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November 18, 1992

Ultrasound Surveillance to Detect Postoperative Venous Thrombosis-Reply

Author Affiliations

University of Rochester (NY) School of Medicine and Dentistry

JAMA. 1992;268(19):2650-2651. doi:10.1001/jama.1992.03490190050024

In Reply.  —Dr Bauer suggests that ultrasound surveillance could be a useful strategy in the management of postoperative thromboembolic disease after total hip arthroplasty. If successful, this would noninvasively identify patients with proximal vein thrombosis and anticoagulation limited to patients in this group. We cannot recommend this approach. In symptomatic patients, ultrasound has a sensitivity for detection of proximal leg vein thrombosis of over 90% in comparison with venography.1,2 However, lower sensitivities of 63% to 89% have been reported after total hip arthroplasty.3-5 Also, ultrasound is insensitive to calf vein thrombosis. Therefore, serial examination would be required to detect extension of asymptomatic calf vein thrombosis into proximal veins with potential for major pulmonary embolism. This may not be effective, as demonstrated by a recent study using serial ultrasound and impedance plethysmography in hospitalized patients with spinal cord injury.6 Despite normal serial noninvasive studies, two of 41 patients