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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The frequency of venous disease probably surpasses that of heart disease and stroke. The fallibility of the clinical diagnosis of pulmonary embolism and deep vein thrombosis (DVT) approaches 50% error in both conditions. Because of the serious errors in omission and commission of the clinical diagnosis of venous thrombosis, a variety of noninvasive diagnostic techniques have been developed within the past decade. The purpose of this paper is to analyze these noninvasive venous modalities with more emphasis on what is available in our vascular lab at Charleston Area Medical Center-Charleston Division, West Virginia University Medical Center.
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PMID:Current status of the vascular laboratory in the diagnosis of deep vein thrombosis. 649 49

The objective of this paper is to review the theoretical basis and clinical application of electrical impedance plethysmography in the noninvasive evaluation of peripheral arterial and venous disease. Theoretical, experimental and clinical studies have now demonstrated a direct relationship between electrical impedance changes and limb volume changes. Potential sources of error have also been identified. This has led to the development of clinical tests based on impedance plethysmography for the detection of peripheral arterial disease, venous insufficiency and venous outflow obstruction. Impedance plethysmography, using the method of venous occlusion, is presently the most commonly employed noninvasive method for the detection of deep venous thrombosis.
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PMID:Impedance plethysmography in the diagnosis of arterial and venous disease. 650 62

The versatility of impedance plethysmography (IPG) in the diagnosis of arterial and venous disease was evaluated in the clinical setting. Eighty-eight consecutive patients suspected of acute or chronic deep venous thrombosis (DVT) and undergoing ascending venography were evaluated using IPG. Venous capacitance (VC) and venous outflow (VO) were expressed as a per cent impedance change (% delta I). The evaluation was considered as abnormal if the VC was less than 1.85% delta I and the VO less than 0.95% delta I. The overall accuracy was 90 per cent with a sensitivity of 92 per cent and specifity of 93 per cent. Arterial blood flow (ABF) was measured in normal volunteers (20 limbs) and patients with intermittent claudication (20 limbs) and rest pain (16 limbs). Resting ABF (cc/100 ml/min) did not differ (P greater than 0.05) in the normal volunteer (4.3 +/- 0.4) and patients with intermittent claudication (4.6 +/- 0.5), but both were significantly greater (P less than 0.05) than ABF in patients with rest pain (3.2 +/- 0.2). Peak ABF during reactive hyperemia (RH) was significantly greater (P less than 0.001) in normal volunteers (24.8 +/- 1.6) than in claudicators (10.5 +/- 1.3), and both flows were significantly greater (P less than 0.0001) than the peak ABF in patients with rest pain (5.3 +/- 0.5). IPG may be used in the assessment of arterial and venous disease. It provides a sensitive test with which to screen patients with suspected DVT. In addition, it is a valuable adjunct in differentiating normal limbs from those with intermittent claudication and/or rest pain.
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PMID:Impedance plethysmography. Noninvasive diagnosis of deep venous thrombosis and arterial insufficiency. 682 36

The clinical diagnosis of acute deep vein thrombosis (DVT) is but 50% accurate when compared to the results of contrast venography. This clinical inaccuracy had led to the dependence of the physician upon laboratory diagnosis. Whereas contrast venography is the gold standard of diagnosis, its expense, special equipment, personnel, and discomfort make it unsuitable for evaluating large numbers of patients. For this reason, numerous noninvasive tests utilizing plethysmographic and Doppler techniques have been developed to evaluate patients with suspected venous disease, and when expertly performed have a degree of accuracy of approximately 90%. This degree of accuracy coincides with the experience of our peripheral vascular laboratory using the Doppler venous examination. Based on these statistics, our current practice is to evaluate patients suspected of having DVT with a Doppler venous examination (Figure 1). If the test is abnormal or equivocal, contrast venography is usually obtained and anticoagulation recommended. Contrariwise, if the Doppler venous examination is normal, venography is not obtained, and anticoagulation treatment is not recommended. This practice should reduce the number of venograms in a patient population that is not at an increased risk of pulmonary embolism or repeated deep venous thrombosis. To evaluate the validity and safety of this practice, one hundred eighty-six patients with normal Doppler venous examinations in whom contrast venography was not obtained were evaluated and form the basis of this report.
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PMID:The normal Doppler venous examination. 683 18

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only, and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty-two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two-thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swelling.
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PMID:Duplex ultrasound assessment of the venous status of the swollen leg. 748 26

