Venous ultrasonography in symptomatic and asymptomatic patients: an updated review

Venous ultrasound is a major tool in both routine clinical care and clinical research. Since the last review, major attempts have been made to improve its methodological strength, and therefore, its value in assessing diagnostic criteria, risks, and outcomes in venous thromboembolism.

In symptomatic patients, further evidence has been provided that the approach of a single examination of the entire venous system is feasible and safe. This holds true for patients with suspicion of deep vein thrombosis as well as of pulmonary embolism. In asymptomatic patients, several attempts have been made to validate venous ultrasound against venography. Even if no direct comparison has been made, the results seem to be more promising in medically ill patients than in those early after major orthopaedic surgery.

For routine clinical use, the single examination strategy still awaits full recognition and implementation into practice. For clinical trials, there is insufficient data about the accuracy of centrally read ultrasound. This fact directly points to the unmet need of a consensus of standardization of venous ultrasound as an endpoint measure in clinical trials regarding the examination procedure itself, its documentation, and the adjudication process.