Skip to main content
SpringerLink
Log in

Role of Duplex Ultrasound Screening/Surveillance in High-Risk Deep Vein Thrombosis Patients

  • Living reference work entry
  • First Online:
Noninvasive Vascular Diagnosis

  • 53 Accesses

Abstract

Deep venous thrombosis can progress to pulmonary embolism and ultimately death if unrecognized by clinicians. It is vitally important for physicians to recognize patients that are high risk for venous thrombosis and provide screening and surveillance if indicated. Ultrasound testing is widely considered a first-line test for identification of patients with deep venous thrombosis. The role of duplex ultrasound in screening and surveillance in high-risk deep vein thrombosis patients has evolved substantially in the last two decades. However, risk stratifying patients who will benefit from venous duplex can be challenging. A thorough and complete clinical history and physical examination is a valuable tool that cannot be under stated. Many scoring systems are now available to guide physicians to recognize patients that are high risk for deep vein thrombosis. We will discuss the various scoring systems and methods to identify patients that are high risk for deep vein thrombosis. We will then review duplex ultrasound and other imaging modalities and provide a strategy for physicians to identify patients with deep venous thrombosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen CJ, Murray CR, Meizoso JP, Ginzburg E, Schulman CI, Lineen EB, Namias N, Proctor KG. Surveillance and early management of Deep Vein Thrombosis decreases rate of pulmonary embolism in high-risk trauma patients. J Am Coll Surg. 2016;222(1):65–72.

    Article  PubMed  Google Scholar 

  2. Arabi YM, Burns KEA, Alsolamy SJ, Alshahrani MS, Al-Hameed FM, Arshad Z, Almaani M, Hawa H, Mandourah Y, Almekhlafi GA, Al Aithan A, Khalid I, Rifai J, Rasool G, Abdukahil SAI, Jose J, Afesh LY, Al-Dawood A, Saudi Critical Care Trials Group. Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial. Intensive Care Med. 2020;46(4):737–46.

    Article  CAS  PubMed  Google Scholar 

  3. Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344–50.

    Article  PubMed  Google Scholar 

  4. Baker JE, Niziolek GM, Elson NC, Pugh AM, Nomellini V, Makley AT, Pritts TA, Goodman MD. Optimizing lower extremity duplex ultrasound screening after traumatic injury. J Surg Res. 2019;243:143–50.

    Article  PubMed  Google Scholar 

  5. Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua prediction score. J Thromb Haemost. 2010;8(11):2450–7.

    Article  CAS  PubMed  Google Scholar 

  6. Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e351S–418S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Brotman DJ, Segal JB, Jani JT, Petty BG, Kickler TS. Limitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism. Am J Med. 2003;114(4):276–82.

    Article  PubMed  Google Scholar 

  8. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2–3):70–8.

    Article  PubMed  Google Scholar 

  9. Chan WS, Lee A, Spencer FA, Crowther M, Rodger M, Ramsay T, Ginsberg JS. Predicting deep venous thrombosis in pregnancy: out in “LEFt” field? Ann Intern Med. 2009;151(2):85–92. https://doi.org/10.7326/0003-4819-151-2-200907210-00004. Erratum in: Ann Intern Med. 2009 Oct 6;151(7):516.

    Article  PubMed  Google Scholar 

  10. Cipolle MD, Wojcik R, Seislove E, Wasser TE, Pasquale MD. The role of surveillance duplex scanning in preventing venous thromboembolism in trauma patients. J Trauma. 2002;52(3):453–62.

    PubMed  Google Scholar 

  11. Crisp JG, Lovato LM, Jang TB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. Ann Emerg Med. 2010;56(6):601–10.

    Article  PubMed  Google Scholar 

  12. Crowther MA, Kelton JG. Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system. Ann Intern Med. 2003;138(2):128–34.

    Article  PubMed  Google Scholar 

  13. Dawson DL, Ronnigen E. Physiologic assessment of the venous system. In: Rutherford’s vascular surgery and endovascular therapy 9th ed: Vascular surgery. 9th ed. Philadelphia: WB Saunders; 2019. p. 246–64.

    Google Scholar 

  14. Dryjski M, O’Brien-Irr MS, Harris LM, Hassett J, Janicke D. Evaluation of a screening protocol to exclude the diagnosis of deep venous thrombosis among emergency department patients. J Vasc Surg. 2001;34(6):1010–5.

    Article  CAS  PubMed  Google Scholar 

  15. Gaitini D, Kaftori JK, Pery M, Markel A. Late changes in veins after deep venous thrombosis: ultrasonographic findings. Rofo. 1990;153(1):68–72.

