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One-Time Comprehensive Ultrasonography To Diagnose Deep Venous Thrombosis: Is That the Solution?
- Dalia El Kheir, MD, MSc; and
- Harry Büller, MD
- From Academic Medical Centre, 1105 AZ Amsterdam, the Netherlands.
The diagnosis of lower-limb deep venous thrombosis (DVT) still poses a daily challenge to health care professionals. Only about 10% to 25% of patients with clinically suspected DVT have DVT confirmed by objective tests (1). If DVT is left untreated, the resulting mortality rate due to pulmonary embolism may exceed 20% (1), whereas a 6-month course of treatment with anticoagulants reduces the mortality rate to less than 1% but carries a 3% to 4% risk for major bleeding (2). Thus, diagnostic strategies to exclude DVT should be accurate, simple to apply to many patients, and cost-effective (3). The article by Stevens and colleagues in this issue (4) describes the results of a diagnostic strategy that may fulfill this purpose. To set the stage for explaining the contribution of this article, we first describe the evolution of recent approaches to diagnosing DVT.
Ultrasonography limited to the common femoral and popliteal veins, using compressibility of the vein as the sole criterion for abnormality, has been the gold standard for diagnosis of symptomatic DVT (5). This so-called limited compression ultrasonography (also known as “two-level” because it evaluates the thigh and popliteal veins) has nearly 100% sensitivity and specificity for proximal DVT as measured by contrast venography (6). However, it is not enough to exclude …
