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Table 1 Duplex Ultrasonography and Deep Vein Thrombosis

Study Subjects Tests Extension Results Design

Baxter, 1990 (31) 40 patients with

suspected lower

extremity DVT

DUS and AV Femoropopliteal and

calf levels

SeZ93%, SpZ100% Prospective,

double blind

van Ramshorst,

1991 (32)

117 patients (126 limbs)

with suspected DVT

or PE

DUS and AV Femoropopliteal level SeZ

90.6%, SpZ94.6%; DUS was more accurate in

grading the anatomical extent of DVT; AV failed

to visualize the PFV with sufﬁcient accuracy in

88% vs. 8.5% with DUS

Prospective

Cogo, 1993 (33) 158 consecutive outpa-

tients with sympto-

matic DVT

CUS, and AV Femoropopliteal and

calf levels

CUS SeZ100% For all thrombi (including isolated

calf DVT), CUS SeZ95%. CUS was normal in all

patients with normal AV (SpZ100%; 95%

CIZ95–100%)

Prospective

Lewis, 1994 (34) 101 patients (103 limbs) DUS and AV Femoropopliteal level SeZ95%, SpZ99%, PPVZ95%, NPVZ99%,

AcZ98%

Prospective

Miller, 1996 (35) 216 patients (220 limbs)

suspected of DVT

DUS and AV Femoropopliteal and

tibioperoneal levels

Above-knee SeZ98.7%, SpZ100%; below-knee

SeZ85.2%, SpZ99.2%. Excluding technically

inadequate studies, below-knee SeZ93.8%

Prospective,

blinded

Theodorou, 2003

(36)

106 patients (115 limbs)

with suspected lower

extremity DVT

DUS and AV Femoropopliteal and

calf levels

SeZ92.8%,SpZ98%, AcZ96.8% Prospective

Abbreviations: Ac, accuracy; AV, ascending venography; CI, conﬁdence intervals; CUS, compression ultrasound; DUS, Duplex ultrasoun

d; DVT, deep vein thrombosis; NPV, negative

predictive value; PE, pulmonary embolism; PFV, profunda femoral vein; PPV, positive predictive value; Se, sensitivity;

Sp, speciﬁcity.

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Medium frequency linear array transducers of 4–7 MHz are routinely used; obese

patients, the pelvic veins and inferior vena cava (IVC) are examined with low frequency

phased or curve-linear array transducers 2–3.5 MHz. The exam begins with the patient

supine and the examined limb externally rotated with the knee in mild ﬂexion.

The CFV and the sapheno-femoral junction are identiﬁed and compressed until the

adjacent artery lumen is reduced on a transverse view, every 3 cm intervals. The veins

should be easily collapsed. When thrombus is present there is limited compression, which

increases as the thrombus ages. Flow characterization is done next in the longitudinal

view, followed by distal augmentation in color mode. The limb distal to the probe is

squeezed and the examined vessels should ﬁll with color wall to wall. The maneuver is

repeated with the Doppler on and tracing augmentation is veriﬁed. The proximal

(femoropopliteal veins) and calf veins (posterior tibial, peroneal, gastrocnemial and soleal

veins) are examined in identical manner (Fig. 3). When imaging of the calf veins is not

optimal in the supine position the examination is performed with the leg in the dependent

position (Fig. 4). The anterior tibial veins are examined only in the presence of local

trauma or symptoms because the prevalence of isolated thrombosis is !1% (40). It is

important to address the entire popliteal fossa to rule out the presence of other conditions

that might be causing the patients’ symptoms. The GSV and the SSV are identiﬁed next

and examined similarly. The iliac veins and IVC are only examined selectively, in cases

where continuous CFV ﬂow is seen with limited phasicity by Doppler, poor distal CFV

augmentation, asymmetric CFV waveforms and bilateral limb symptoms with normal

lower extremity DUS. Nonocclusive thrombosis of the iliac vein or the IVC can be missed

as they may not have any hemodynamic effects in the CFV. The prevalence of non-

occlusive thrombi in these veins is not known. Therefore these veins should be still

examined if there is strong suspicion for thrombosis. In centers that do not have experience

in examining these veins by DUS and when DUS is technically difﬁcult, ascending,

computed tomography (CT) or magnetic resonance (MR) venography should

be performed.

