Related Experiment Video
Updated: Dec 13, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
In Well-Selected Patients With a Femoral Deep Vein Thrombosis Central Venous Imaging May Identify Additional
Chong Li1, Thomas S Maldonado1, Glenn R Jacobowitz1
1Division of Vascular Surgery, Department of Surgery, 12297New York University Langone Medical Center, New York, NY, USA.
Insights
Axial imaging of the central veins in patients with femoral deep vein thrombosis (DVT) identified more iliocaval pathology. This imaging approach revealed additional treatable conditions, altering patient management strategies.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Thrombosis Research
Background:
- Femoral deep vein thrombosis (DVT) diagnosis often leads to anticoagulation without immediate central venous assessment.
- Current practice may overlook significant iliocaval pathology in patients presenting with femoral DVT.
Purpose of the Study:
- To evaluate if axial imaging of the central venous system identifies additional iliocaval pathology in femoral DVT patients.
- To determine if this imaging impacts the need for intervention.
Main Methods:
- Retrospective review of prospectively maintained registry (Nov 2014-Mar 2020).
- Compared patients with femoral DVT who underwent axial iliocaval imaging (Group A) versus those who did not (Group B).
- Primary outcome: percutaneous central venous intervention; Secondary outcomes: DVT extent, duplex patency, symptom persistence.
Main Results:
- Group A (n=24) showed increased prevalence of DVT in common femoral and iliocaval veins after central imaging compared to duplex alone.
- Significantly more patients in Group A underwent invasive treatment (67%) versus Group B (16%), P < 0.0001.
- No significant difference in duplex patency or persistent symptoms between groups.
Conclusions:
- Axial imaging of the central venous system can reveal additional iliocaval pathology in patients with femoral DVT.
- This imaging approach may alter management by identifying treatable conditions.
- Selective central venous imaging provides a more comprehensive assessment for DVT patients.
Objective:
Patients who present acutely with a femoral deep vein thrombosis (DVT) diagnosed by ultrasound are often treated with anticoagulation and instructed to follow-up electively. This study sought to assess whether obtaining axial imaging of the central venous system results in the identification of additional iliocaval pathology warranting treatment.
Methods:
This study was a retrospective review of a prospectively maintained registry from November 2014 through April 2017 with follow-up through March 2020. Consecutive patients with a diagnosis of femoral DVT diagnosed by ultrasound were evaluated; those who underwent axial imaging of the iliocaval system (Group A) were compared to those who did not undergo imaging of the central veins (Group B). The primary outcome was the performance of any percutaneous central venous intervention. Secondary outcomes included the extent of DVT identified on duplex and after axial imaging, follow-up duplex patency and persistence of severe symptoms.
Results:
Eighty patients presented with an ultrasound diagnosis of a femoral vein DVT. Mean follow-up was 551 ± 502 days. Group A comprised 24 patients (30%) and Group B comprised 56 patients (70%). Baseline demographics did not differ significantly between the 2 groups. After duplex imaging, Group A exhibited an increased prevalence of DVT in the common femoral vein. After central imaging, Group A exhibited an increased prevalence of DVT in the iliocaval veins. The number of patients who underwent invasive treatment differed significantly between the 2 groups, Group A 16/24 (67%) vs. Group B 9/56 (16%), P < 0.0001. The number of patients that demonstrated duplex patency and had persistent symptoms on follow-up did not differ significantly.
Conclusions:
Patients with an ultrasound diagnosis of femoral DVT may have additional iliocaval pathology warranting intervention. Well-selected imaging of the central veins may reveal a more complete picture, potentially altering management.
Related Concept Videos
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:29Venous Thrombosis III: Interprofessional Care
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:18Veins of the Abdomen and Pelvis
The inferior vena cava is fed by numerous smaller veins. The lumbar veins, for instance, drain the posterior abdominal wall, emptying both directly into the inferior vena cava and into the...
01:30Venous Thrombosis I: Introduction
01:15Veins of Lower Limbs
Formed by the union of the medial and lateral plantar veins, the posterior tibial vein, rising through the calf muscle, assimilates the fibular vein. The anterior tibial vein, a superior extension of the foot's dorsalis pedis vein, merges with the posterior tibial vein at the...