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Updated: Sep 25, 2026
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Duplex scanning potential at reconstruction of main veins
I M Ignat'ev1, S Iu Akhunova, R A Bredikhin
1Interregional Clinicodiagnostic Centre, Republican Clinical Hospital, Kazan, Russia.
Insights
Duplex scanning (DS) accurately evaluates reconstructive surgery for postthrombotic disease. This ultrasound technique offers a 100% accurate assessment of vein grafts and transplanted valves, outperforming traditional methods.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Medical Technology
Background:
- Postthrombotic disease significantly impacts lower extremity venous function.
- Reconstructive venous surgery aims to restore deep vein patency and valve function.
- Evaluating surgical outcomes requires accurate and reliable diagnostic methods.
Purpose of the Study:
- To assess the efficacy of duplex scanning (DS) in evaluating reconstructive operations for postthrombotic disease.
- To compare DS with contrast phlebography for assessing venous reconstructions.
- To analyze hemodynamic characteristics and identify causes of valvular incompetence in venous autotransplants.
Main Methods:
- Studied 89 patients undergoing various deep vein reconstructions (grafting, transposition, autotransplantation).
- Utilized duplex scanning (DS) for assessing veno-venous graft patency and transplanted valve function.
- Performed hemodynamic assessments in horizontal and vertical positions, including Valsalva's maneuver and exercise tests.
Main Results:
- Duplex scanning demonstrated 100% accuracy in evaluating graft patency and valve function.
- DS proved superior to contrast phlebography in assessing reconstructive outcomes.
- Supravalvular thrombosis was identified as the primary cause of valvular incompetence in autotransplants.
Conclusions:
- Duplex scanning is a highly effective and accurate tool for evaluating reconstructive venous surgery outcomes.
- Hemodynamic data from DS aids in selecting optimal surgical approaches and predicting results.
- Understanding causes of valvular incompetence guides postoperative management and improves patient outcomes.
Abstract:
The purpose of the present study was to determine the duplex scanning (BS) potential for the evaluation of the results of reconstructive operations for postthrombotic disease. We examined 89 patients who underwent different reconstructions on the deep veins of the lower extremities. The operations included crossover vein graft in unilateral occlusions of the iliac veins (36 patients), bypass grafting in occlusion of the femoral and popliteal veins (12), transposition (23) and autotransplantation (18) of the venous segments containing good valves in recapitalization of the deep great veins. Ultrasound diagnosis of the patency of the veno-venous grafts and function of the transposed or transplanted valves had an accuracy of 100%. DS has been demonstrated to compare very favourably with contrast phlebography. We present the functional characteristics of the blood flow in the veno-venous bypasses when the patient is in the horizontal and vertical positions at rest and under conditions of hydrodynamic provocation of the retrograde blood flow at Valsalva's test, compression tests and of the antegrade blood flow at physical exercise. The tests which upgrade the effectiveness of ultrasonography have been worked out. The morphological variants of lesion of the transplanted venous valve cusps have been established. It is demonstrated that the main cause of valvular incompetence of autotransplants lies in supravalvular (sinusoidal) thrombosis which develops in the early postoperative time, thereby giving rise to the block of the cusps of a transplanted valve. The data on the hemodynamics of venous autotransplants, obtained in the course of the study enable one to select an optimal variant of reconstructive operation, to delineate the postoperative treatment policy and to predict the results of surgical intervention.
