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Thromb Haemost 1996; 75(02): 242-245
DOI: 10.1055/s-0038-1650252
Original Article
Schattauer GmbH Stuttgart

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

Marie Magnusson
1   The Department of Clinical Physiology, Östra Hospital, Göteborg, Sweden
,
Bengt I Eriksson
2   The Department of Orthopaedics, Östra Hospital, Göteborg, Sweden
,
Peter Kãlebo
3   The Department of Radiology, Östra Hospital, Göteborg, Sweden
,
Ramon Sivertsson
1   The Department of Clinical Physiology, Östra Hospital, Göteborg, Sweden
› Author Affiliations
Further Information

Publication History

Received: 24 May 1995

Accepted after resubmission20 October 1995

Publication Date:
26 July 2018 (online)

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Summary

Patients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.

CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

 

  • References

  • 1 Talbot SR. Use of Real-Time Imaging in identifying deep venous obstruction: A preliminary report. Bruit 1982; 6: 41-42
    PubMedGoogle Scholar
  • 2 Raghavendra BN, Horii SC, Hilton S, Subramanyam BR, Rosen RJ, Lam S. Deep venous thrombosis: Detection by probe compression of veins. J Ultrasound Med 1986; 5: 89-95
    CrossrefPubMedGoogle Scholar
  • 3 Elias A, Le Corff G, Bouvier JL, Benichou M, Serradimigni A. Value of real time B mode ultrasound imaging in the diagnosis of deep vein thrombosis of the lower limbs. Int Angiol 1987; 6: 175-182
    PubMedGoogle Scholar
  • 4 Vogel P, Laing FC, Jeffrey RB, Wing VW. Deep venous thrombosis of the lower extremity: US evaluation. Radiology 1987; 163: 747-751
    CrossrefPubMedGoogle Scholar
  • 5 Langsfeld M, Hershey FB, Thorpe L, Auer AI, Binnington HB, Hurley JJ, Woods JJ. Duplex B-mode imaging for the diagnosis of deep venous thrombosis. Arch Surg 1987; 122: 587-591
    CrossrefPubMedGoogle Scholar
  • 6 O’Leary DH, Kane RA, Chase BM. A prospective study of the efficacy of B-scan sonography in the detection of deep venous thrombosis in the lower extremities. J Clin Ultrasound 1988; 16: 1-8
    CrossrefPubMedGoogle Scholar
  • 7 Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, ten Cate JW, Huisman MV, Biiller HR. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342-345
    CrossrefPubMedGoogle Scholar
  • 8 Polak JF, Culter SS, O’Leary DH. Deep veins of the calf: Assessment with color Doppler flow imaging. Radiology 1989; 171: 481-485
    CrossrefPubMedGoogle Scholar
  • 9 Cronan JJ, Froehlich JA, Dorfman GS. Image-directed Doppler ultrasound: A screening technique for patients at high risk to develop deep vein thrombosis. J Clin Ultrasound 1991; 19: 133-138
    CrossrefPubMedGoogle Scholar
  • 10 Mattos MA, Londrey GL, Leutz DW, Hodgson KJ, Ramsey DE, Barkmeier LD, Stauffer ES, Spadone DP, Sumner DS. Color-flow duplex scanning for the surveillance and diagnosis of acute deep venous thrombosis. J Vase Surg 1992; 15: 366-376
    CrossrefPubMedGoogle Scholar
  • 11 Davidson BL, Elliott CG, Lensing AWA. Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. Ann Int Med 1992; 117: 735-738
    CrossrefPubMedGoogle Scholar
  • 12 Tremaine MD, Choroszy CJ, Menking SA. Deep vein thrombosis in the total hip arthroplasty patient after hospital discharge. J Vase Technol 1992; 16: 23-27
    PubMedGoogle Scholar
  • 13 Murdock LE, Hofmann AA, Friedman R, Goble M, Groth H, Johnson W, Elliott G. The role of duplex ultrasonography in the detection of deep-vein thrombosis in asymptomatic, postoperative total hip and knee arthroplasty patients. Orthop Trans 1992 1993; 16: 710-711
