Messina L M, Sarpa M S, Smith M A, Greenfield L J
Diagnostic Vascular Laboratory, Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0329.
Surgery. 1993 Nov;114(5):921-7.
Because duplex ultrasonography is used increasingly to evaluate patients suspected of having acute deep venous thrombosis of the lower extremity, the clinical significance of limiting venous duplex scanning to the common femoral, superficial femoral, and popliteal veins becomes an important question.
We prospectively studied by venous color flow duplex ultrasonography 181 patients referred for evaluation to rule out acute deep venous thrombosis to determine (1) the frequency with which the iliac and calf veins could be imaged adequately to determine the presence or absence of acute deep venous thrombosis, (2) the frequency of acute venous thrombosis in these venous segments, and (3) the time required to scan these additional segments.
In 79% of the patients studied, one segment of the iliac venous system was imaged adequately to determine the presence or absence of venous thrombosis. In the lower extremity, the common femoral vein, the superficial femoral vein, and the popliteal vein were imaged adequately in 94% of the patients. In 76% of the patients all three calf veins were imaged adequately to determine whether acute deep venous thrombosis was present or absent. The anterior tibial vein was the most difficult vein to image consistently and was imaged adequately in 76% of the patients referred. The mean time to scan the affected limb was 8 minutes 37 seconds. Forty-seven patients (26%) of the 180 patients studied had positive venous scans. Twenty-three percent of the patients who had positive scans were found to have iliac vein involvement. Thirty-two percent who had positive venous scans were found to have thrombosis of the calf veins. Fifteen percent of the 47 patients who had positive scans had either an isolated iliac or calf vein thrombosis.
We believe this frequency of isolated iliac or calf vein thrombosis coupled with the frequency of successful imaging of these venous segments and the short additional time required to image these segments justifies the inclusion of routine imaging of the iliac and calf veins in patients undergoing venous duplex scanning to rule out acute deep venous thrombosis.
由于双功超声检查越来越多地用于评估疑似下肢急性深静脉血栓形成的患者，因此将静脉双功扫描局限于股总静脉、股浅静脉和腘静脉的临床意义成为一个重要问题。
我们对181例因评估而转诊以排除急性深静脉血栓形成的患者进行了静脉彩色血流双功超声检查的前瞻性研究，以确定：（1）髂静脉和小腿静脉能够被充分成像以确定是否存在急性深静脉血栓形成的频率；（2）这些静脉段中急性静脉血栓形成的频率；（3）扫描这些额外静脉段所需的时间。
在79%的研究患者中，髂静脉系统的一个节段被充分成像以确定是否存在静脉血栓形成。在下肢，94%的患者股总静脉、股浅静脉和腘静脉被充分成像。在76%的患者中，所有三条小腿静脉都被充分成像以确定是否存在急性深静脉血栓形成。胫前静脉是最难持续成像的静脉，在转诊患者中76%能被充分成像。扫描患侧肢体的平均时间为8分37秒。在180例研究患者中，47例（26%）静脉扫描呈阳性。在扫描呈阳性的患者中，23%被发现有髂静脉受累。在扫描呈阳性的患者中，32%被发现有小腿静脉血栓形成。在47例扫描呈阳性的患者中，15%有孤立的髂静脉或小腿静脉血栓形成。
我们认为，孤立的髂静脉或小腿静脉血栓形成的频率，加上这些静脉段成功成像的频率以及成像这些静脉段所需的额外时间较短，证明在进行静脉双功扫描以排除急性深静脉血栓形成的患者中纳入髂静脉和小腿静脉的常规成像检查是合理的。