Figure 3 Acute thrombosis in the soleal vein in the midcalf. The vein is distended and contains

echolucent material. It is located within the soleus muscle as it is seen by the surrounding muscle

ﬁbers. He was a 47-year-old male with a history of epilepsy status burned with hot water while

having a seizure. His left leg was swollen and later was found to be painful.

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DUS is negative if complete approximation of the near and far vein walls during

compression or complete color ﬁlling of the lumen without defects are visualized. It is

positive if a vein is partially compressible or non compressible, if echogenic material is

seen within the vein, or if a ﬁlling defect on color imaging or absence of Doppler signal

is identiﬁed.

Recurrent episodes are diagnosed similarly. It is relatively easy in the superﬁcial

system, given that local symptoms at the site of thrombosis indicate a new event. But the

diagnosis of recurrent DVT is more difﬁcult because the presence of old thrombus

complicates the interpretation of ultrasound or AV (41). Establishing its diagnosis requires

comparison of the location and size of this thrombus to those seen in a previous DUS. An

increase of O2 mm in the compressed diameter of a previously thrombosed venous

segment has been reported to be diagnostic of recurrent DVT (42,43). These results come

from a single center that has performed this study in the femoral and popliteal veins only

and need further conﬁrmation from other centers prior to widespread acceptance.

DUS can estimate the age of the thrombus. Diagnostic criteria for acute and chronic

DVT are summarized in Table 2.

Magnetic Resonance Venography

High-resolution images are produced after radio-frequency pulses are applied to a patient

within complex and controlled magnetic ﬁelds. These pulses perturb protonic spins of the

hydrogen nucleus (mainly in molecules of water), producing resonant radio-frequency

signals, echoes of the original. Different shades of gray represent different tissues, with

white being a high signal (large amount of hydrogen protons) and black indicating no

signal (areas without hydrogen protons such as air or cortical bone) (44). The imaging

plane is chosen by the examiner for each image sequence performed with the information

always collected in three planes, which can be changed as needed. This implies that there

is no secondary image manipulation that may alter imaging resolution as there is with

Figure 4 Chronic thrombosis in the femoral vein. He was a 76-year-old patient with swelling,

varicose veins and skin changes. He had a femoropopliteal DVT 5 years ago. He recently developed

pain in his calf, which was worst on standing. There was no new thrombosis but he had partially

recanalized femoral and popliteal veins with reﬂux. The femoral vein is partially recanalized with

echogenic material that has similar brightness with the surrounding tissues. Abbreviation: DVT, deep

vein thrombosis.

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computed tomographic scanning. The IVC and pelvic veins can be imaged using this

technology with high sensitivities and speciﬁcities. Table 3 depicts the results of several

prospective studies that compared MR venography and AV or DUS (45–50).

When compared with AV it is less invasive, offers lower morbidity and may identify

other soft tissue pathology (51). Its major advantage over CT and AV is the ability to depict

ﬂow and its dynamics without the use of contrast. However, it does not offer signiﬁcant

advantages over DUS. Due to its highercost, cumbersome patient monitoring, inability to be

used with metallic implants or claustrophobic patients, time requirements and

unavailability, this technique should be used as a complimentary test to DUS. Moreover,

interpretation of MR venographic studies can be difﬁcult for those unfamiliar with the

procedure and its several associated ﬂow-related artifacts. Its use is currently limited to

instances where contrast use is contraindicated, or when other diagnostic modalities cannot

provide diagnostic information, especially in the abdominopelvic area (44).