    PubMedGoogle Scholar
  • 14 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
    CrossrefPubMedGoogle Scholar
  • 15 Van Bemmelen PS, Bedford G, Strandness DE. Visualization of calf veins by color flow imaging. Ultrasound Med Biol 1990; 16: 15-17
    CrossrefPubMedGoogle Scholar
  • 16 Comerota AJ, Katz ML, Hashemi HA. Venous duplex imaging for the diagnosis of acute deep venous thrombosis. Haemostasis 1993; (Suppl. 23) Suppl 1: 61-71
    PubMedGoogle Scholar
  • 17 Persson AV, Jones C, Zide R, Jewell ER. Use of the triplex scanner in diagnosis of deep vein thrombosis. Arch Surg 1989; 124: 593-596
    CrossrefPubMedGoogle Scholar
  • 18 Foley WD, Middleton WD, Lawson TL, Erickson S, Quiroz FA, Macrander S. Color Doppler ultrasound imaging of lower-extremity venous disease. AJR 1989; 152: 371-376
    CrossrefPubMedGoogle Scholar
  • 19 Baxter GM, McKechnie S, Duffy P. Colour Doppler ultrasound in deep venous thrombosis: A comparison with venography. Clin Radiol 1990; 42: 32-36
    CrossrefPubMedGoogle Scholar
  • 20 Schindler JM, Kaiser M, Gerber A, Vuilliomenet A, Popovic A, Bertel O. Colour coded duplex sonography in suspected deep vein thrombosis of the leg. Br Med J 1990; 301: 1369-1370
    CrossrefPubMedGoogle Scholar
  • 21 Rose SC, Zwiebel WJ, Nelson BD, Priest DL, Knighton RA, Brown JW, Lawrence PF, Stults BM, Reading JC, Miller FJ. Symptomatic lower extremity deep venous thrombosis: Accuracy, limitations, and role of color duplex flow imaging in diagnosis. Radiology 1990; 175: 639-644
    CrossrefPubMedGoogle Scholar
  • 22 Yucel EK, Fisher JS, Egglin TK, Geller SC, Waltman AC. Isolated calf venous thrombosis: diagnosis with compression US. Radiology 1991; 179: 443-446
    CrossrefPubMedGoogle Scholar
  • 23 Kalodiki E, Marston R, Volteas N, Leon M, Lapropoulos N, Fisher CM, Christopoulos D, Touquet R, Nicolaides AN. The combination of liquid crystal thermography and duplex scanning in the diagnosis of deep vein thrombosis. Eur J Vase Surg 1992; 6: 311-316
    CrossrefPubMedGoogle Scholar
  • 24 Baxter GM, Duffy P, Partridge E. Colour flow imaging of calf vein thrombosis. Clin Radiol 1992; 46: 198-201
    CrossrefPubMedGoogle Scholar
  • 25 Bradley MJ, Spencer PA, Alexander L, Milner GR. Colour flow mapping in the diagnosis of the calf deep vein thrombosis. Clin Radiol 1993; 47: 399-402
    CrossrefPubMedGoogle Scholar
  • 26 Barnes RW, Nix ML, Barnes CL, Lavender RC, Golden WE, Harmong BH, Ferris EJ, Nelson CL. Perioperative asymptomatic venous thrombosis: Role of duplex scanning versus venography. J Vase Surg 1989; 9: 251-260
    CrossrefPubMedGoogle Scholar
  • 27 Flinn WR, Sandager GP, Cerullo LJ, Havey RJ, Yao JST. Duplex venous scanning for the prospective surveillance of perioperative venous thrombosis. Arch Surg 1989; 124: 901-905
    CrossrefPubMedGoogle Scholar
  • 28 Borris LC, Christiansen HM, Lassen MR, Olsen AD, Schptt P. Comparison of real-time B-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thromb Heamost 1989; 61: 363-365
    PubMedGoogle Scholar
  • 29 Froehlich JA, Dorfman GS, Cronan JJ, Urbanek PJ, Herndon JH, Aaron RK. Compression ultrasonography for the detection of deep venous thrombosis in patients who have a fracture of the hip. J Bone Joint Surg 1989; 71: 249-256
    CrossrefPubMedGoogle Scholar
