• Deep vein thrombosis are predisposing factors

common with pulmonary embolism (PE)

• Venous thromboembolism (VTE) incidence
increases sharply with age
• Almost two-thirds of VTE cases are isolated deep
vein thromboses (DVTs), and 80% are proximal
(White RH, 2003)
• DVT is considerably more common in the lower
than upper limbs.

• If DVT becomes symptomatic then clinical features

include acute pain, swelling, calf tenderness and a
moderately raised temperature
Background

• Long-term complications include post-thrombotic

syndrome (PTS), defined as chronic venous
symptoms and/or signs secondary to DVT.
• It represents the most frequent chronic DVT
complication, occurring in 30–50% of patients
within 2 years after proximal DVT.9 In 5–10% of
cases, PTS is severe
(Praendoni et al; J Haematol 2009)
Background

Risk Factor For Deep Vein Thrombosis

Background
 Wells Score
criteria for DVT
Overview
• Venous ultrasound (VUS) is the first line DVT
imaging modality
• It is based on B-mode, combined or not with color-
Doppler US, and power imaging techniques.
• DVT diagnostic criteria are crosssectional vein
incompressibility, direct thrombus imaging with
vein enlargement, and abnormal spectral and color-
Doppler flow.
Overview
• DVT diagnostic criteria are crosssectional vein
incompressibility, direct thrombus imaging with
vein enlargement, and abnormal spectral and color-
Doppler flow

• VUS can be performed by examining popliteal and

common femoral veins only [2-point/2-region
compression venous ultrasonography (CUS) or
limited CUS],
Overview
• DVT diagnostic criteria are crosssectional vein
incompressibility, direct thrombus imaging with
vein enlargement, and abnormal spectral and color-
Doppler flow

• VUS can be performed by examining popliteal and

common femoral veins only [2-point/2-region
compression venous ultrasonography (CUS) or
limited CUS],
(J Thromb Haemost, 2015)
Overview
• In clinically suspected DVT, VUS provides overall
sensitivity of 94.2%

• CUS has shown good performance (96.1%

sensitivity, 96.8% specificity)

• Clinical prediction rule (two-level modified Wells

score) is recommended to stratify patients with
suspected lower limb DVT
Overview

B-mode appearance of a normal CFV prior to compression

(left) and after transducer compression (right)
Compresion Ultrasound
Compression of the left common femoral vein (CFV) thrombus in serial images. Applying
light pressure, the greatersaphenous vein (GSV) compresses with minimal compression
of the superficial femoral (SFA)and profunda femoris (PFA) arteries. Edema may blur the
appearance of the deep vessels, while compression often increasesvisibility of veins and
thrombus.
Overview
Bilateral or Unilateral Testing ?
• Bilateral examinations have been standard sincethe
noninvasive test modality of choice in the 1980s.
Conversion to duplex ultrasound continued the
tradition and is suggested by intersocietal
Commission for the Accreditation of Vascular
Laboratories (ICAVL) accreditation.
• Many laboratories (75%) are now performing
unilateral studies on patients who present with
unilateral symptoms
Summary
• The role of duplex ultrasonography as the preferred
test for the diagnosis of DVT is well established,and the
ready availability of duplex ultrasound equipmenthas
made it the preferred diagnostic examination for acute
DVT in most healthcare facilities.
• Its low equipment cost, portability, and low
complication rates due to its noninvasive approach
make this technique particularly applicable for testing
in either the ambulatory outpatient or the critically ill,
intensive care patient
Reference:
• White RH. The epidemiology of venous thromboembolism.
Circulation 2003;
• Di Nisio M, Sohne M, Kamphuisen PW, Buller HR. D-Dimer
test in cancer patients with suspected acute pulmonary
embolism. J Thromb Haemost 2005;3:1239–1242.
• Le Gal G, Robert-Ebadi H, Carrier M, Kearon C, Bounameaux
H, Righini M. Is it useful to also image the asymptomatic leg
in patients with suspected deep vein thrombosis? J Thromb
Haemost 2015;13:563–566.
• Galanaud JP, Sevestre MA, Genty C, Pernod G, Quere I,
Bosson JL. Is it useful to also image the asymptomatic leg in
patients with suspected deep vein thrombosis? Comment. J
Thromb Haemost 2015;13:2127–2130