RSS Feeds
Single Complete Compression Ultrasonography for Suspected Deep Venous Thrombosis: Ideal in Routine Clinical Practice?
- Scott M. Stevens, MD; and
- C. Gregory Elliott, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate the insights of Drs. Righini, Bounameaux, and Le Gal into the ramifications of use of single comprehensive duplex ultrasonography for suspected symptomatic DVT of the legs. We studied single comprehensive duplex ultrasonography because it is efficient and convenient compared with routine repeated simplified compression ultrasonography. We recognize that validated strategies use a sensitive d-dimer assay and clinical score to reduce the number of simplified compression ultrasonography studies used for suspected DVT (1), and we do not believe that our findings decrease the attractiveness of such strategies. We agree with El Kheir and Büller's recommendation (2) that comprehensive duplex ultrasonography should be studied in conjunction with clinical scoring and sensitive d-dimer assay.
The identification of isolated calf DVT does indeed provide an additional challenge for the treating clinician. While outcome data on this diagnosis are limited, it is worth noting that clinicians may opt for serial duplex ultrasonography in lieu of therapeutic anticoagulation in this clinical situation, prescribing anticoagulation only for patients in whom thrombus propagates to involve the popliteal or more proximal deep veins (3). Additional therapeutic strategies have been offered in various guidelines (4, 5). Employing a strategy of repeated imaging raises the obvious criticism that serial duplex ultrasonography would then be performed, undermining the value of our results. However, isolated calf DVT was found in only a small proportion of the total patients in our study (4.3%), and we noted more than 20 negative initial results on comprehensive ultrasonography for every instance of isolated calf DVT detected. Even if a repeated testing strategy is chosen for isolated calf DVT, there would still be a significant reduction in the total number of ultrasonography tests compared with the strategy of routine serial simplified compression ultrasonography. We very much agree that the natural history, risks, and optimal management of isolated calf DVT should be the subject of further clinical study.
Scott M. Stevens, MD
C. Gregory Elliott, MD
LDS Hospital and University of Utah; Salt Lake City, UT 84143
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
