#14 DUPLEX VENOUS IMAGING: ROLE FOR A
COMPREHENSIVE LOWER EXTREMITY EXAMINATION.
Dwayne K. Badgett, MD, Ibrahim G. Eid, MD, Mohammad N. Kahn, MD, Maya
C. Comerota and Anthony J. Comerota, MD
Temple University Hospital, Philadelphia, PA.
Objectives: Real time compression ultrasonography (CU) along
with venous Doppler imaging is the most commonly performed
noninvasive vascular examination. It has become the definitive
diagnostic test for the majority of patients suspected with deep
venous thrombosis (DVT). Some have recommended that CU alone of the
common femoral vein (CFV) and the popliteal vein (PV) is all that is
required, since a complete examination is time consuming and calf
veins are difficult to visualize. However, if only the CFV and PV
are examined, all patients with isolated superficial femoral vein
(SFV) and calf DVT remain undiagnosed. The purpose of this study is
to establish the value of a comprehensive venous duplex examination
compared to CFV and PV compression alone for detecting both proximal
and infrapopliteal DVT.
Methods: From January 1996 through December 1997, the initial
venous duplex examinations of 5767 extremities in 3061 patients were
reviewed and results tabulated according to presence and location of
clot. The ATL 3000 with a 7-14 MHz probe was used. Studies were
interpreted as normal, proximal DVT (popliteal and above, with or
without calf DVT), isolated calf or isolated SFV deep venous
thrombosis.
Results: Of the 5767 extremities examined, 1343 (23%)
extremities (in 951 patients) contained DVT. Of these, 979 (72.8%)
extremities (in 694 patients) had proximal DVT. Isolated calf DVT
was present in 332 (24.7%) extremities (in 257 patients) and isolated
SFV was present in 32 (2.38%) extremities (in 31 patients). More
importantly, isolated SFV comprised 3.26% of all proximal DVT. The
average additional time for a Registered Vascular Technologist to
perform a comprehensive examination was 4-5 minutes per
extremity.
Conclusions: If only the CFV and PV were examined, 27.1%
(isolated SFV + isolated calf vein DVT) of all DVT and 3.26% of
proximal DVT would have been missed. A complete venous duplex
examination altered the care of 287 (30.17%) of all patients examined
who had DVT, and is therefore recommended as the standard noninvasive
examination.
