Home-Diagnosis of Deep Venous Thrombosis with Impedance Plethysmography

Summary

In order to assess the value of I.P.G. for the diagnosis of D.V.T. in general practice, an I.P.G. was carried out by a skilled technician in 255 consecutive patients with suspected D.V.T. at home. Ascending venography was carried out in 185 of these patients. In addition, blood for assay of AT III, platelet count, fibrinogen, a₂-antiplasmin, ethanol gelation test and spontaneous platelet aggregation was collected at the time the I.P.G. was performed. In 61 patients (33%) venography showed the presence of D. V.T., and was negative in the remaining 124 patients. I.P.G. was positive in 51 of the 61 patients with D.V.T., a sensitivity of 84%. I.P.G. was normal in 115 of the 124 patients with a negative venogram, a specificity of 93%. The sensitivity of the I.P.G. for proximal vein thrombosis was 92% and for calf vein thrombosis 68%. Mean a₂-antiplasmin concentration was significant (p Ã0.05) lower (101 ± 15%, mean ± SD) inpatients with D.V.T. compared with patients with a normal venogram (107 ± 11%, mean ± SD). No differences between the two groups were observed in the other coagulation parameters assayed, and none was of diagnostic value, either alone or in combination with I.P.G. This study shows that I.P.G. is of potential value for the home diagnosis of D.V.T., in particular proximal vein thrombosis. This is potentially clinically useful, because these thrombi are thought to carry a high risk for pulmonary embolism.

Keywords

Deep venous thrombosis - Impedance plethysmography - Home-diagnosis

• References

• 1 McLachlin J, Richards T, Paterson J C. An evaluation of clinical signs in the diagnosis of venous thrombosis. Arch Surg 1962; 85: 738-744
• 2 Coon WW, Coller FA. Clinicopathologic correlation in thromboembolism. Surg Gynecol Obstet 1959; 109: 259-269
• 3 Haeger K. Problems of acute deep venous thrombosis. 1. The interpretation of signs and symptoms. Angiology 1969; 20: 219-222
• 4 Nicolaides AN, Kakkar VV, Field ES, Renney JTG. The origin of deep vein thrombosis: a venographic study. Br J Radiol 1971; 44: 653-663
• 5 Gibbs NM. Venous thrombosis of the lower limbs with particular reference to bed rest. Br J Surg 1957; 45: 209-236
• 6 Hunter WC, Sneeden VD, Robertson TD, Snyder GAC. Thrombosis of the deep veins of the leg. Its clinical significance as exemplified in three hundred and fifty-one autopsies. Arch Intern Med 1941; 68: 1-17
• 7 McLachlin J, Paterson JC. Some basic observations on venous thrombosis and pulmonary embolism. Surg Gynecol Obstet 1951; 93: 1-8
• 8 Sevitt S, Gallagher N. Venous thrombosis and pulmonaryembolism. A clinico-pathological study in injured and burned patients. Br J Surg 1961; 48: 475-489
• 9 Rabinov K, Paulin S. Röntgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
• 10 Bettmann MA, Paulin S. Leg phlebography: The incidence, nature and modification of undesirable side effects. Radiology 1977; 122: 101-104
• 11 Wheeler HB, Pearson D, O’Connell D, Mullick SC. Impedance phlebography. Technique, interpretation and results. Arch Surg 1972; 104: 164-169
• 12 Wheeler HB, O’Donnell JA, Anderson FA, Penney BC, Peura RA, Benedict C. Bedside screening for venous thrombosis using occlusive impedance phlebography. Angiology 1975; 26: 199-210
• 13 Johnston KW, Kakkar VV. Plethysmographie diagnosis of deep vein thrombosis. Surg Gynecol Obstet 1974; 139: 41-44
• 14 Johnston KW, Kakkar VV, Spindler JJ, Corrigan TP, Fossard DP. A simple method for detecting deep venous thrombosis. An improved electrical technique. Am J Surg 1974; 127: 349-352
• 15 Hull R, van AkenWG, Hirsh J, Gallus AS, Hoicka G, Turpie AGG, Walker I, Gent M. Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis. Circulation 1976; 53: 696-700
• 16 Morrell MT, Dunnill MS. The post-mortem incidence of pulmonary embolism in a hospital population. Br J Surg 1968; 55: 347-352
• 17 Abildgaard U, Lie M, Ødegaard OR. Antithrombin (heparin-cofactor) assay with “new” chromogenic substrates (S-2238 and chromozym TH). Thromb Res 1977; 11: 549-553
• 18 Friberger P, Knös M, Gustavson S, Aurell L, Claesson G. Methods for determination of plasmin, antiplasmin and plasminogen by means of substrate S-2251. Haemostasis 1978; 7: 138-145
• 19 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-246
• 20 Eastham RD. Simple method for separating platelets from red cells before enumeration with an electronic counter. J Clin Pathol 1965; 18: 248-249
• 21 Godal HC, Abildgaard U, Kierulf P. Ethanol gelation and fibrin momomers in plasma. Scand J Haematol (suppl) 1971; 13: 189-191
• 22 Wu KK, Hoak JC. Spontaneous platelet aggregation in arterial insufficiency: mechanisms and implications. Thromb Haemostas 1976; 35: 702-711
• 23 Ipsen J, Feigl P. Bancroft’s introduction to biostatistics. Harper & Row Publishers; New York: 1970
• 24 Hull R, Hirsh J, Sackett DL, Powers P, Turpie AGG, Walker I. Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis: an alternative to venography. N Engl J Med 1977; 296: 1497-1500
• 25 Hull R, Tayler DW, Hirsh J, Sackett DL, Powers P, Turpie AGG, Walker I. Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximal vein thrombosis. Circulation 1978; 58: 898-902
• 26 Mavor GE, Mahaffy RG, Walker MG, Duthie JS, Dhall DP, Gaddie J. Peripheral venous scanning with ¹²⁵I-tagged fibrinogen. Lancet 1972; 1: 661-663
• 27 Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep vein thrombosis. Lancet 1969; 2: 230-232
• 28 Sevitt S. Venous thrombosis and pulmonary embolism. Am J Med 1962; 33: 703-716
• 29 Mavor GE, Galloway JMD. The iliofemoral venous segment as a source of pulmonary embolism. Lancet 1967; 1: 871-874
• 30 Mavor GE, Galloway JMD. Iliofemoral venous thrombosis. Br J Surg 1969; 56: 45-59
• 31 Mostbeck A, Partsch H, Köhn H, König B. Lungenembolie bei Bein-Beckenvenenthrombose Ergebnisse einer prospektiven Studie. Diagnostik, Häufigkeit, nuklearmedizinisches und klinisches Erscheinungsbild. Wien Klin Wochenschr 1980; 92: 464-471
• 32 Savelyev VS, Yablokov EG, Kirienko AI, Savelyev SV. Surgical prevention of pulmonary embolism. World J Surg 1980; 4: 709-716
• 33 Hull R, Hirsh J, Sackett DL, Taylor DW, Carter C, Turpie AGG, Zielinsky A, Powers P, Gent M. Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125-1 fibrinogen leg scanning. Ann Int Med 1981; 94: 12-15