Deep venous thrombosis of the lower extremity: US evaluation

The sensitivity of duplex ultrasonography (US) for detecting deep venous thrombosis of the lower extremity was compared with that of venography in a prospective study of 54 patients. Doppler analysis of the common femoral vein and US imaging of the deep venous system from the common femoral vein to the popliteal vein was performed. Common femoral vein response to the Valsalva maneuver was recorded. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for the common femoral vein, and 94% sensitive for the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler flow and abnormal response of the common femoral vein to the Valsalva maneuver enabled thrombi to be detected only in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with deep venous thrombosis proximal to the deep calf veins. US should be the screening examination of choice for evaluating patients with suspected lower extremity deep venous thrombosis.     

Deep venous thrombosis: detection by high-resolution real-time ultrasonography

High-resolution real-time ultrasonography was performed in 11 patients with clinically suspected deep venous thrombosis (DVT) of the lower extremity. Contrast venography was performed in all patients within 24 hours of sonographic examination. The common femoral vein at the groin and the popliteal vein in the popliteal fossa were evaluated for presence or absence of intraluminal soft-tissue mass (thrombi), compressibility of the veins, and response to performance of the Valsalva maneuver. Of the 11 patients, six were shown to have DVT by contrast venography. In all six cases there was complete agreement between sonography and contrast venography as to the presence or absence of thrombi in the common femoral vein or the popliteal vein.     

Floating thrombi: diagnosis and follow-up by duplex ultrasound.

The clinical features and evolution of floating thrombi (FT) diagnosed by duplex ultrasound were examined. In 76 consecutively diagnosed above-knee deep venous thromboses the prevalence of FT was 18%. Of 44 FT diagnosed in 39 patients, 18 (39%) were located in the common femoral, 12 (26%) in the popliteal and seven (15%) in the external iliac veins. Serial duplex examinations revealed that 31% of FT in the iliofemoral segment disappeared 33% remained unchanged and 36% adhered to the vein wall within 2 weeks following diagnosis. After 3 months, 87% of the floating segments had disappeared, irrespective of the localization or therapeutic regimen. Thirteen patients experienced pulmonary embolism before (12/13) or following (4/13) diagnosis of floating thrombosis; three of four superficial femoral vein FT embolized. Fifteen per cent of the patients with FT died during the study period and 28% of the thrombi were associated with a malignant neoplasm; the incidence of malignancy was 60% in superficial and 39% in common femoral vein FT.     

Chronic-stage deep vein thrombosis of the lower extremities: indirect CT venographic findings

OBJECTIVE: To describe the computed tomographic (CT) findings of chronic deep vein thrombosis (DVT) and its evolution from acute DVT. METHODS: Fifty-one consecutive patients with 52 legs confirmed as acute DVT by CT venography underwent follow-up computed tomography more than 2 months later. Follow-up CT findings were assessed retrospectively by consensus between 2 radiologists. The frequencies of CT findings were analyzed for affected venous segments: common iliac, external iliac, femoral, popliteal, and calf veins. RESULTS: Twelve legs (23%) were completely normalized on follow-up computed tomography, but 40 legs (77%) showed abnormal findings as follows: luminal obliteration (n = 16), decreased caliber (n = 30), residual thrombi (n = 3), fibrotic bands (n = 28), ipsilateral muscle enlargement (n = 28), ipsilateral subcutaneous edema (n = 11), and superficial collateral vein development (n = 23). The external iliac vein (26/40, 65%) was the most commonly affected site followed in decreasing order by femoral (29/50, 58%), common iliac (9/18, 50%), popliteal (22/47, 47%), and calf veins (9/43, 21%). Trends were observed whereby luminal obliteration affected iliac veins and fibrotic bands affected femoropopliteal veins. CONCLUSIONS: Luminal obliteration, decreased caliber, fibrotic bands, ipsilateral muscle enlargement, and superficial collateral vein development are common CT findings in chronic DVT of the lower extremity.     

Deep venous thrombosis of the leg: US findings

In a prospective study, 121 consecutive patients with a clinical diagnosis of deep venous thrombosis of the leg were examined with real-time ultrasonography. The findings were correlated with the results of venography. The common femoral vein and the popliteal vein were evaluated for intraluminal echoes and compressibility, and the common femoral vein was also evaluated for an increase in diameter in response to the Valsalva maneuver. The superficial femoral vein and the calf veins were not evaluated. The results indicate that compressibility of the common femoral and popliteal veins is the best indication of deep venous thrombosis, with a sensitivity of 96% and a specificity of 97%. The accuracy of detection was not improved by including data from thrombus visualization or the response of the common femoral vein to the Valsalva maneuver.     