    Article  CAS  PubMed  Google Scholar 

  16. Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol. 2010;56(1):1–7.

    Article  PubMed  Google Scholar 

  17. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Grady-Benson JC, Oishi CS, Hanson PB, Colwell CW Jr, Otis SM, Walker RH. Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty. J Bone Joint Surg Am. 1994;76(11):1649–57.

    Article  CAS  PubMed  Google Scholar 

  19. Ibrahim EH, Iregui M, Prentice D, Sherman G, Kollef MH, Shannon W. Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis. Crit Care Med. 2002;30(4):771–4.

    Article  PubMed  Google Scholar 

  20. Intersocietal Accreditation Commission. IAC Standards and Guidelines for Vascular Testing Accreditation. Available from: https://www.intersocietal.org/vascular/standards/IACVascularTestingStandards2018.pdf. Accessed 27 Oct 2020.

  21. Jorge A, Sanchez PG, Hayanga JWA, Pilewski JM, Morrell M, Tuft M, Ryan J, D’Cunha J. Routine deep vein thrombosis screening after lung transplantation: incidence and risk factors. J Thorac Cardiovasc Surg. 2020;159(3):1142–50.

    Article  CAS  PubMed  Google Scholar 

  22. Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med. 1998;128(8):663–77. https://doi.org/10.7326/0003-4819-128-8-199804150-00011. Erratum in: Ann Intern Med 1998 Sep 1;129(5):425.

    Article  CAS  PubMed  Google Scholar 

  23. Ko A, Harada MY, Barmparas G, Chung K, Mason R, Yim DA, Dhillon N, Margulies DR, Gewertz BL, Ley EJ. Association between enoxaparin dosage adjusted by anti-factor Xa trough level and clinically evident venous thromboembolism after trauma. JAMA Surg. 2016;151(11):1006–13.

    Article  PubMed  Google Scholar 

  24. Kopelman TR, Walters JW, Bogert JN, Basharat U, Pieri PG, Davis KM, Quan AN, Vail SJ, Pressman MA. Goal directed enoxaparin dosing provides superior chemoprophylaxis against deep vein thrombosis. Injury. 2017;48(5):1088–92.

    Article  PubMed  Google Scholar 

  25. Le Gal G, Righini M. Controversies in the diagnosis of venous thromboembolism. J Thromb Haemost. 2015;13(Suppl 1):S259–65.

    Article  PubMed  Google Scholar 

  26. Lim W, Le Gal G, Bates SM, Righini M, Haramati LB, Lang E, Kline JA, Chasteen S, Snyder M, Patel P, Bhatt M, Patel P, Braun C, Begum H, Wiercioch W, Schünemann HJ, Mustafa RA. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018;2(22):3226–56.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord. 2016;4(2):153–60.

    Article  PubMed  Google Scholar 

  28. Martin GE, Pugh A, Williams SG, Hanseman D, Nomellini V, Makley AT, Pritts TA, Goodman MD. Lower extremity duplex ultrasound screening protocol for moderate- and high-risk trauma patients. J Surg Res. 2019;235:280–7. https://doi.org/10.1016/j.jss.2018.10.010.

    Article  PubMed  Google Scholar 

  29. Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M, Banton K, Beilman GJ. Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients. World J Emerg Surg. 2016;11:24.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Streiff MB, Meissner MH. Ultrasound for lower extremity deep venous thrombosis: multidisciplinary recommendations from the Society of Radiologists in ultrasound consensus conference. Circulation. 2018;137(14):1505–15.

    Article  PubMed  Google Scholar 

  31. Owings JT, Gosselin RC, Anderson JT, Battistella FD, Bagley M, Larkin EC. Practical utility of the D-dimer assay for excluding thromboembolism in severely injured trauma patients. J Trauma. 2001;51(3):425–9; discussion 429–30

    CAS  PubMed  Google Scholar 

  32. Pedraza García J, Valle Alonso J, Ceballos García P, Rico Rodríguez F, Aguayo López MÁ, Muñoz-Villanueva MDC. Comparison of the accuracy of emergency department-performed point-of-care-ultrasound (POCUS) in the diagnosis of lower-extremity deep vein thrombosis. J Emerg Med. 2018;54(5):656–64.

    Article  PubMed  Google Scholar 

  33. Prandoni P, Lensing AW, Bernardi E, Villalta S, Bagatella P, Girolami A, DERECUS Investigators Group. The diagnostic value of compression ultrasonography in patients with suspected recurrent deep vein thrombosis. Thromb Haemost. 2002;88(3):402–6.