Computed Tomography Venography

A computed tomography scanner is an X-ray device that yields cross-sectional images in

different shades of gray representing different tissues. The gray scale is similar to what we

are used to when interpreting plain X rays, with black representing air and white

representing bone. Tones in between represent the X-ray beam attenuation. Its images are

always cross-sections, but they can be reformatted in different planes, although that

manipulation results in less spatial resolution. Other reasons for low resolution include

patient motion, differences in respiratory phases from one image to the next, and

cardiovascular pulsation transmitted to neighboring structures. Newer scanner designs,

such as the spiral CT, are faster and allow many pictures to be acquired during a single

patient’s breath. Motion artifact is thus reduced and contrast utilization is maximized (44).

The use of CT venography of the legs and abdominal veins is currently limited and

usually performed in combination with CT angiography of the pulmonary arteries to allow

a complete examination of VTE (52). Very few studies address the utility of CT

venography as a sole diagnostic method for DVT. The results of those clinical trials are

summarized in Table 4 (53–55). One of them correlated CT and AV ﬁndings in the

Table 2 Diagnostic Criteria to Differentiate Acute vs. Chronic Deep Vein Thrombosis

Criteria Acute Chronic

Vein size Distended Reduced; occasionally vein

segments cannot be

traced by DUS

Collateral vessels Not usually seen Often surrounding throm-

bosed segments

Thrombus echogenicity Echolucent to intermediate echogenicity;

the brightness is less than the

adventitia and adjacent tissues

Bright echoes within the

lumen similar to adjacent

tissues

Lumen characteristics Non- or partially compressible Normal size or reduced;

ﬁlling defects and reﬂux

may be found

Wall characteristics Thin and smooth Normal, thickened or

undistinguished from

luminal ﬁbrous tissue

Abbreviation: DUS, duplex ultrasound.

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Table 3 Magnetic Resonance Imaging and Deep Vein Thrombosis

Study Subjects Tests Extension Results Design

Erdman, 1990 (45) 36 patients with

suspected

upper or lower

extremity DVT

MRV and AV Acquisitions from

the knee,

midthigh, pubic

symphysis

SeZ90%; SpZ100%; Kappa agreement levelZ0.752

(p!0.0001)

Prospective

Carpenter, 1993 (46) 85 VA patients

with suspected

DVT

MRV and AV IVC to popliteal

veins

SeZ100%; SpZ90%; PPVZ100%; NPVZ96% Prospective

Evans, 1993 (47) 61 patients with

suspected DVT

MRV and AV Pelvis to calf Pelvis SeZ100% (95%CIZ72–100%) SpZ95%

(95%CIZ85–99%)

Prospective, blinded

Thigh SeZ100% (95%CIZ83–100%) SpZ100%

(95%CIZ93–100%)

Calf SeZ87% (95%CIZ60–98%) SpZ97%

(95%CIZ93–100%)

Evans, 1996 (48) 75 patients with

suspected DVT

MRV and DUS Femoropopliteal SeZ100% (95%CIZ87–100%) SpZ100%

(95%CIZ92–100%) AcZ83% (95%CIZ72–90%)

Prospective

Fraser, 2002 (49) 101 patients with

suspected DVT

MRV and AV Iliofemoral,

femoropopliteal,

calf areas

SeZ94–96%, SpZ90–92% overall; SeZ83–92%,

SpZ94–96% calf; SeZ97%, Sp

Z100% femoro-

popliteal; SeZ100%, SpZ100% iliofemoral.

Interobserver variabilityZ0.89–0.98

Prospective, blinded

Fraser, 2003 (50) 55 nonconsecu-

tive patients

with suspected

DVT

MRV and AV Femoral and iliac

veins

SeZ100% for both femoral and iliac veins; SpZ100%

for iliacs and 97% for femorals. Interobserver

variabilityZ0.85 (femoral) and 0.97 (iliac)

Prospective, blinded

Abbreviations: Ac, accuracy; AV, ascending venography; CI, conﬁdence intervals; CT, computed tomography; DUS, Duplex ultrasonography; DVT, deep vein thrombosis; IVC, inferior

vena cava; MRV, magnetic resonance venography; NPV, negative predictive value; PE, pulmonary embolism; PPV, posi

tive predictive value; Se, sensitivity; Sp, speciﬁcity; VA, Veteran

Affairs Hospital.