彩色多普勒超声诊断下肢静脉疾病的临床价值——与DSA比较研究

目的 探讨彩色多普勒超声在下肢静脉疾病中的应用价值,并与DSA比较.方法 成用彩色多普勒超声仪对48例临床疑有下肢静脉疾病患者行二维彩色多普勒血流成像、脉冲多普勒及Valsalva试验等检查,并与DSA检查比较.结果 48例患者中有下肢深静脉血栓形成27例,其中15例合并下肢深静脉瓣膜功能不全,8例合并下肢浅静脉曲张,2例两者俱存,另有1例左侧腘窝囊肿合并腘静脉血栓,部分病例提示髂静脉流速减慢.单纯下肢静脉瓣膜功能不全5例,单纯下肢浅静脉曲张6例,6例两者俱存.4例超声检查正常,其中2例DSA提示有髂静脉受压.以DSA为诊断标准,诊断符合率为95.8%,两种方法行一致性检验,Kappa值为0.65.结论 彩色多普勒超声对下肢静脉疾病的临床诊断及疗效判断有重要的应用价值.     

Color Doppler ultrasound imaging of lower-extremity venous disease

A color Doppler ultrasound imaging device was used to evaluate 475 patients with suspected lower-extremity venous thrombosis. Occlusive and nonocclusive femoral and popliteal thrombi were detected in 200 studies (42%). In phase 1 of the study (240 examinations), peripheral augmentation with the use of periodic calf compression was required to show color flow throughout the femoropopliteal venous segment. In phase 2 (235 examinations), with a software upgrade to enhance detectability of slow flow, spontaneous flow could be appreciated in the normal, partly thrombosed, and recanalized femoral popliteal veins without augmentation. Augmentation was often necessary to view tibioperoneal veins. Of the total study group, conventional venography was performed for correlation in 47 patients. In the other patients, clinicians relied on the color Doppler test for the definitive diagnosis of the presence or absence of femoral popliteal venous thrombosis and treated these patients on the basis of the color Doppler test result. In the femoral veins, color Doppler studies and venography agreed in all 12 positive and 35 negative cases. In the popliteal veins, there was agreement in five isolated popliteal thromboses and in 10 femoral popliteal thromboses; there were two false-negative color Doppler studies of isolated popliteal thromboses. In four patients, Doppler studies detected nonocclusive thrombus not evident on venography. Color Doppler imaging is easy to perform and does not require augmentation to view color flow in the femoropopliteal venous segment. Eccentric thrombus and partially canalized thrombus can be shown. Initial experience suggests color Doppler imaging may be useful in the detection of tibioperoneal venous thrombosis.     

Utility of foot venography as part of the routine lower-extremity venogram: A prospective study

Two-hundred foot venograms were performed in patients suspected of deep vein thrombosis (DVT). Eighty studies were positive for DVT in the calf, popliteal, superficial femoral, or common femoral veins. Of these, 16 (20%) had an associated venous thrombosis in the foot. One hundred and ten studies were negative. Of these, none had a positive foot venogram. It is therefore our feeling that an additional study of the foot need not be performed unless there are symptoms specifically referable to this area.     

George W. Holmes Lecture. Deep venous thrombosis and pulmonary embolism: correlative evaluation and therapeutic implications.

Deep venous thrombosis and pulmonary embolism are significant causes of morbidity and mortality in the United States; estimates range from 120,000 to 150,000 deaths annually. Although usually symptomatic, deep venous thrombosis can be clinically occult, in part due to incomplete obstruction or in part related to duplication, triplication, and fenestration anomalies, primarily of the superficial femoral or popliteal vein. Additionally, pulmonary emboli caused by deep venous thrombosis may be clinically silent. Because of therapeutic implications, especially indications for insertion of inferior vena caval filters, comprehensive assessments of both the disease process (i.e., deep venous thrombosis) and the complication (i.e., pulmonary emboli) are important. Thus, when a pulmonary embolus is the presenting process, correlative assessment of deep venous thrombosis, even in the absence of symptoms or signs in the lower extremity, may be of therapeutic significance. Conversely, when deep venous thrombosis of the lower extremities involving the popliteal or superficial femoral vein is the presenting process, correlative assessment of the pulmonary circulation, even when no pulmonary symptoms or signs are present, may be of therapeutic significance. Relative to the diagnosis of pulmonary embolism, the roles of assays of D-dimer, ventilation-perfusion lung scans, and segmental occlusion studies of the pulmonary circulation are discussed. Finally, the indications for insertion of inferior vena caval filters above the renal veins are presented and examples are shown.     

