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A new scoring system for the detailed description of the distribution and thrombotic burden in deep leg vein
O Björgell1, P E Nilsson, P J Svensson
1Department of Diagnostic Radiology, University Hospital in Malmö, Sweden.
Insights
A new scoring system for deep vein thrombosis (DVT) accurately captures thrombotic burden by including all major leg and pelvic veins, unlike the Marder system which often underestimates DVT severity.
Area of Science:
- Vascular Medicine
- Radiology
- Medical Imaging
Background:
- The Marder system, commonly used for deep vein thrombosis (DVT) research, has limitations.
- It excludes key deep vein segments, leading to underestimation of thrombotic burden and potential false-negative results.
Purpose of the Study:
- To develop and validate a novel scoring and distribution system for DVT.
- This new system aims to encompass all major deep veins in the leg and pelvis for comprehensive research applications.
Main Methods:
- A prospective, comparative study involving 247 patients.
- 105 patients with positive phlebography were analyzed using the new system and compared to the Marder system.
Main Results:
- The Marder system significantly underestimated DVT distribution and thrombotic burden in 72% of patients.
- 12% of DVT cases were missed entirely by the Marder system, classified as false-negative.
- The new system successfully scored all DVTs and relevant vein segments, providing a complete assessment.
Conclusions:
- The developed scoring system offers a more comprehensive and accurate method for assessing DVT.
- It addresses the limitations of previous systems by including all critical deep vein segments.
- This enhanced system is crucial for accurate DVT research and understanding deep vein insufficiency progression.
Abstract:
The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system. In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investigations. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.