Clinical Application Of Ultrasonography In Diagnosis And Interventional Therapy Of Deep Venous Thrombosis

Part One Diagnosis evaluation for different section of lower extremity venous thrombosis by color Doppler ultrasound compared to DSAObjective To evaluate two-dimension and color Doppler ultrasonography in diagnosis of deep venous thrombosis for different segments of lower extremity compared with digital subtract angiography.Methods Fifty-eight patients suspected of deep venous thrombosis enrolled in the study between 2003 and 2006 in Tangdu hospital. All patients manifested different degree of engorgement, intermittent or rest pain on affected extremity and limping. Every segment venous of affected extremities was observed by color Doppler ultrasonography. Caliber, range, and shape of throbosis in involved vein were measured and recorded. All patients underwent digital subtract angiography (DSA) examination. CDFI findings were compared with the results of DSA. Statistical analysis was according to quadruple tabular form. The indexes include sensitivity, specificity, accuracy, false positive rate and so on. Every segment of lower extremity deep venous was evaluated and analysis. Results Total of 196 vessels of fifty-eight patients were detected with CDFI and DSA. CDFI showed thrombosis in 150 affected segments of vessels; DSA showed 143 segments of vessels. Evaluation findings of statistical analysis with quadruple tabular form as follows: sensitivity of common iliac vein was 82.6%, specificity was 66.7%, accuracy was 78.1%; sensitivity of external iliac vein was 83.3%, specificity was 80.0%, accuracy was 82.4%; sensitivity of hypogastria vein was 80.0%, specificity was 66.7%, accuracy was 76.9%; sensitivity of popliteal vein was 92.6%, specificity was 92.9%, accuracy was 92.7%; sensitivity of femoral vein was 96.9%, specificity was 93.8%, accuracy was 95.3%; sensitivity of small saphenous vein was 81.8%, specificity was 75.0%, accuracy was 80.0%; sensitivity of great saphenous vein was 88.2%, specificity was 75%, accuracy was 85.7%; sensitivity of anterior tibial vein was 71.4%, specificity was 75%, accuracy was 72.7%; sensitivity of posterior tibial veins was 72.7%, specificity was 75%, accuracy was 73.3%; Total of 8 collateral circulations were detected. The sensitivity was 82.5%, specificity was 75.0% and accuracy was 83.3%.Conclusion As the first-choice examination for deep venous thrombosis, ultrasonography has different diagnostic value for different segment of venous. It is more sensitive and accurate for femoral, popliteal and external iliac veins thrombus but less sensitive for anterior, posterior tibial veins and bypass circuit vessels. Part two Application of ultrasonography in interventional therapy of deep venous thrombosisObjective To approach the application method of two-dimensional and color Doppler ultrasonography in interventional therapy of deep venous thrombosis. Methods Seventeen patients doubted deep venous thrombosis were underwent ultrasonic diagnosis and follow-up evaluation before or after interventional therapy of filter and/or stent implantation. Position, shape and blood flow circulation of filter and stent were observed by color Doppler ultrasonography. Results Total of twelve filters and 10 stents were implanted in 17 patients. All of the grafts were displayed clearly by ultrasonography, which showed hyper-echo parallel line in the venous lumen. In the follow-up study, ten filters and 9 stents showed well-shaped and well-filled color flow. Thrombogenesis were found in 2 filters and 1 stent, which displayed close-up solid light spot in the metal-like hyer-echo lumen, with poor-filled blood flow by color Doppler ultrasonography.Conclusion Ultrasonography is of great value and first-choice method in interventional therapy of deep venous thrombosis.