Miller N, Obrand D, Tousignant L, Gascon I, Rossignol M
Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Canada.
Eur J Vasc Endovasc Surg. 1998 Jan;15(1):18-23. doi: 10.1016/s1078-5884(98)80067-1.
Determine the need for bilateral duplex scanning (DS) in patients with unilateral symptoms of acute DVT of the leg.
Prospective study.
One thousand, one hundred and sixty-one consecutive patients with recent unilateral symptoms of pain or swelling.
Bilateral DS were performed and demographic data including risk factors for DVT were entered into a computerised database.
Of the 250 cases (22%) of acute DVT, thrombus was confined to the symptomatic limb in 80% (200/250) and to the asymptomatic limb (AL) in 5% (12/250), while bilateral DVT was found in 15% (38/250). The management was not altered by the contralateral DS findings in any patient with bilateral thrombus. Ten of the 12 cases of DVT confined to the AL were localised to the infrapopliteal level; advanced malignancy, recent joint surgery or hypercoagulability were noted in nine patients, including all those requiring treatment.
In the presence of unilateral symptoms of DVT, we recommend DS of the symptomatic extremity only; bilateral examination should be confined to patients with normal duplex findings in the symptomatic limb following recent joint surgery, or in the presence of advanced malignancy or hypercoagulability. Bilateral DS would therefore be required in approximately 11% of cases with unilateral symptoms of DVT.
确定单侧下肢急性深静脉血栓形成（DVT）症状患者进行双侧双功超声扫描（DS）的必要性。
前瞻性研究。
1161例近期出现单侧疼痛或肿胀症状的连续患者。
进行双侧DS检查，并将包括DVT危险因素在内的人口统计学数据录入计算机数据库。
在250例（22%）急性DVT病例中，80%（200/250）的血栓局限于有症状的肢体，5%（12/250）局限于无症状肢体（AL），15%（38/250）为双侧DVT。在任何双侧血栓患者中，对侧DS检查结果均未改变治疗方案。局限于AL的12例DVT病例中有10例位于腘静脉以下水平；9例患者存在晚期恶性肿瘤、近期关节手术或高凝状态，包括所有需要治疗的患者。
对于有单侧DVT症状的患者，我们仅建议对有症状的肢体进行DS检查；双侧检查应仅限于近期关节手术后有症状肢体双功超声检查结果正常的患者，或存在晚期恶性肿瘤或高凝状态的患者。因此，约11%有单侧DVT症状的病例需要进行双侧DS检查。
