118例）和监测组（55%，139例中的76例）的DVT总体发生率无差异，但结果可由A/K血栓的差异（84%[118例中的99例]和47%[76例中的36例]）（p<0.001）和闭塞性A/K血栓的差异（84%[69例中的58例]和23%[31例中的7例]）（p<0.0001）来解释。在有A/K血栓的患者中，诊断组97%（69例中的67例）有血流动力学可检测到的血栓，而监测组仅48%（25例中的12例）（p<0.001）。将RFUT与用于监测的无创研究相结合，显著提高了对A/K和远端血栓的敏感性。当将当前监测组与先前报道的诊断组中同样进行的研究进行比较时，患者选择似乎对IPG和RFUT联合检测结果也有显著影响。任何患者群体中血栓的位置和大小可能因检测指征和时间而有所偏差，从而显著影响无创检测的敏感性。IPG和PRG对于评估疑似DVT患者是可靠的。然而，术后DVT患者中非闭塞性血栓的发生率很高。由于无创血流动力学检测不能准确识别术后DVT，它们不能用于生成流行病学数据或作为评估全关节置换患者预防效果研究的终点，因此仍需要对深静脉系统进行解剖学研究。
