ISSN:1424-8832    

DOI:10.1159/000217137

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000217138

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000217139

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Clinical diagnosis of deep vein thrombosis (DVT) is unreliable, and treatment should not be undertaken without objective confirmation. The traditional ‘gold standard’ for the diagnosis of DVT has been venography, but ultrasonic imaging has now replaced venography as the new diagnostic standard in many hospitals. A variety of noninvasive physiologic tests are also useful in selected circumstances. These include plethysmography, Doppler flow studies, radioisotope tests, thermography and peripheral blood tests which reflect activation of coagulation or thrombolysis. We describe the clinical application of these diagnostic procedures, both for symptomatic patients suspected to have DVT and for asymptomatic patients at high risk for DVT. The selection of an appropriate diagnostic modality depends upon institutional capabilities, cost-effectiveness and individual patient circumstan

ISSN:1424-8832    

DOI:10.1159/000217140

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Deep-vein thrombosis of the lower extremity is a frequent disorder associated with morbidity and mortality due to pulmonary embolism and the postthrombotic syndrome. It was not until the introduction of contrast venography that the inaccuracy of the clinical diagnosis became apparent. Since then, management decisions have usually been based on objective diagnostic test. Venography is generally considered the reference method for the diagnosis of deep-vein thrombosis, but it is invasive and associated with serious side effects. Several noninvasive or less invasive objective diagnostic methods have been developed. These diagnostic methods are distinctly different in technology and consequently in their ability to demonstrate or refute deep-vein thrombosis. In this review, a critical analysis is provided on the accurary of the current noninvasive diagnostic approaches to venous thrombosis in patients with a first episode of clinically suspected deep-vein thrombosis. Results of studies were considered only when their methodology fulfilled the essential criteria for evaluation of a diagnostic test.

ISSN:1424-8832    

DOI:10.1159/000217141

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Postoperative deep vein thrombosis is usually asymptomatic so that pulmonary embolism is often the first clinical manifestation of venous thromboembolism. The diagnostic accuracy of impedance plethysmography, 125I-fibrinogen leg scanning and real-time B-mode ultrasonography has been extensively evaluated in patients with asymptomatic deep vein thrombosis. Impedance plethysmography has been evaluated in a number of studies and its sensitivity has been invariably found to be approximately 20% or less. These results seem to be due to the high prevalence in asymptomatic patients of distal, small and nonocclusive thrombi, unable to produce a critical obstruction of the venous flow. The accuracy of 125I-fibrinogen leg scanning has been assessed in a number of studies and found to be significantly different in the initial and more recent studies. This difference has been found to be due to the quality of the study design: the better the methodology, the lower the diagnostic accuracy of 125I-fibrinogen leg scanning. The association of impedance plethysmography and 125I-fibrinogen leg scanning do not result in an improvement of the results obtained by the single diagnostic method. Study methodology strongly influenced the results obtained with real-time B-mode ultrasonography with a reported sensitivity of approximately 50% in the studies performed adopting an appropriate methodology. In conclusion, noninvasive diagnostic methods are inaccurate in the diagnosis of asymptomatic deep vein thrombosis. Thus, venography remains the only accurate diagnostic method for the diagnosis of asymptomatic deep vein thrombosis.

ISSN:1424-8832    

DOI:10.1159/000217142

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

After a first episode of deep vein thrombosis (DVT), 30-50% of the patients will develop complaints suspect of recurrent DVT. Of these patients, only 20-30% do indeed have a recurrent episode of DVT. To identify patients with a true recurrent DVT, objective testing is mandatory in every patients. However, all the available tests have their limitations in patients with recurrent DVT. In this review, diagnostic strategies using venography, impedance plethysmography, 125I-fibrinogen leg scanning and ultrasonography in patients with recurrent DVT will be discussed. Furthermore, some epidemiologic data and pathophysiologic mechanisms concerning DVT will be considered.

ISSN:1424-8832    

DOI:10.1159/000217143

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In the pregnant patient with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE), accurate diagnosis is required to identify patients with DVT or PE who would benefit from appropriate anticoagulant therapy, and to exclude DVT and PE in the majority of patients so they are not exposed to the risks of anticoagulants. The diagnosis of DVT and PE during pregnancy is problematic. The use of invasive diagnostic tests, such as venography and pulmonary angiography, is limited because of the potential risks to the fetus of radiation exposure. Due to hemodynamic changes associated with pregnancy, noninvasive diagnostic tests such as impedance plethysmography and venous Doppler may be falsely abnormal. Diagnostic approaches for DVT and PE will be outlined that can accurately and safely confirm or exclude suspected DVT and PE during pregnancy.

ISSN:1424-8832    

DOI:10.1159/000217144

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Although clinical diagnosis of pulmonary embolism (PE) is not sufficiently reliable to determine management, it is valuable for stratifying patients into high, intermediate, and low clinical suspicion of embolism. Clinical assessment can then be combined with lung scanning to identify groups of patients with a sufficiently high or low probability of PE that a decision to anticoagulate or withhold therapy can be made. Approximately half of patients with suspected PE will fall into one of these categories. Thrombosis in the deep veins of the leg (DVT) can be detected by noninvasive tests in approximately 50%, and by bilateral venography in approximately 70% of patients with PE, and provides grounds for anticoagulation of some patients with nondiagnostic combinations of clinical and lung scan assessments. Failure to detect DVT makes it less likely but does not exclude the possibility that the patient had a PE. Preliminary evidence suggests that the majority of patients with nondiagnostic combinations of clinical assessment, lung scanning, and negative noninvasive tests for DVT can safely be managed without anticoagulation, provided serial noninvasive tests for DVT remain normal over a 2-week period. Pulmonary angiography may be advisable in patients with nondiagnostic combinations of the above tests in whom (a) the probability of PE remains high (e.g. 30-80%), (b) cardiopulmonary reserve is poor, (c) serial follow-up is not feasible, or (d) future management (e.g. subsequent pregnancy) would be influenced by the result. D-Dimer measurements are sensitive but nonspecific for PE and therefore may have a high negative predictive value, further simplifying the diagnostic approach to PE.

ISSN:1424-8832    

DOI:10.1159/000217145

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1424-8832    

DOI:10.1159/000217146

出版商:S. Karger AG    

年代:1995

数据来源: Karger