Venous Duplex Above and Below The Diaphragm

108 Pages·2017·6.45 MB·English

by  Washko, Patrick

Venous Duplex
Above and Below The Diaphragm
Patrick A Washko BSRT,RDMS,RVT,FSVU
Coordinator /Technical Director
UNC Rex healthcare
Peripheral Vascular lab
North Carolina Heart and vascular Hospital
Raleigh, NC
UNC Rex Healthcare
North Carolina heart and Vascular Hospital

• S. Wayne Smith M.D.RVT,RDMS,FSVM,RVPI
• Patrick A Washko BSRT,RDMS,RVT,FSVU
• Robert Mendes M.D
• Brian Stull, RDMS,RVT
• Lauren Odom RDMS,RVT
• Brandy O’hara RDMS, RVS
• Elvira Castellanos RDMS,RVT
• Hillary Sawyer RVT
• Darryl Smith RDMS,RVT
• Lauren Littenden BS, RVT
• OlusegunOsinbowale, M.D.RVPI
• Jim Morgan MS, RVT
• Liliana Nanez M.D.RPVI
• Dorian de Frietas M.D. ,RVPI
• Jason Kim M.D. ,RVPI
• Martyn Knowles M.D. RPVI
• Aaron Thomas, P.A.C, RVT
• Sharon Wertz RDMS,RDCS,RVS
• Kelly Edwards RDMS
• Tara Hatley RDMS
• Daniel Sherril RVT
• Anna Moore BS RDMS
• Kristen Stahura BS RVT
Diagnostic Approach to Acute
Deep Venous Thrombosis
• >1 million patients seek
medical care per year for
leg pain and/or swelling
• Approximately 20% of
these are diagnosed with
DVT
Wells, et.al JAMA .2006 295(2) :199-207
VTE

Until 1990’s VTE ( DVT)
was considered primarily as a
complication of hospitalization for major
surgery ( or associated with late stage of
terminal illness )

To Circulation, Vol 107 No 23 June 17 2003
Venous Thromboembolism ( VTE)
• The precise number of people affected by DVT/PE is unknown, although
as many as 900,000 people could be affected (1 to 2 per 1,000) each year
in the United States.

• Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also
called venous thromboembolism).
– 10 to 30% of people will die within one month of diagnosis.
– Sudden death is the first symptom in about one-quarter (25%) of people who have
a PE.

• Among people who have had a DVT, one-half will have long-term
complications (post-thrombotic syndrome) such as swelling, pain,
discoloration, and scaling in the affected limb.

• One-third (about 33%) of people with DVT/PE will have a recurrence
within 10 years.

• Approximately 5 to 8% of the U.S. population has one of several genetic
risk factors, also known as inherited thrombophilias in which a genetic
defect can be identified that increases the risk for thrombosis.

2010 Apr;38(4 Suppl):S495-501. doi: 10.1016/j.amepre.2009.12.017.
Venous thromboembolism: a public health concern.
MG, Hooper WC, Critchey SE, Ortel TL
.
DVT
Pre-Test Probability Assessment of Outpatients
with Clinical Suspicion of DVT

• Acute Limb Swelling - involved extremity 2 cm
or greater difference in circumference
Documented previous history of DVT
•
Malignancy
•
Recent surgery
•
Hypercoagulable state
•
CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on
Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996
DVT
Clinical Assessment of Outpatients
with Suspicion of DVT:

438 Outpatients
•
153 had acute swelling with 2 cm
–
circumference difference
65 (42%) were positive for DVT by Venous
–
Duplex Ultrasonography
CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on
Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996
DVT
Clinical Assessment of Outpatients
with Suspicion of DVT:

99 outpatients with at least one risk
•
factor, but without >2 cm
circumference difference
38 (37%) were positive for DVT by
•
Venous Duplex Ultrasonography
CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on
Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996
DVT
Clinical Assessment of Outpatients
with Suspicion of DVT:

137 outpatients with no acute swelling
•
and no risk factors for DVT
134 (98%) had no DVT by Venous Duplex
•
Ultrasonography

CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on
Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996
DVT
Clinical Assessment of Outpatients

with Suspicion of DVT:

31 outpatients seen with cellulitis,
•
none had DVT
44 outpatients with chronic swelling >
•
4 wks
1 acute DVT

2 chronic DVT

CB Burnham, SJ Burnham, et al. Appropriate Utilization of Venous Duplex Ultrasound in Outpatients Based on
Clinical Practice Guidelines. The Journal of Vascular Technology. 20(4): 197-203. 1996