[Deep venous thrombosis. Evaluation of a non-invasive diagnostic procedure based on compression ultrasonography and measurement of D-dimer plasma levels].
BACKGROUND
Clinical diagnosis of deep venous thrombosis (DVT) of the leg is unreliable. An accurate diagnosis is important for therapeutic decision since anticoagulant treatment, though potentially dangerous, is useless in case of a false positive diagnosis, whereas a false negative diagnosis may lead to withdrawal of an extremely necessary anticoagulation. Contrast venography is still recognized as the gold standard method for the diagnosis of DVT, but in recent years a variety of accurate non-invasive methods has been developed. The ultrasound compression sonography (CUS) is considered a simple non invasive test highly sensitive and specific for proximal DVT in symptomatic outpatients, though non adequately sensitive and specific for isolated calf DVT. Plasma D-dimer levels (DD, fibrin degradation products) have a high negative predictive value for DVT. The aim of this study, performed in outpatients with suspected leg DVT, was to validate, versus venography, a non-invasive, easy to perform and fast diagnostic procedure based on a combination of CUS and D-dimer test. End points of the procedure were: confirmation or exclusion of proximal DVT; suspicion of isolated calf DVT in which case the test would be repeated in a few days to detect any possible proximalization of thrombosis.


METHODS
Sixty-eight consecutive outpatients, 37 male, with clinically suspected first episode of leg DVT were eligible and examined with CUS, DD test and venography.


RESULTS
The results showed that the diagnostic procedure under examination has a high sensibility and specificity for DVT.


CONCLUSIONS
It can thus be recommended as routine diagnostic procedure in symptomatic outpatients with suspected DVT reserving venography special cases only.
Guazzaloca
G
G
Cattedra e Divisione di Angiologia e Malattie della Coagulazione, Policlinico Sant'Orsola-Malpighi, Bologna.
Palareti
G
G
Legnani
C
C
Fortunato
G
G
Grauso
F
F
Rodorigo
G
G
De Rosa
V
V
Golfieri
R
R
Gianpalma
E
E
Marri
D
D
Pazzaglia
M
M
Franchi
R
R
Coccheri
S
S
D000554:Ambulatory Care Facilities; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D010690:Phlebography; D011237:Predictive Value of Tests; D013924:Thrombophlebitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D