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Table 4 Computed Tomography Imaging and Deep Vein Thrombosis

Study Subjects Tests Extension Results Design

Baldt, 1996 (53) 52 patients with

suspected DVT

CTV and AV IVC to the ankle SeZ100% (95%CIZ92–100%)

SpZ96% (95%CIZ84–98%);

PPVZ91%; NPVZ100%

Prospective

Loud, 2001 (54) 308 patients with

suspected PE

CTV (venous

phase at

time of CTPA),

DUS

Diaphragm to

upper calves

SeZ97%; SpZ100% for femoropopliteal Prospective,

multicenter,

blinded

Peterson, 2001 (55) 136 patients with

suspected PE

CTV, DUS Above-the-knee SeZ71%; SpZ93%; PPVZ53%;

NPVZ97%, AcZ90%

Retrospective

Abbreviations: Ac, accuracy; AV, ascending venography; CI, conﬁdence intervals; CTPA, computed tomographic pulmonary arteriogram; CTV, computed tomographic venography; DUS,

duplex ultrasound; DVT, deep vein thrombosis; NPV,

negative predictive value; PE, pulmonary embolism; PPV, positive predictive value; Se, sensitivity; Sp, speciﬁcity.

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Table 5 D-dimer Testing and Deep Vein Thrombosis

Study Subjects Tests Results Design

Wells, 1999 (60) 150 consecutive

inpatients with

suspected DVT

Dd, PTP, DUS and AV 1.8% (95%CIZ0.02–6.4%) patients considered to

have DVT excluded had events in a 3-month

follow-up. The Dd NPV in LPPZ96.2% (not

statistically different from the NPV of a

negative DUS in LPP (97.8%)

Prospective

Anderson, 2000 (61) 214 patients with

suspected DVT

Dd, PTP and DUS (ﬁngerstick

SimpliRED whole blood

agglutination)

Dd SeZ82.5%, SpZ84.9%, NPVZ96.9% (95%

CIZ93-99.1%) overall, and 100% (95%CI

Z96.3–100%) in LPP, 94.1% (95%CI

Z83.8–98.8%) in MPP and 86.7% (95% CI

Z59.4–98.3%) in HPP

Prospective cohort

Kearon, 2001 (62) 445 outpatients with

suspected ﬁrst DVT

Dd and PTP 40% patients had both a LPP and a negative Dd.

1 of them had DVT during a 3 month follow-up

(NPVZ99.4% [95% CIZ96.9–100%])

Prospective cohort

Kovacs, 2001 (63) 993 patients with

suspected DVT

or PE

Comparison of Accuclot,

IL-Test and SimpliRED

SeZ90,87 and 79% NPVZ98, 97 and 96% Prospective

Bates, 2003 (64) 556 consecutive outpa-

tients with suspected

ﬁrst DVT

Dd, PTP and CUS 283 patients (51%) had LPP or MPP and negative

Dd. 1 of them had DVT on follow-up (NLR

Z0.05 [CI, 0.01–0.23]). Dd NLR overallZ0.03

(CIZ0.01–0.16)

Prospective cohort

Philbrick, 2003 (65) 6 studies using Dd 16 different Dd assays SeZ76.6–100%, SpZ39.5–93.9%,

NPVZ78.8–100%

Meta-analysis

Schutgens, 2003 (66) 812 patients with

suspected DVT.

Dd, PTP and CUS NPV: 97.7%, Se: 98.4% Prospective multicenter

cohort

Wells, 2003 (67) 1096 outpatients with

suspected DVT

Dd, PTP and DUS LPP, NPV: 99.1% HPP, NPV: 89% Dd reduced

the use of DUS, from 1.34 tests/patient (control:

DUS imaging alone) to 0.78

Prospective

randomized

Abbreviations: Ac, accuracy; AV, ascending venography; CI, conﬁdence intervals; CUS, compression ultrasound; Dd, D-dimer; DUS, Duplex ultrasound; DVT, deep vein thrombosis;

HPP, high probability patients; LPP, low probability

patients; MPP, moderate probability patients; NLR, negative likelihood ratio; NPV, negative predictive value; PE, pulmonary

embolism; PPV, positive predictive value; PTP, pretest probability; Se, sensitivity; Sp, speciﬁcity.

