[Diagnostic strategies of thrombo-embolic venous disease]

The advent of non invasive tests (D-dimer and lower limb venous compression ultrasonography) and minimally invasive tests (helical CT scan) and the rehabilitation of clinical assessment have allowed the development of safe, rational and cost-effective diagnostic strategies for deep venous thrombosis and pulmonary embolism. Several algorithms have been validated in studies in which patients classified as not having venous thromboembolism are left untreated and followed up during 3 months. The safety of such strategies is established by comparing the 3-month thromboembolic risk in such patients with that of patients left untreated based on a normal venogram, pulmonary angiogram or lung scintigram. Venography or pulmonary angiography remains necessary in selected cases such as patients with a high clinical probability of venous thromboembolism and an inconclusive non invasive workup, representing only approximately 5 to 10% of all patients. Finally, suspected massive pulmonary embolism is a distinct clinical situation in which echocardiography plays a major role.