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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Is there a necessity for whole-leg lower-limb ultrasound in the setting of deep vein thrombosis?
1Department of Haematology and Cell Biology, School of Pathology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; National Health Laboratory Service, Universitas Academic Hospital, Bloemfontein, South Africa.
Insights
Isolated distal deep vein thrombosis (IDDVT) is uncommon, suggesting a proximal-only ultrasound approach may suffice. Black African and mixed-race patients showed higher rates of proximal deep vein thrombosis (PDVT).
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Epidemiology
Background:
- Isolated distal deep vein thrombosis (IDDVT) lacks established treatment guidelines, unlike proximal deep vein thrombosis (PDVT).
- Current diagnostic approaches involve whole-leg or proximal-only ultrasound, leading to varied clinical management.
- Understanding IDDVT prevalence is crucial for optimizing diagnostic strategies.
Purpose of the Study:
- To determine the prevalence of IDDVT at Universitas Academic Hospital.
- To inform potential adaptations and tailored ultrasound approaches for distinct patient subpopulations.
- To evaluate the utility of proximal-only ultrasound for diagnosing deep vein thrombosis (DVT).
Main Methods:
- Retrospective review of 2,208 ultrasound investigations from January 2015 to December 2020.
- Collection of demographic data, HIV status, and thrombosis location/extent.
- Analysis of 983 DVT cases, differentiating between PDVT and IDDVT.
Main Results:
- Out of 1,005 positive DVT cases, 86.0% were PDVT and 14.0% were IDDVT.
- A female predominance was noted (1:2.02 male-to-female ratio).
- Black African and mixed-race patients had lower IDDVT rates compared to white patients; 66.0% of patients were HIV positive.
Conclusions:
- The low prevalence of IDDVT supports the adoption of a proximal-only ultrasound approach.
- Black African and mixed-race ethnicity, along with male sex, were linked to higher PDVT incidence.
- Further research on IDDVT propagation is recommended for tailored diagnostic strategies in diverse groups.
Background:
Isolated distal deep vein thrombosis (IDDVT) is thrombosis that occurs in the lower-limb venous system, limited to the calf veins, with no extension into the popliteal veins. Proximal propagation or proximal DVT (PDVT) has well-defined treatment protocols in which anticoagulation shows clear benefit. IDDVT, however, does not always require treatment because the risk-benefit relationship of anticoagulation is not well established. The divergence in IDDVT treatment has led to two ultrasound approaches: whole-leg and proximal- only ultrasound, with repeat examination when indicated.
Objective:
To investigate the prevalence of IDDVT using the current ultrasound approach at Universitas Academic Hospital, in order to advise on possible adaptation and tailored approaches in distinct subpopulations.
Methods:
A retrospective file review of ultrasound investigations performed from 1 January 2015 to 31 December 2020 at the vascular suite in Universitas Academic Hospital, Bloemfontein, South Africa. Demographic data, HIV status and the anatomical site and anatomical extent of the thrombosis were collected.
Results:
In total, 2 208 files were reviewed, which included 1 203 (54.5%) cases negative for DVT, with an alternative diagnosis possible in 113 (9.4%) of the negative cases. Of the 1 005 (45.5%) positive cases, 983 had adequate data for analysis, with 845 (86.0%) PDVT and 138 (14.0%) IDDVT cases. A female predominance was observed, with a male-to-female ratio of 1:2.02. Black African and mixed-race patients had significantly less IDDVT than white patients. Nearly two-thirds (66.0%) of the patients were HIV positive. However, HIV as a risk factor for PDVT did not meet statistical significance (p=0.053).
Conclusion:
The low prevalence of IDDVT in the study cohort suggests that a proximal-only ultrasound approach can be adopted. Additionally, black African and mixed-race ethnicity, as well as male sex, were associated with a higher incidence of PDVT. Further prospective evaluation of the propagation rate of IDDVTs might advocate for tailored ultrasound approaches in different demographic groups.
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