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detection of DVT in 52 symptomatic patients. CT venography showed a 100% sensitivity

(CIZ0.92–1.00), 96% speciﬁcity (CIZ0.84–0.98), 91% positive predictive value and

100% negative predictive value (NPV). CT venography was superior in demonstrating

extension of DVT into the pelvic veins and IVC than was AV. The amount of contrast

required by CT is signiﬁcantly less compared to AV (53). Obvious disadvantages include

its invasiveness, inability to be performed at the bedside, its cost and the need for ionizing

radiation and iodinated contrast material.

D-dimer and Pretest Probability

Classiﬁcation into low-, intermediate- and high-risk groups using pretest probability

(PTP), empirically or using scoring systems is essential when suspecting VTE. It reduces

the need for initial and supplementary testing and allows considerable reﬁnement of the

posterior likelihood of VTE following non-invasive imaging (56). The simpliﬁed Wells

scores for suspected DVT and PE is the most used (57). An overview of data suggests that

fewer patients tend to be classiﬁed as low PTP when assessed empirically (56).

D-dimer testing detects ﬁbrin degeneration products. The development of

monoclonal antibodies made its detection possible, using the principle of enzyme-linked

immunosorbent assay (ELISA) or agglutination techniques. An increased D-dimer level is

not speciﬁc for VTE. It may be seen in cancer, sepsis, kidney failure, pregnancy and

trauma or in the postoperative state. Because a very low PPV has been reported in most

studies (28–31%) (58,59), objective testing must be performed before instigating

treatment. Therefore D-dimer testing is most appropriate in the outpatient setting. But a

negative test is most accurate for exclusion of VTE, especially in patients with a low PTP

(NPVZ99.5%) and least accurate in patients with a high PTP (NPVZ85.7%). The results

of seven recent prospective trials and one meta-analysis that studied D-dimer testing and

DVT are shown in Table 5 (60–67). From the socioeconomic point of view, patients with

low PTP and a normal D-dimer are the largest number of outpatients referred for testing.

Considerable resources may be saved if future studies conﬁrm the utility of D-dimer

testing in those patients by reducing the number of further imaging needed (68). When

a patient has a high PTP, it is probably cost-effective to obtain a DUS without the need for

D-dimer testing, given the high likelihood for the latter to be positive in this subgroup of

patients (about 75%). This needs to be studied further before any recommendations

are given.

The results from one commercially available test might not be applicable to others

and different results may be obtained when using the same manufacturer’s assay (69).

In patients with suspected DVT, rapid ELISA tests show promise as a practical D-dimer

assay. They have a similar sensitivity to that of the conventional ELISA assay. The most

studied and reliable tests are the SimpliRED whole-blood assay (Agen Biomedical,

Brisbane, Australia) or the Instant-IA rapid ELISA (Stago, Asnieres, France) in

combination with a noninvasive test or PTP can safely rule out DVT in the outpatient

setting (68,69).

KEY POINTS

† Venous thromboembolism is responsible for a large number of hospital

admissions and for more than 50,000 deaths every year.

† Its etiology is multifactorial with endothelial damage, hypercoagulability and

stasis having different impact on different patients.

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† There is an association between superﬁcial vein thrombosis and DVT and

a questionable relationship with malignancy. Concomitant DVT should be ruled

out at presentation.

† Postphlebitic syndrome occurs in over 20% of patients. Ipsilateral recurrent

DVT, a combination of reﬂux and obstruction and popliteal vein reﬂux, are

signiﬁcantly associated with skin changes and ulceration.

† Ascending venography is rarely used for screening. It is invasive, not widely

available and can produce venous thrombosis.

† Duplex ultrasound is the most frequently used test for DVT screening and

surveillance. It is noninvasive, portable and relatively inexpensive. It can

differentiate between acute and chronic thrombus and detect other pathologies.

