Circulation, Vol 88, 1730-1735, Copyright © 1993 by American Heart Association
P Prandoni, A Cogo, E Bernardi, S Villalta, P Polistena, P Simioni, F Noventa, L Benedetti and A Girolami
BACKGROUND. The objective of this study was to develop a simple ultrasound
method for measuring thrombus regression in patients with proximal
deep-vein thrombosis (DVT) and to test its utility for the detection of DVT
recurrence. METHODS AND RESULTS. The study comprised a cross-sectional
survey and a prospective investigation (149 and 145 patients,
respectively). In both phases, the normalization rate of a previously
abnormal ultrasound test, applying the criterion of full compressibility of
the common femoral and popliteal veins (C-US method), was assessed. In the
prospective study, the vein diameter under maximum compression (thrombus
thickness) was measured in the abnormal venous segments at scheduled times
(1, 3, 6, and 12 months). In patients presenting with suspected DVT
recurrence, the procedure was repeated and results were compared with those
available from the previous examination. Noncompressibility of a previously
normal(ized) venous segment and enlargement of thrombus thickness (> or
= 2 mm) were considered diagnostic of proximal DVT recurrence. The
diagnostic accuracy of the C-US method alone, as well as of the combined
ultrasound methods (C-US + thrombus thickness), was assessed against
contrast phlebography. C-US test normalization occurred in only 30% of
patients within 1 year. A significant reduction of the thrombus mass (P
< .0001) was recorded throughout the entire study period. However, a
major decrease in thrombus mass (> 50%) was recorded within the first 3
months. Of 29 patients who developed a suspected recurrent DVT,
phlebography confirmed diagnosis in 11. The C-US method alone showed an
excellent accuracy (100%) but was applicable in only 6 patients (21%). Both
the sensitivity and the specificity for proximal DVT recurrence of the
combined ultrasound methods were 100% (95% confidence interval, 69% to 100%
and 81% to 100%, respectively) and were applicable in all patients.
CONCLUSIONS. The serial ultrasound measurement of thrombus mass after an
acute episode of DVT may allow the correct identification of patients who
develop a recurrent proximal-vein thrombosis.
ARTICLES
A simple ultrasound approach for detection of recurrent proximal-vein thrombosis
Department of Patologia Medica II University, Italy.
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