  • 30 Monreal M, Montserrat E, Salvador R, Bechini J, Donoso L, MaCallejas J, Foz M. Real-time ultrasound for diagnosis of symptomatic venous thrombosis and for screening of patients at risk: Correlation with ascending conventional venography. Angiol 1989; 40: 527-533
    CrossrefPubMedGoogle Scholar
  • 31 Comerota AJ, Katz ML, Greenwald LL, Leefmans E, Czeredarczuk M, White JV. Venous duplex imaging: Should it replace hemodynamic tests for deep venous thrombosis. J Vase Surg 1990; 11: 53-61
    CrossrefPubMedGoogle Scholar
  • 32 Woolson ST, McCrory DW, Walter JF, Maloney WJ, Watt JM, Cahill PD. B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement. J Bone Joint Surg 1990; 72: 983-987
    CrossrefPubMedGoogle Scholar
  • 33 Borris LC, Christiansen HM, Lassen MR, Olsen AD, Schptt P. Realtime B-mode ultrasonography in the diagnosis of postoperative deep vein thrombosis in non-symptomatic high-risk patients. Eur J Vase Surg 1990; 4: 473-475
    CrossrefPubMedGoogle Scholar
  • 34 White RH, Goulet JA, Bray TJ, Daschbach MM, McGahan JP, Hartling RP. Deep-vein thrombosis after fracture of the pelvis: Assessment with serial duplex-ultrasound screening. J Bone Joint Surg 1990; 72: 495-500
    CrossrefPubMedGoogle Scholar
  • 35 Barnes CL, Nelson CL, Nix ML, McCowan TC, Lavender RC, Barnes RW. Duplex scanning versus venography as a screening examination in total hip arthroplasty patients. Clin Orthop 1991; 271: 180-189
    PubMedGoogle Scholar
  • 36 Woolson ST, Pottorff G. Venous ultrasonography in the detection of proximal vein thrombosis after total knee arthroplasty. Clin Orthop 1991; 273: 131-135
    PubMedGoogle Scholar
  • 37 Ginsberg JS, Caco CC, Brill-Edwards PA, Panju AA, Bona R, Demers CM, Tuters LM, Nugent P, McGinnis J, Grant BM, Vander Lander Vries MA. Venous thrombosis in patients who have undergone major hip or knee surgery: detection with compression US and impedance plethysmography. Radiology 1991; 181: 651-654
    CrossrefPubMedGoogle Scholar
  • 38 Agnelli G, Volpato R, Radicchia S, Veschi F, Di Filippo P, Lupattelli L, Nenci GG. Detection of asymptomatic deep vein thrombosis by real-time B-mode ultrasonography in hip surgery patients. Thromb Haemost 1992; 68: 257-260
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Elliott CG, Suchyta M, Rose SC, Talbot S, Ford C, Raskob G, Hull R, Davidson B. Duplex ultrasonography for the detection of deep vein thrombi after total hip or knee arthroplasty. Angiol 1993; 44: 26-33
    CrossrefPubMedGoogle Scholar
  • 40 Jongbloets LMM, Lensing AWA, Koopman MMW, Biiller HR, ten Cate JW. Limitations of compression ultrasound for the detection of symptomless postoperative deep vein thrombosis. Lancet 1994; 343: 1142-1144
    CrossrefPubMedGoogle Scholar
  • 41 Grady-Benson JC, Oishi CS, Hanson PB, Colwell CW, Otis SM, Walker RH. Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty. J Bone Joint Surg 1994; 76: 1649-1657
    CrossrefPubMedGoogle Scholar
  • 42 Wells PS, Lensing AWA, Davidson BL, Prins MH, Hirsh J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. Ann Intern Med 1995; 122: 47-53
    CrossrefPubMedGoogle Scholar
  • 43 Kalebo P, Anthmyr B-A, Eriksson BI, Zachrisson BE. Phlebographic findings in venous thrombosis following total hip replacement. Acta Radiol 1990; 31: 259-263
    CrossrefPubMedGoogle Scholar
  • 44 Liu G-C, Ferris EJ, Reifsteck JR, Baker ME. Effect of anatomic variations on deep venous thrombosis of the lower extremity. AJR 1986; 146: 845-848
    CrossrefPubMedGoogle Scholar