† The accuracy of CT venography is comparable to duplex ultrasound. When

combined with CT lung angiography, it represents a useful tool for the diagnosis

of PE. Its cost, need for contrast and radiation exposure are its main limitations.

† MR scanning is mainly used as a conﬁrmatory test or to evaluate the proximal

venous systems. It has a low morbidity, does not need contrast and may diagnose

additional soft tissue pathologies. Its cost and limited availability makes it a poor

screening test.

† For outpatient screening a combination of clinical parameters and D-dimer

testing is effective for identifying patients for venous duplex scan. A negative

test is most accurate for exclusion of VTE in patients with a low pretest

probability and less accurate in patients with a high pretest probability.

REFERENCES

1. Prandoni P, Mannucci PM. Deep-vein thrombosis of the lower limbs: diagnosis and

management. Baillieres Best Pract Res Clin Haematol 1999; 12:533–554.

2. Bosson JL, Labarere J, Sevestre MA, et al. Deep vein thrombosis in elderly patients

hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors,

prophylaxis, and prevalence. Arch Intern Med 2003; 163:2613–2618.

3. Anderson FA, Jr., Wheeler HB, Goldberg RJ, et al. A population-based perspective of the

hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism.

The Worcester DVT Study. Arch Intern Med 1991; 151:933–938.

4. Stewart GJ, Ritchie WGM, Lynch PR. Venous endothelial damage produced by massive

sticking and emigration of leukocytes. Am J Pathol 1974; 74:507–532.

5. Stewart GJ, Stern HS, Lynch PR, Malmud LS, Schaub RG. Responses of canine jugular veins

and carotid arteries to hysterectomy: increased permeability and leukocyte adhesions and

invasion. Thromb Res 1980; 20:473–489.

6. Heit JA, Silverstein MD, Mohr DN, et al. The epidemiology of venous thromboembolism in the

community. Thromb Haemost 2001; 86:452–463.

7. Gouin-Thibault I, Arkam R, Nassiri S, et al. Markers of activated coagulation in patients

with factor V Leiden and/or G20210A prothrombin gene mutation. Thromb Res 2002;

107:7–11.

8. Emmerich J, Rosendaal FR, Cattaneo M, et al. Combined effect of factor V Leiden and

prothrombin 20210A on the risk of venous thromboembolism—pooled analysis of 8 case-

control studies including 2310 cases and 3204 controls. Study Group for Pooled-Analysis

in Venous Thromboembolism. Thromb Haemost 2001; 86:809–816.

9. Becattini C, Agnelli G. Pathogenesis of venous thromboembolism. Curr Opin Pulm Med 2002;

8:360–364.

Leon and Labropoulos126

https://t.me/med1917

10. Downing LJ, Wakeﬁeld TW, Strieter RM, et al. Anti-P-selectin antibody decreases

inﬂammation and thrombus formation in venous thrombosis. J Vasc Surg 1997; 25:81627.

11. Lohr JM, Kerr TM, Lutter KS, et al. Lower extremity calf thrombosis-to treat or not to treat.

J Vasc Surg 1991; 14:618–623.

12. White R, McGahan J, Daschbach M, Hartling R. Diagnosis of deep-vein thrombosis using

duplex ultrasound. Ann Intern Med 1989; 111:297–304.

13. Verlato F, Zucchetta P, Paolo P, et al. An unexpectedly high rate of pulmonary embolism in

patients with superﬁcial thrombophlebitis of the thigh. J Vasc Surg 1999; 30:1113–1115.

14. Lutter KS, Rerr TM, Roedersheimer R, Lohr JM, Sampson MG, Cranley JJ. Superﬁcial

thrombophlebitis diagnosed by duplex scanning. Surgery 1991; 100:42–77.

15. Hafner CD, Cranley JJ, Krause RJ, Strasser ES. A method of managing superﬁcial

thrombophlebitis. Surgery 1964; 55:201–206.

16. Bounameaux H, Reber-Wasem MA. Superﬁcial thrombophlebitis and deep vein thrombosis.

A controversial association. Arch Intern Med 1997; 157:1822–1824.

17. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous

thrombosis. Ann Intern Med 1996; 125:1–7.

18. Meissner MH, Caps MT, Bergelin RO, et al. Propagation, rethrombosis and new thrombus

formation after acute deep vein thrombosis. J Vasc Surg 1995; 22:558–567.

19. Prandoni P. Long-term clinical course of proximal deep venous thrombosis and detection of

recurrent thrombosis. Semin Thromb Hemost 2001; 27:9–13.

20. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism:

a controlled trial. Lancet 1960; 1:1309–1312.

21. Anderson FA, Wheeler HB. Physician practices in the management of venous thromboembo-

lism: a community-wide survey. J Vasc Surg 1992; 15:707–714.

22. Killewich LA, Macko RF, Cox K, et al. Regression of proximal deep venous thrombosis is

associated with ﬁbrinolytic enhancement. J Vasc Surg 1997; 26:861–868.

23. Labropoulos N, Kang SS, Mansour MA, Giannoukas AD, Moutzouros V, Baker WH. Early

thrombus remodeling of isolated calf deep vein thrombosis. Eur J Vasc Endovasc Surg 2002;

23:344–348.

24. Prandoni P, Lensing AWA, Prins MHE, et al. Residual vein thrombosis as a predictive factor

of recurrent venous thromboembolism. Ann Intern Med 2002; 137:955–960.

25. Rohrer MJ, Cutler BS, MacDougall E, Herrmann JB, Anderson FA, Jr., Wheeler HB.

A prospective study of the incidence of deep venous thrombosis in hospitalized children. J Vasc

Surg 1996; 24:46–49.

26. Kamida CB, Kistner RL, Eklof B, Masuda EM. Lower extremity ascending and descending

phlebography. In: Gloviczki P, Yao JST, eds. Handbook Of Venous Disorders. London, UK:

Arnold Publishers, 2001:132–139.

27. Bjorgell O, Nilsson PE, Jarenros H. Isolated nonﬁlling of contrast in deep leg vein segments

seen on phlebography, and a comparison with color Doppler ultrasound, to assess the incidence

of deep leg vein thrombosis. Angiology 2000; 51:451–461.

28. Hull R, Hirsh J, Sackett DL, et al. Clinical validity of a negative venogram in patients with

clinically suspected venous thrombosis. Circulation 1981; 64:622–625.

29. Albrechtsson U, Olsson CG. Thrombotic side-effects of lower-limb phlebography. Lancet

1976; 1:723–724.

30. Wheeler HB, Hirsh J, Wells P, Anderson FA, Jr. Diagnostic tests for deep vein thrombosis.

Clinical usefulness depends on probability of disease. Arch Intern Med 1994; 154:1921–1928.

31. Baxter GM, McKechnie S, Duffy P. Colour Doppler ultrasound in deep venous thrombosis:

a comparison with venography. Clin Radiol 1990; 42:32–36.

32. van Ramshorst B, Legemate DA, Verzijlbergen JF, et al. Duplex scanning in the diagnosis of

acute deep vein thrombosis of the lower extremity. Eur J Vasc Surg 1991; 5:255–260.

33. Cogo A, Lensing AW, Prandoni P, Buller HR, Girolami A, ten Cate JW. Comparison of real-

time B-mode ultrasonography and Doppler ultrasound with contrast venography in the

diagnosis of venous thrombosis in symptomatic outpatients. Thromb Haemost 1993;

70:404–407.

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Соседние файлы в папке Библиотека им академика М.И. Перельмана

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12.10.20266 Мб0Книга_3947_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3949_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3950_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3951_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3952_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3953_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3954_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3955_Библиотеки_им_академика_М_И_Перельмана.pdf
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12.10.20266 Мб0Книга_3956_Библиотеки_им_академика_М_И_Перельмана.djvu
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12.10.20266 Мб0Книга_3957_Библиотеки_им_академика_М_И_Перельмана.djvu
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12.10.20266 Мб0Книга_3958_Библиотеки_им_академика_М_И_Перельмана.djvu