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Article
September 1983

The Noninvasive Venous Vascular LaboratoryA Prospective Analysis

Author Affiliations

From the Departments of Surgery, St Francis Hospital and Medical Center, Hartford, Conn, and the University of Connecticut School of Medicine, Farmington. Dr Russell is now with the Veterans Administration Medical Center, Newington, Conn, and the University of Connecticut School of Medicine, Farmington.

Arch Surg. 1983;118(9):1024-1028. doi:10.1001/archsurg.1983.01390090014003
Abstract

• We undertook a prospective study to ascertain the accuracy of the noninvasive venous vascular laboratory in diagnosing clinically suspected deep-vein thrombosis. Of 88 patients studied with contrast venography and bilateral plethysmography, 41% had normal venograms; 15%, isolated venous thrombosis in the calf; and 44%, proximal deep-vein thrombosis. Clinical and Doppler examinations could not differentiate these three groups. The composite venous score was reliable at extreme values. By considering scores of 3.9 or less as negative, 8.0 or more as positive, and 4.0 to 7.9 as indeterminate, a suitable combination of sensitivity (75%), specificity (100%), and overall accuracy (90%) was obtained. Low-risk patients with scores of 3.9 or less should be observed. Patients with scores of 8.0 or greater can undergo anticoagulation without contrast venography, which is mandatory for patients with indeterminate venous scores and high-risk patients with scores of 3.9 or less.

(Arch Surg 1983;118:1024-1028)

