[Diagnosis of deep leg vein thrombosis with Doppler sonography, duplex sonography and phlebography. A prospective study of 66 patients].
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Biomedical subjects
Publications and source records attributed to M Stapff.
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Ultrasound waves spread in the body in changing the acoustic pressure in a high frequency causing heat production or acoustic cavitation. There are many adverse effects known in cell cultures or in animals. Epidemiologic studies showed no evidence at the present time that ultrasound causes any biological effects in human subjects. Therefore further observations, especially of new applications are necessary.
The diagnosis of thrombosis of the deep leg veins or pelvic veins is usually established on the basis of technical procedures. Clinical signs such as swelling, erythema or warming are unreliable. Plethysmographic measures have a low specificity, nuclear medicine studies enable assessment, limited to the lower leg, only after 24 hours. Continuous-wave Doppler sonography, as is the case with plethysmography, does not allow differentiation between intra- or extravascular cause of the obstruction to flow; hemodynamically-unimportant, floating thrombi cannot be detected. Ascending phlebography is an invasive procedure exposing the patient to contrast medium with its possible allergic reactions, radiation and thrombosis or local inflammation. Duplex-sonography enables the combination of high-resolution ultrasonic B-imaging with a pulsed Doppler unit which provides a noninvasive means for direct visualization of the involved vessel. For the examination, preferably, linear scanners are employed with a frequency of at least 5 megahertz. With the patient in the supine position, first, the iliac vein, medial to the artery, is imaged, then the common femoral vein and the great saphenous vein (Figure 1). Then the patient is turned and the popliteal vein and, as far as possible, the veins of the lower leg are examined from the back. Direct proof of thrombosis is considered the documentation of intraluminal echo-intense structures (Figure 2) associated with absence of complete compressibility of the vascular lumen in cross-section with slight pressure of the transducer (Figures 3a and 3b).(ABSTRACT TRUNCATED AT 250 WORDS)
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50 cases, in which phlebography was indicated by clinical symptoms of deep venous thrombosis, were examined by duplex-sonography. In comparison with the phlebographic findings, duplex-sonography was 100% sensitive in detecting thrombosis of the popliteal, femoral and iliac veins and 89% respectively 95% and 100% specific. A sonographic performance of the calf veins was only possible in 44%, the sensitivity in these cases was 92%, specificity 50%. Thus, the non-invasive duplex-sonography is a very appropriate method to diagnose thrombosis of the popliteal region and proximal. For proving or excluding thrombosis of the calf veins phlebography remains necessary.
Adventitial cystic disease and entrapment syndromes of the popliteal artery are rare causes of ischemia in the lower leg in younger patients without cardiovascular risk factors. The 38-year-old male patient described in this case report showed both types of these rare abnormalities in the same vessel, both usually requiring surgical revision even in causing only few symptoms.
Abdominal duplex-sonography is a new method of diagnosing noninvasively arterial and venous lesions of abdominal vessels. Depending on the experience of the investigator definite diagnoses can be made in some cases. Further technical improvements of ultrasound probes and signal processing may give valuable information about hemodynamics of abdominal vessels. Thus, duplex-sonography is a useful addition of clarifying physiology and pathology of abdominal blood flow.
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