D'Oria Mario, Girardi Laura, Amgad Ahmed, Sherif Mohab, Piffaretti Gabriele, Ruaro Barbara, Calvagna Cristiano, Dueppers Philip, Lepidi Sandro, Donadini Marco Paolo
Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy.
Research Center on Thromboembolic Diseases and Antithrombotic Treatment, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
Diagnostics (Basel). 2025 Jan 2;15(1):82. doi: 10.3390/diagnostics15010082.
Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information.
深静脉血栓形成（DVT）是一种病理状态，当血栓在深静脉系统内形成时就会发生。通常情况下，它累及下肢，较少累及上肢或其他不常见部位，如脑静脉或内脏静脉。虽然腿部深静脉血栓形成本身很少致命，偶尔会导致威胁肢体的后果，但其最可怕的并发症，即肺栓塞，可能是致命的，并且显著增加了医疗成本，影响了受影响患者及其护理人员的生活质量。由于其高准确性、易用性和安全性，双功超声（DUS），特别是压迫超声（CUS），已成为深静脉血栓形成诊断的一线成像方式。对疑似深静脉血栓形成的评估需要多方面的方法，在这种情况下，由于其许多独特的优势，压迫超声迅速成为关键的诊断工具。在欧洲血管外科学会和美国血液学会最新的临床实践指南中，其在疑似深静脉血栓形成诊断算法中的核心作用已得到明确确立。事实上，双功超声能够有效地显示血流，并以高敏感性（近端深静脉血栓形成通常超过90%）和特异性（近端深静脉血栓形成通常接近100%）识别诸如血栓形成等异常情况。此外，压迫超声是非侵入性的，可在床边随时进行，且避免了辐射暴露，使其成为适用于各种临床环境的理想方法。压迫超声不仅在急性深静脉血栓形成的诊断中发挥了重要作用，而且在其治疗的随访中也发挥了重要作用。此外，这种方法可以提供预后评估，主要是在复发性血栓形成和/或潜在并发症（如血栓后综合征）的风险分层方面。总之，鉴于其已证实的益处，压迫超声是许多医生应该熟悉的技术，尤其是那些在急诊科、重症监护病房或普通病房工作的医生。如有需要，在存在不确定性和/或需要更多信息的情况下，可能会要求具有更先进超声技能的医疗人员（如放射科医生、血管病医生或血管外科医生）进行再次评估。
