Thromb Haemost 1982; 47(02): 141-144
DOI: 10.1055/s-0038-1657149
Original Article
Schattauer GmbH Stuttgart

Diagnosis of Deep Vein Thrombosis by Combination of Doppler Ultrasound Flow Examination and Strain Gauge Plethysmography

An Alternative to Venography Only in Particular Conditions Despite Improved Accuracy of the Doppler Method
H Bounameaux
The Angiology Centre, Medical Policlinic of the Department of Medicine, and Department of Radiology, University Hospital, Geneva, Switzerland
,
B Krähenbühl
The Angiology Centre, Medical Policlinic of the Department of Medicine, and Department of Radiology, University Hospital, Geneva, Switzerland
,
S Vukanovic
The Angiology Centre, Medical Policlinic of the Department of Medicine, and Department of Radiology, University Hospital, Geneva, Switzerland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 22. Oktober 1981

Accepted 17. Februar 1982

Publikationsdatum:
13. Juli 2018 (online)

Summary

Doppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method had an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive methods cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both.

After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

 
  • References

  • 1 Coon WW, Park WW, Jacob BK. Venous thromboembolism and other venous diseases in the Tecumseh Community Health Study. Circulation 1973; 48: 839-846
  • 2 Kakkar VV. The problems of thrombosis in the deep veins of the leg. Ann R Coll Surg Engl 1969; 45: 257-276
  • 3 Lambie JM, Mahaffy RG, Barber DC, Karmody AM, Scott MM, Matheson NA. Diagnostic accuracy in venous thrombosis. Br Med J 1970; 2: 142-143
  • 4 Nicolaides AN, Kakkar VV, Fiels ES, Renney JTG. The origin of deep vein thrombosis: A venographic study. Br J Radiol 1971; 44: 653-663
  • 5 Flanigan DP, Goodreau JJ, Burnham SJ, Bergan JJ, Yao JST. Vascular laboratory diagnosis of clinically suspected acute deep-vein thrombosis. Lancet 1978; 02: 331-334
  • 6 Hull R, Hirsh J, Sackett DL, Powers P, Turpie AGG, Walker I. Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis. An alternative to venography. New Engl J Med 1977; 296: 1497-1500
  • 7 Hull R, Hirsh J, Sackett DL, Taylor W, Carter C, Turpie AGG, Zielinsky A, Powers P, Gent M. Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125I-Fibrinogen leg scanning. Ann Intern Med 1981; 94: 12-15
  • 8 Hull R, Hirsh J, Sackett DL, Stoddart G. Cost effectiveness of clinical diagnosis, venography, and noninvasive testing in patients with symptomatic deep-vein thrombosis. New Engl J Med 1981; 304: 1561-1567
  • 9 Poulose KP, Kapcar AJ, Reba RC. False positive 125I-Fibrinogen test. Angiology 1976; 27: 258-261
  • 10 Simon CA, Krähenbühl B. Venous stop-flow pressure: A simple and non-invasive technique for diagnosing deep-vein thrombosis. Lancet 1977; 02: 1008-1009
  • 11 Barnes RW, Collicott PE, Mozersky DJ, Sumner DS, Strandness DE. Non-invasive quantitation of maximum venous outflow in acute thrombophlebitis. Surgery 1972; 72: 971-991
  • 12 Rampton JB, Armstrong Jr JD. Bilateral venography of the lower extremities. Radiology 1977; 123: 802-804
  • 13 Albrechtsson U, Olsson CG. Thrombotic side effects of lower limb phlebography. Lancet 1976; 01: 723-724
  • 14 Bettman M, Paulin S. Leg phlebography: the incidence, nature and modifications of undesirable side-effects. Radiology 1977; 122: 101-104
  • 15 Hull R, van Aken WG, Hirsh J, Gallus AS, Hoicka G, Turpie AGG, Walker I, Gent M. Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis. Circulation 1976; 53: 696-700
  • 16 Harris WH, Waltman AC, Athanasoulis C, Wessinger SJ, Salzman EW. The accuracy of the in vivo diagnosis of deep vein thrombosis in patients with prior venous thromboembolic disease or severe varicose veins. Thromb Res 1981; 21: 137-145
  • 17 Meadway J, Nicolaides AN, Walker CJ, O’Connel JD. Value of doppler ultrasound in diagnosis of clinically suspected deep vein thrombosis. Br Med J 1975; 4: 552-554
  • 18 Richards L, Armstrong Jr JD, Tikoff G, Hershgold EJ, Booth JL, Rampton JB. Noninvasive diagnosis of deep vein thrombosis. Arch Intern Med 1976; 136: 1091-1096
  • 19 Müller-Brand J, Schmitt HE, Freund R, Füllemann GH, Widmer LK. Frühdiagnose tiefer Unterschenkel-Venenthrombosen bei ambulanten Patienten. Vasa 1979; 8: 231-236
  • 20 Benedict Jr KT, Wheeler HB, Patwardhan NA. Impedance plethysmography: correlation with contrast venography. Radiology 1977; 125: 695-699
  • 21 Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep vein thrombosis. Lancet 1969; 02: 230-232