多层螺旋CT血管成像与DSA对照诊断下肢静脉阻塞性病变

目的探讨多层螺旋CT血管成像(multi-slice CT angiography,MSCTA)在下肢静脉阻塞性病变中的应用价值。方法对32例临床疑有下肢静脉阻塞性病变患者行16层螺旋CT血管成像及血管三维重建,并进行DSA检查,结合临床资料分析CTA技术及其在下肢静脉阻塞性病变中的应用价值。结果32例疑诊下肢静脉阻塞性病变患者,MSCTA诊断髂静脉受压综合征19例,其中左侧髂总静脉受压16例,右侧髂总静脉或其分支受压3例。下肢深静脉血栓形成9例,其中左下肢2例,右下肢5例,双下肢2例。左侧腹股沟区囊肿压迫左侧髂外静脉1例。单纯左下肢浅静脉曲张1例。以上30例CT诊断结果均与DSA结果相符合。MSCTA诊断右侧股腘静脉扩张1例,未见异常1例,该2例DSA均提示下肢深静脉瓣膜功能不全。结论MSCTA对下肢静脉阻塞性病变的诊断有较高的临床应用价值。     

下肢静脉MRA的评价

目的：探讨MRA在诊断下肢深静脉狭窄和血栓形成的应用价值。材料和方法：25例临床诊断为下肢深静脉血栓形成患者，进行2DTOF法MRA检查，其中3例同时行动态增强MRA（DCEMRA）。检查范围包括下腔静脉下段至小腿静脉。25例中的18例同时行彩超检查。结果：25例MRA共显示静脉以上（包括静脉）深静脉225条，其中正常静脉76条，血栓形成32条，轻度狭窄（1－49％）50条，明显狭窄（50－99％）45条，闭塞（10％）22条。18例MRA与彩超对照可比静脉162条，彩超示正常静脉53条，异常静脉109条，二者显示一致152条，符合率为93．82％（152／162）。结论：MRA对显示下腔静脉狭窄和血栓形成的部位、范围和程序准确性较高，为临床正确诊断和治疗后随访提供了新的无损伤检查手段。     

Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.     

Deep venous thrombosis evaluation with limited-flip-angle, gradient- refocused MR imaging: preliminary experience

Sixteen patients (17 lower extremities) were prospectively examined with venography and limited-flip-angle, gradient-refocused magnetic resonance (MR) imaging for the presence or absence of deep venous thrombosis. Thrombosed vessels showed decreased-to-absent signal intensity, while patent vessels had high signal intensity. In 16 of 17 extremities, MR images allowed accurate detection and localization of the thrombi found with venography. In the remaining extremity, MR imaging allowed correct identification of thrombus in the iliac and femoral veins but incorrectly demonstrated clot in the calf and popliteal veins. MR imaging with limited-flip-angle, gradient-refocused pulse sequences appears to be a sensitive, noninvasive means of detecting deep venous thrombosis.     

Subcutaneous whole-body radionuclide venography using Tc-99m in vivo tagged red blood cells

PURPOSE: The accurate diagnosis of deep vein thrombosis (DVT) is essential to prevent its complications and to initiate appropriate treatment. Doppler ultrasound (DUS), contrast venography, and intravenous radionuclide venography have been used for many years to detect DVT. However, obtaining venous access in the foot for injection of contrast agent can be difficult. METHODS: The authors introduce the technique of subcutaneous radionuclide venography using Tc-99m in vivo tagged red blood cells and compare it with DUS, a widely used method. Sixty patients (120 lower extremities) underwent subcutaneous radionuclide venography and DUS. RESULTS: The concordance rate was 94% in the femoral veins and 95% in the popliteal veins. Subcutaneous radionuclide venography revealed 10 iliac vein thromboses and 2 inferior vena cava thromboses that were not detected by DUS. CONCLUSIONS: Subcutaneous radionuclide venography is a useful alternative method for detecting DVT. It is particularly valuable for evaluating DVT in the iliac veins and in the inferior vena cava.     

Value of a blood pool contrast agent in MR venography of the lower extremities and pelvis: preliminary results in 12 patients.

The purpose of this study was to determine the value of a blood-pool contrast media (NC100150, Nycomed Imaging (now Amersham Health) Oslo, Norway) for evaluation of venous thrombosis of the deep veins of the pelvis and lower extremities. Twelve patients were prospectively evaluated with conventional X-ray venography (XRV) and MR venography (MRV) after injection of NC100150 (2 ml/kg body weight). The source images and 3D maximum intensity projection (MIP) were viewed on an independent workstation. Diagnosis was made in consensus from two radiologists. Diagnostic image quality was achieved in 87 veins with XRV and MRV. As determined by XRV, thrombus was present in 30 out of 87 veins (34.5%). There was agreement concerning absence or presence of thrombi in 83 out of 87 veins (95.4%; kappa = 0.9 +/- 0.05). Compared to XRV, overall sensitivity and specificity of blood-pool MRV were 93.3% and 96.5%, respectively. Two venous thromboses of the popliteal and posterior tibial vein were diagnosed in MRV, but not in XRV. Conversely, two venous thromboses below the knee had been missed by MRV. NC100150 allows prolonged and improved visualization of the peripheral vasculature and may overcome some limitations of gadolinium contrast media. A more complete examination of the proximal venous tree may be possible than with conventional XRV. Arterial and venous enhancement and motion artifacts can limit image interpretation.     