Venous disease accounts for up to 90% of all cases of chronic leg ulcers. Patients with venous disease have relatively unhealthy, ischemic tissue in the lower legs, and slight trauma often initiates an ulcer. Symptoms include leg swelling, which is often unilateral and persistent, and a dull ache that worsens with standing, walking, or sitting with the legs down. Approximately 50% of patients have a history of deep vein thrombosis. A careful history and examination can rule out other causes and guide appropriate therapy as well as prophylaxis against progressive disease. Elevation, compression, occlusion, and debridement are the mainstays of treatment. Ulcer healing is gradual, often requiring weeks to months of therapy. Preventing recurrence requires careful attention to compression; surgery may be indicated.
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PMID:Venous disease: how to heal and prevent chronic leg ulcers. 763 25

A 1987 survey of U.S. orthopedic surgeons found that 84% used some form of DVT prophylaxis. Ten percent used prophylaxis only for their "high-risk patients," and 6% never used prophylaxis. Twenty percent of the surgeons had at least one THR patient die from a fatal PE in the last five years. Fifty percent of the surgeons using warfarin had subsequently discontinued its use because of bleeding complications and monitoring difficulties. Compared with a survey done 13 years previously, this recent study showed a dramatic rise in the number of surgeons using DVT prophylaxis. The majority, however, were using methods that are ineffective: 67% used aspirin and 17% used fixed doses of subcutaneous heparin. Because the incidences of DVT and PE in THR patients are high, all of these patients should receive prophylaxis. The standard LDH regimen, effective for patients receiving gynecologic, general, and most orthopedic procedures, is ineffective for THR patients. The available prophylactic methods proven to reduce DVT and PE in THR patients are adjusted-dose subcutaneous heparin, dextrans, low-dose warfarin, and EPC. Comparative studies have not clearly demonstrated superiority of any one method. However, low-dose warfarin may offer better protection in very high-risk patients. External pneumatic compression offers protection without increasing bleeding risks. Dextrans are effective but are expensive and may be associated with significant side effects. Adjusted-dose subcutaneous heparin is also effective but is cumbersome to use. Low-molecular-weight heparin appears to be a promising alternative. We recommend the routine use of EPC and reserve low-dose warfarin fro patients with histories of prior thromboembolic or venous disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The pathogenesis and prevention of thromboembolic complications in patients undergoing total hip replacement. 828 8

Of the more than 200 patients recently evaluated for venous disease, 8 were diagnosed with lower extremity masses. Three patients were referred for superficial phlebitis and four for deep venous obstructive disease. The eighth mass was found during work-up for varicose veins. Five masses were identified by palpation, and three were identified by duplex scan. All were confirmed by magnetic resonance imaging (MRI) or computed tomography (CT). Of the eight masses, three were malignant: a metastatic melanoma, a histiocytoma, and a myxoid liposarcoma. Nonmalignant masses included a hematoma, an inflammatory lesion, a hemangioma, and an intramuscular lipoma. One patient presented with deep venous thrombosis secondary to an occluded popliteal artery aneurysm compressing the popliteal vein. Thus, patients presenting with ostensible venous disease may have other pathologic conditions responsible for symptomatology. Careful physical examination will reveal a mass in a majority of patients who have one. Duplex scanning will identify masses that should be confirmed by MRI or CT. Definitive diagnosis should be made by biopsy, due to the high possibility of malignancy.
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PMID:Patients evaluated for venous disease may have other pathologic conditions contributing to symptomatology. 839 61

There are few conditions in medicine as difficult to diagnose as pulmonary embolism. This is certainly not due to the rarity of the disease which is probably as common as myocardial infarction in France. The circumstances surrounding pulmonary embolism and the risk factors of deep venous thrombosis have been well identified. The risk of thromboembolic venous disease has been assessed for each type of surgery. The methods of treatment and prevention have progressed over a number of years. However, in practice, these advances have not "transformed" the frequency of the disease or reduced its mortality. Further progress could come from improved identification of patients at risk, especially by biological tests and new abnormalities of blood coagulation.
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PMID:[Epidemiology of pulmonary embolism]. 881 27

In order to test the responsibility of inferior vena cava clips in post thrombotic venous disease, we performed a comparative retrospective study 7 to 10 years after vena cava interruption by clip. Patients were compared with patients matched for sex, age, and prior deep vein thrombosis (same period and same localisation) but without inferior vena cava partial interruption. The results show that 1) functional complaints were significantly higher in the vena cava clip group; 2) valvular incompetency, in the initially thrombosed leg, (tested by scanning duplex) was not different in the two groups: 3) inversely, on the other leg, valvular incompetency was greater in the vena cava clip group. Furthermore this valvular incompetency was principally located at a femoral level, suggesting that the vena cava clip may induce backward thrombosis; 4) complications were independent of vena cava thrombosis.
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PMID:[Chronic venous insufficiency 7 to 10 years after partial vena cava interruption with a clip]. 896 43


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