Utility of venous compression in deep venous thrombosis evaluation revisited

Ultrasound venous compression (UVC) is considered the gold standard for confirmation of deep venous thrombosis (DVT) of the lower extremities. The objective of this study was to assess the contribution and significance of venous compression in comparison to color flow duplex (CFD) ultrasonography alone in the diagnosis of DVT.

Retrospective analysis was performed of all DVT studies during two years period. DVT examinations were performed with a 5.8-7.6 MHz linear broadband transducer following the American Institute of Ultrasound in Medicine guidelines for the performance of DVT examination. The images were categorized as normal, partial thrombus, or complete thrombus.

A total of 428 patients comprised the study group. In total, 467 DVT examinations were performed (39 patients had bilateral examinations). Of the lower extremity examinations, 347/467were normal and 120/467 were abnormal. Complete thrombus was evident in 49/120 patients, while 71/120 patients had partial thrombus. We observed the thrombus on gray scale imaging in all 120 positive patients. No patient had venous compression negative for thrombus and CFD positive for thrombus. There was one patient with visualization of thrombus on gray scale imaging and complete venous compression (negative for thrombus). CFD examination of this patient was also negative for thrombus.

UVC did not provide any additional information for the diagnosis of DVT. If CFD demonstrates the presence of DVT, venous compression is not necessary, although it can further confirm the presence of DVT. No additional DVTs were diagnosed by using venous compression alone (Tab. 2, Fig. 2, Ref. 27).