Strothman G, Blebea J, Fowl R J, Rosenthal G
Department of Surgery, University of Cincinnati Medical Center, OH 45267-0558, USA.
J Vasc Surg. 1995 Nov;22(5):543-7. doi: 10.1016/s0741-5214(95)70035-8.
Bilateral lower extremity venous duplex scanning for acute deep venous thrombosis (DVT) has been advocated because of the high incidence of occult contralateral leg involvement. We investigated the clinical necessity of such a policy.
The results from 2996 venous duplex studies performed during the past 2 years were retrospectively reviewed. A total of 1694 of these scans were performed on patients with symptoms, of whom 248 (15%) were found to have an acute DVT. Symptoms were limited to one side in 198 patients, whereas bilateral complaints were noted in 50 patients.
Among the patients with symptoms of acute DVT, 72 (29%) had bilateral involvement. Bilaterality was more likely in patients with bilateral symptoms than in those with only unilateral symptoms (56% vs 22%; p < 0.005). Of the patients with unilateral symptoms and bilateral DVT, all of them had either acute (80%) or acute and chronic (20%) thrombosis in the symptomatic leg. The contralateral asymptomatic limb had fewer acute and more chronic DVT (41% and 55%, respectively). No patient from the entire group admitted with symptoms had an acute DVT in the asymptomatic limb without a concomitant acute DVT in the symptomatic leg. Unilateral scanning would decrease the examination time by 21% and potentially increase total reimbursement for symptomatic venous scans by 9% compared with routine bilateral duplex scanning.
Although bilateral involvement is frequent in patients with symptoms of acute DVT, treatment in these patients is not altered by this finding. We conclude that contralateral venous scanning in patients with unilateral symptoms is not clinically indicated and that unilateral scanning would result in improved cost-efficiency for vascular laboratories.
由于隐匿性对侧下肢受累的发生率较高，双侧下肢静脉双重扫描用于急性深静脉血栓形成（DVT）已得到提倡。我们调查了这一策略的临床必要性。
回顾性分析过去2年中进行的2996例静脉双重扫描的结果。其中1694例扫描是对有症状的患者进行的，这些患者中有248例（15%）被发现患有急性DVT。198例患者的症状局限于一侧，而50例患者有双侧症状。
在有急性DVT症状的患者中，72例（29%）有双侧受累。双侧有症状的患者比仅有单侧症状的患者更易出现双侧受累（56%对22%；p<0.005）。在有单侧症状和双侧DVT的患者中，所有患者在有症状的下肢均有急性（80%）或急性和慢性（20%）血栓形成。对侧无症状肢体的急性DVT较少，慢性DVT较多（分别为41%和55%）。在整个有症状入院的患者组中，没有患者在无症状肢体有急性DVT而在有症状的下肢没有伴随急性DVT。与常规双侧双重扫描相比，单侧扫描可将检查时间缩短21%，并可能使有症状静脉扫描的总报销费用增加9%。
尽管有急性DVT症状的患者中双侧受累很常见，但这一发现并不改变这些患者的治疗。我们得出结论，有单侧症状的患者进行对侧静脉扫描没有临床指征，单侧扫描将提高血管实验室的成本效益。