320排CT血管造影和超声诊断下肢深静脉血栓价值比较

目的：探讨320排容积 CT 静脉造影(CTV)和超声(US)对下肢深静脉血栓(DVT)的诊断价值。方法回顾性分析经DSA 证实为下肢 DVT 的患者51例,对比直接法 CTV 及 US 对下肢不同部位栓子的检出率。结果51例患者中,CTV 共诊断DVT 48例,发现栓子124处,US 诊断静脉血栓46例,发现栓子86处。其中盆腔 DVT CTV 检出34处,US 检出10处,胫腓静脉血栓 CTV 检出25处,US 检出5处,CTV 检出股深静脉血栓2处,US 检出11处。结论直接法 CTV 及 US 对下肢 DVT 的诊断均具有较高的临床应用价值,而前者对盆腔 DVT 及胫腓静脉血栓的检出率更高,而对股深静脉血栓的显示不及后者。     

顺行插管综合介入治疗下肢深静脉慢性血栓形成

目的 评价顺行性插管对下肢深静脉慢性血栓形成（LEDVT）的综合介入治疗的临床应用价值。方法 40例髂和（或）股静脉长段，全段或多节段血栓形成的患者。均经健侧股静脉穿刺先置入下腔静脉滤器，然后经患侧Guo静脉穿刺插管。综合运用血管内溶栓，血栓抽吸，血栓消融器消融。球囊成形术及腔内支架置入术治疗。结果 经皮Guo静脉穿刺插管成功率87.5%(35/40)。失败的5例改手术切开暴露Guo静脉再穿刺插管成功。综合介入治疗后总有效率100%。其中治愈率42.5%（17/40），显效率47.5%(19/40)，好转率10.0%(4/40)。无严重并发症发生。结论 经皮Guo静脉顺行性穿刺插管途径和结合多项介入技术综合运用治疗慢性LEDVT是安全有效的方法。     

静脉顺行造影在静脉畸形骨肥大综合征的应用

目的：探讨静脉顺行造影在静脉畸形骨肥大综合症（KTS）的应用价值。方法：对9例下肢静脉畸形骨肥大症患者行顺性静脉造影检查,其中有4例于术后复查顺性静脉造影,以评价静脉畸形的部位、狭窄的范围与程度。9例患者均行B超检查。结果：静脉造影显示本组9例患者中,1例胫腓干静脉狭窄,1例胫腓干静脉狭窄,1例胫腓干静脉狭窄并Guo静脉狭窄,4例静脉狭窄。4例行手术治疗的患者,于术后复查下肢静脉造影,显示浅静脉曲张较术前减少,深静脉通畅度改善。结论：静脉造影提供了明确的静脉畸形范围,从而对临床治疗提供可靠的依据;并有利于术前、术后对比,以评价疗效。     

双侧股静脉入路在左下肢深静脉血栓介入治疗中的应用

目的 探讨采用双侧股静脉入路介入插管溶栓方法治疗左下肢深静脉血栓的可行性.方法 对18例从右股静脉或右颈静脉入路行左髂股静脉插管失败的急性左下肢深静脉血栓患者.采用左侧股静脉顺行法穿刺,注射埘比剂证实穿刺成功后将导丝插入至下腔静脉,将导丝从右侧股静脉或颈静脉穿出或拉出后建立导丝轨道,冉沿导丝将导管自右向左逆行插入左侧髂...     

经腘静脉顺行穿刺治疗下肢静脉血栓的探讨

目的：探讨经腘静脉顺行穿刺治疗下肢静脉血栓的可行性及优越性。方法：下肢静脉血栓患者19例，经对侧股静脉放置下腔静脉滤器后，使用骨科止血带加压成功穿刺腘静脉，15例顺行插管抽血栓，4例使用Amplatz血栓清除器（ATD）。结果：19例均获成功，栓塞血管复通达100％。临床症状消失，无症状性复发。结论：下肢静脉血栓中使用骨科止血带后可有效地提高顺行穿刺腘静脉成功率，是下肢静脉溶栓治疗的有效方法。