References
1.
Borow M, Goldson H:  Postoperative venous thrombosis: Evaluation of five methods of treatment . Am J Surg 1981;141:245-251.Article
2.
Cooperman M, Martin E Jr, Satiani B, et al:  Detection of deep venous thrombosis by impedance plethysmography . Am J Surg 1979;137:252-254.Article
3.
Hull R, Hirsh J, Sackett DL, et al:  Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis . N Engl J Med 1977;296:1497-1500.Article
4.
Cranley JJ, Canos AJ, Sull WJ:  The diagnosis of deep venous thrombbosis: Fallibility of clinical symptoms and signs . Arch Surg 1976;11:34-36.Article
5.
Wu KK, Hoak JC, Barnes RW:  A prospective comparison of four methods for the diagnosis of deep vein thrombosis . Thromb Haemost 1974;32:260-265.
6.
Raines JK, Jaffrin MY, Rao S:  A noninvasive pressure-pulse recorder: Development and rationale . Med Instrum 1973;7:245-250.
7.
Sufian S:  Noninvasive vascular laboratory diagnosis of deep venous thrombosis . Am Surg 1981;47:254-258.
8.
Schroeder PJ, Dunn E:  Mechanical plethysmography and Doppler ultrasound . Arch Surg 1982;117:300-303.Article
9.
Daniel WW: Biostatistics: A Foundation for Analysis in the Health Sciences . New York, John Wiley & Sons Inc, 1974.
10.
McBride KJ, O'Connell TF Jr, Pauker SG, et al:  Venous volume displacement plethysmography: Its diagnostic value in deep venous thrombosis as determined by receiver operator characteristic curves . Cardiovasc Dis, Bull Texas Heart Inst 1981;8:499-508.
11.
Young AE, Henderson BA, Phillips DA, et al:  Impedance plethysmography: Its limitations as a substitute for phlebography . Cardiovasc Intervent Radiol 1978;1:233-239.Article
12.
Albrechtsson U, Olsson CG:  Thrombotic side-effects of lower-limb phlebography . Lancet 1976;1:723-724.Article
13.
Bettman MA, Paulin S: Leg  phlebography: The incidence, nature, and modification of undesirable side effects . Radiology 1977;122:101-104.Article
14.
Bettman MA, Salzman EW, Rosenthal D, et al:  Reduction of venous thrombosis complicating phlebography . Am J Res 1980;134:1169-1172.
15.
Sauerbrei E, Thomson JC, McLachlan MSF, et al:  Observer variation in lower limb venography . J Can Assoc Radiol 1981;31:28-29.
16.
Siegel B, Popky GL, Wagner DK, et al:  A Doppler ultrasound method for diagnosing lower extremity venous disease . Surg Gynecol Obstet 1968;127:339-350.
17.
Evans DS:  The early diagnosis of thromboembolism by ultrasound . Ann R Coll Surg Engl 1971;49:225-249.
18.
Strandness DE Jr, Sumner DS:  Ultrasonic velocity detector in the diagnosis of thrombophlebitis . Arch Surg 1972;104:180-183.Article
19.
Alexander RH, Folse R, Pizzorne J, et al:  Thrombophlebitis and thromboembolism . Ann Surg 1974;180:883-887.Article
20.
Yao JST, Henkin RE, Bergan JJ:  Venous thromboembolic disease: Evaluation of new methodology in treatment . Arch Surg 1974;109:664-670.Article
21.
Barnes RW, Russell HE, Wu KK, et al:  Accuracy of Doppler ultrasound in clinically-suspected venous thrombosis of the calf . Surg Gynecol Obstet 1976;143:425-428.
22.
Nicholas GG, Miller JE, DeMuth WE, et al:  Clinical vascular laboratory diagnosis of deep venous thrombosis . Ann Surg 1977;186:213-215.Article
23.
Flanigan DP, Goodreau JJ, Burnham SJ, et al:  Vascular-laboratory diagnosis of clinically-suspected acute deep-vein thrombosis . Lancet 1978;2: 331-334.Article
24.
Sumner DS, Lambeth A:  Reliability of Doppler ultrasound in the diagnosis of acute venous thrombosis both above and below the knee . Am J Surg 1979;138:205-210.Article
25.
Cranley JJ, Canos AJ, Sull WJ, et al:  Phleborheographic technique for diagnosing deep vein thrombosis of the lower extremities . Surg Gynecol Obstet 1975;141:331-339.
26.
Collins GL Jr, Rich NM, Anderson CA, et al:  Phleborheographic diagnosis of venous obstruction . Ann Surg 1979;189:25-28.Article
27.
Classen JN, Richardson JB, Koontz C:  A three-year experience with phleborheography: A noninvasive technique for the diagnosis of deep venous thrombosis . Ann Surg 1982;195:800-803.Article
28.
Nolan TR, Ordonez C, Rosen AJ, et al:  Diagnostic accuracy of phleborheography in deep venous thrombosis . Am Surg 1982;48:77-78.
29.
Gross WS, Burney RE:  Therapeutic and economic implications of emergency department evaluation for venous thrombosis . J Am Coll Emerg Phys 1979;8:110-113.Article
30.
Barnes RW, Collicott PE, Mozersky DJ, et al:  Noninvasive quantitation of maximum venous outflow in acute thrombophlebitis . Surgery 1972; 72:971-979.
31.
Barnes RW, Hokanson DE, Wu KK, et al:  Detection of deep vein thrombosis with an automatic electrically calibrated strain gauge plethysmography . Surgery 1977;82:219-223.
32.
Steer ML, Spotnitz AJ, Cohen SI, et al:  Limitations of impedance phlebography for diagnosis of venous thrombosis . Arch Surg 1973;106: 44-48.Article
33.
Wheeler HB, O'Connell JA, Andersen FA Jr, et al:  Occlusive impedance phlebography for diagnosis of venous thrombosis . Prog Cardiovasc Dis 1974;17:119-205.
34.
Wheeler HB, O'Connell JA, Andersen FA Jr, et al:  Bedside screening for venous thrombosis using occlusive impedance phlebography . Angiology 1975;26:199-210.Article
35.
Wheeler HB, Anderson FA Jr, Cardullo PA, et al:  Suspected deep vein thrombosis: Management by impedance plethysmography . Arch Surg 1982;117:1206-1209.Article
36.
Clarke-Pearson DL, Creasman WT:  Diagnosis of deep venous thrombosis in obstetrics and gynecology by impedance phlebography . Obstet Gynecol 1981;58:52-57.
37.
Hanel KC, Abbott WM, Reidy NC, et al:  The role of two noninvasive tests in deep venous thrombosis . Ann Surg 1981;194:725-730.Article
38.
Browse NL:  The 125I fibrinogen uptake test . Arch Surg 1972;104:160-163.Article
39.
Hull R, Hirsch J, Sackett DL, et al:  Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125I fibrinogen leg scanning . Ann Intern Med 1981;94:12-15.Article
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