    CAS  PubMed  Google Scholar 

  34. Righini M, Galanaud JP, Guenneguez H, Brisot D, Diard A, Faisse P, Barrellier MT, Hamel-Desnos C, Jurus C, Pichot O, Martin M, Mazzolai L, Choquenet C, Accassat S, Robert-Ebadi H, Carrier M, Le Gal G, Mermilllod B, Laroche JP, Bounameaux H, Perrier A, Kahn SR, Quere I. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomized, double-blind, placebo-controlled trial. Lancet Haematol. 2016;3(12):e556–62.

    Article  PubMed  Google Scholar 

  35. Righini M, Jobic C, Boehlen F, Broussaud J, Becker F, Jaffrelot M, Blondon M, Guias B, Le Gal G, EDVIGE study group. Predicting deep venous thrombosis in pregnancy: external validation of the LEFT clinical prediction rule. Haematologica. 2013;98(4):545–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rocha AT, Tapson VF. Venous thromboembolism in intensive care patients. Clin Chest Med. 2003;24(1):103–22.

    Article  PubMed  Google Scholar 

  37. Rosen CL, Tracy JA. The diagnosis of lower extremity deep venous thrombosis. Emerg Med Clin North Am. 2001;19(4):895–912.

    Article  CAS  PubMed  Google Scholar 

  38. Sampson FC, Goodacre SW, Thomas SM, van Beek EJ. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17(1):175–81. https://doi.org/10.1007/s00330-006-0178-5.

    Article  PubMed  Google Scholar 

  39. Segal JB, Eng J, Tamariz LJ, Bass EB. Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007;5(1):63–73.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Silveira PC, Ip IK, Goldhaber SZ, Piazza G, Benson CB, Khorasani R. Performance of Wells score for deep vein thrombosis in the inpatient setting. JAMA Intern Med. 2015;175(7):1112–7.

    Article  PubMed  Google Scholar 

  41. So S, Patel RM, Orebaugh SL. Ultrasound imaging in medical student education: impact on learning anatomy and physical diagnosis. Anat Sci Educ. 2017;10(2):176–89. https://doi.org/10.1002/ase.1630.

    Article  PubMed  Google Scholar 

  42. Spain DA, Richardson JD, Polk HC Jr, Bergamini TM, Wilson MA, Miller FB. Venous thromboembolism in the high-risk trauma patient: do risks justify aggressive screening and prophylaxis? J Trauma. 1997;42(3):463–7; discussion 467–9

    Article  CAS  PubMed  Google Scholar 

  43. Thomas SM, Goodacre SW, Sampson FC, van Beek EJ. Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis. Clin Radiol. 2008;63(3):299–304. https://doi.org/10.1016/j.crad.2007.09.010.

    Article  CAS  PubMed  Google Scholar 

  44. Tick LW, Ton E, van Voorthuizen T, Hovens MM, Leeuwenburgh I, Lobatto S, Stijnen PJ, van der Heul C, Huisman PM, Kramer MH, Huisman MV. Practical diagnostic management of patients with clinically suspected deep vein thrombosis by clinical probability test, compression ultrasonography, and D-dimer test. Am J Med. 2002;113(8):630–5.

    Article  PubMed  Google Scholar 

  45. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227–35.

    Article  CAS  PubMed  Google Scholar 

  46. Wells PS, Lensing AW, Davidson BL, Prins MH, Hirsh J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. A meta-Analysis. Ann Intern Med. 1995;122(1):47–53.

    Article  CAS  PubMed  Google Scholar 

  47. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I4–8.

    PubMed  Google Scholar 

  48. Zhou H, Hu Y, Li X, Wang L, Wang M, Xiao J, Yi Q. Assessment of the risk of venous thromboembolism in medical inpatients using the Padua prediction score and Caprini risk assessment model. J Atheroscler Thromb. 2018;25(11):1091–104.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vascular Surgery Fellow, Spectrum Health, Michigan State University, Grand Rapids, MI, USA

    Jacob Frisbie & Robert Cuff

Authors
  1. Jacob Frisbie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Cuff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacob Frisbie .

Editor information

Editors and Affiliations

  1. Department of Surgery, West Virginia University, Charleston, WV, USA

    Ali F. AbuRahma

  2. Johns Hopkins University, Baltimore, USA

    Bruce A. Perler

Section Editor information

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University - Charleston Division, Charleston, WV, USA

    Ali F. AbuRahma

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Frisbie, J., Cuff, R. (2021). Role of Duplex Ultrasound Screening/Surveillance in High-Risk Deep Vein Thrombosis Patients. In: AbuRahma, A.F., Perler, B.A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-030-49616-6_71-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-49616-6_71-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-49616-6

  • Online ISBN: 978-3-030-49616-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation