Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

Giancarlo Agnelli; Benilde Cosmi; Stefano Radicchia; Franca Veschi; Enrico Boschetti; Luciano Lupattelli; Emanuele Rinonapoli; Giuseppe G Nenci

doi:10.1055/s-0038-1649563

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 1993; 70(02): 266-269
DOI: 10.1055/s-0038-1649563

Original Articles

Clinical Studies

Schattauer GmbH Stuttgart

Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

Authors

Giancarlo Agnelli

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy
Benilde Cosmi

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy
Stefano Radicchia

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy
Franca Veschi

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy
Enrico Boschetti

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy
Luciano Lupattelli

¹The Istituto di Radiologia, Università di Perugia, Perugia, Italy
Emanuele Rinonapoli

²The Istituto di Clinica Ortopedica, Università di Perugia, Perugia, Italy
Giuseppe G Nenci

The Istituto di Medicina Interna e di Medicina Vascolare, Università di Perugia, Perugia, Italy

Abstract

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Summary

Impedance plethysmography (IPG) has high sensitivity and specificity in patients with symptomatic deep vein thrombosis (DVT) while it fails to detect asymptomatic DVT. The aim of this study was to determine whether the features of thrombi such as location, size and occlusiveness could explain the different accuracy of IPG in symptomatic and asymptomatic DVT patients. One-hundred and seventeen consecutive outpatients with a clinical suspicion of DVT and 246 consecutive patients undergoing hip surgery were admitted to the study. In symptomatic patients IPG was performed on the day of referral, followed by venography, while in asymptomatic patients IPG was performed as a surveillance programme, followed by bilateral venography.

A venography proved DVT was observed in 37% of the symptomatic patients and 34% of the asymptomatic limbs. A significantly higher proportion of proximal DVTs was found in symptomatic patients than in asymptomatic patients (78% vs 46%; p = 0.001). The mean Marder score, taken as an index of thrombus size, was significantly higher in symptomatic patients than in asymptomatic patients (19.0 vs 9.6; p = 0.0001). A significantly higher proportion of occlusive DVTs was observed in symptomatic than in asymptomatic patients (69% vs 36%; p = 0.001).

We conclude that the unsatisfactory diagnostic accuracy of IPG in asymptomatic DVT is due to the high prevalence of distal, small and non occlusive thrombi. Such thrombi are unlikely to cause a critical obstruction of the venous outflow and therefore to produce a positive IPG.

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Referenzen

References
1 Haeger K. Problems of acute deep venous thrombosis.I. The interpretation of signs and symptoms. Angiology 1969; 20: 219-220
2 Cranley JJ, Canos AJ, Suil WJ. The diagnosis of deep venous thrombosis: fallibility of clinical symptoms and signs. Arch Surg 1976; 111: 34-36
3 Hull RD, Seeker-Walker RH, Hirsh J. Diagnosis of deep vein thrombosis. In Thrombosis and Haemostasis: Basic Principles and Clinical Practice. Colman RW, Hirsh J, Marder VJ, Salzman EW. (eds) Philadelphia, PA: Lippincott; 1987: 1220-1238
4 O’Donnell Jr TF, Abbott WM, Athanasoulis CA, Millan VG, Callow AD. The diagnosis of deep venous thrombosis in the outpatient by venography. Surg Gynecol Obstet 1980; 150: 69-75
5 Bettman MA. In Venous Thrombosis and Pulmonary Embolism Diagnostic Methods. Hirsh J. (ed) New York: Churchill Livingstone; 1987: 20-268
6 Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Buller HR, Turpie AG, Powers P, Kinch D, Dodd PE, Gill GJ, Leclerc JR, Gent M. Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis. Ann Intern Med 1985; 102: 21-28
7 Huisman MV, Büller HR, ten Cate JW, Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. N Engl J Med 1986; 314: 823-828
8 Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, ten Cate JW, Huisman MV, Büller HR. Detection of deep-vein thrombosis by real time B-mode ultrasonography. N Engl J Med 1989; 320: 342-345
9 Harris WH, Athanasoulis C, Waltman AC, Salzman EW. Cuff impedance phlebography and ¹²⁵I-fibrinogen scanning versus roentgenographic phlebography for diagnosis of thrombophlebitis following hip surgery. J Bone Joint Surg 1976; 58A: 939-944
10 Hull R, Hirsh J, Sackett DL, Powers P, Turpie AGG, Walker I, McBride J. The value of adding impedance plethysmography to ¹²⁵I- fibrinogen leg scanning for the detection of deep vein thrombosis in high risk surgical patients: a comparative study between patients undergoing general surgery and hip surgery. Thromb Res 1979; 15: 227-234
11 Comerota AJ, Katz ML, Grossi RJ, White JV, Czeredarczuk M, Bowman G, DeSai S, Vujic I. Th£ comparative value of non invasive testing for diagnosis and surveillance of deep vein thrombosis. J Vase Surg 1988; 7: 40-49
12 Paiement G, Wessinger SJ, Waltman AC, Harris WH. Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Am J Surg 1988; 155: 400-404
13 Cruickshank MK, Levine MN, Hirsh J, Turpie AGG, Powers P, Jay R, Gent M. An evaluation of impedance plethysmography and ¹²⁵I- fibrinogen leg scanning in patients following hip surgery. Thromb Haemostas 1989; 62: 830-834
14 Borris LC, Christiansen HM, Lassen MR, Olsen AD, Schott P. Comparison of real time B-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thromb Haemostas 1989; 61: 363-365
15 Agnelli G, Volpato R, Radicchia S, Veschi F, Di FilippoP, Lupattelli L, Nenci GG. Detection of asymptomatic deep vein thrombosis by real time B-mode ultrasonography in hip surgery patients. Thromb Haemostas 1992; 68: 257-260
16 Agnelli G, Longetti M, Cosmi B, Lupattelli L, Barzi F, Levi M, Nenci GG. Diagnostic accuracy of the computerized impedance plethysmography in the diagnosis of symptomatic deep vein thrombosis: a controlled venographic study. Angiology 1990; 41: 559-563
17 Agnelli G, Cosmi B, Ranucci V, Renga C, Mosca S, Lupattelli L, Di FilippoP, Rinonapoli E, Nenci GG. Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery. A venography-controlled study. Arch Intern Med 1991; 151: 2167-2171
18 Prandoni P, Lensing AWA, Huisman MV, Jonker JJC, Vigo M, Borm JJJ, Büller HR, Sing AK, Carta M, ten Cate JW. A new computerized impedance plethysmograph: accuracy in the detection of proximal deep-vein thrombosis in symptomatic outpatients. Thromb Haemostas 1991; 65: 229-232
19 Agnelli G, Cosmi B, Di FilippoP, Ranucci R, Veschi F, Longetti M, Renga C, Barzi F, Gianese F, Lupattelli L, Rinonapoli E, Nenci GG. A randomized double-blind placebo-controlled trial of dermatan sulphate for prevention of deep vein thrombosis in hip fracture. Thromb Haemostas 1992; 67: 203-208
20 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
21 Marder VJ, Soulen RL, Atchartakam V, Budzynski AZ, Parulekar S, Kim JR, Edvard N, Zahavi J, Algazy KM. Quantitative venographic assessment of deep vein thrombosis in the evaluation of streptokinase and heparin therapy. J Lab Clin Med 1977; 89: 1018-1028
22 Sackett D, Haynes R, Tugwell P. Clinical Epidemiology a Basic Science for Clinical Medicine. 1.. Little, Brown and Company. 1985: 59