Distribution of Lower Extremity Deep Vein Thrombosis and Implications for Limited Compression Ultrasound Examinations



      Limited compression bedside ultrasonography (LCUS) including two-point, three-point, and extended compression examinations have become increasingly popular among emergency physicians to assess for lower extremity deep venous thrombosis (DVT).


      Our objective in this study was to determine the prevalence and distribution of lower extremity DVT in sites identified by complete duplex ultrasonography (CDUS) that may potentially be missed using limited compression ultrasonography techniques.


      This was a retrospective, multicenter study conducted at 12 hospitals within the Northwell Health system over a span of 4 years. Study participants (emergency department patients) underwent CDUS to assess for possible DVT. Images were reviewed and interpreted by radiologists and vascular surgeons at each of the participating institutions.


      A total of 42,487 CDUS examinations were performed, of which 3383 were positive for DVT. DVTs were deemed to be acute in 2664 (79%) and chronic in the remaining 21% on the basis of comparison with previous studies and appearance of the vein. Of the acute DVTs, 136 (5.1%) were confined to the common femoral vein, 116 (4.4%) to the femoral vein, 8 (0.3%) to deep femoral vein, 213 (8.0%) to popliteal vein, and 934 (35.1) to calf veins alone.


      In our study, a significant number of DVTs were identified in sites that may have been potentially missed on LCUS examinations, thereby supporting the use of complete duplex ultrasonography when available.


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        • McLendon K
        • Goyal A
        • Bansal P
        • et al.
        Deep Venous Thrombosis Risk Factors.
        StatPearls, 2021
        • Zierler BK.
        Ultrasonography and diagnosis of venous thromboembolism.
        Circulation. 2004; 109 (I-9–14)
        • Burnside PR
        • Brown MD
        • Kline JA.
        Systematic review of emergency physician–performed ultrasonography for lower-extremity deep vein thrombosis.
        Acad Emerg Med. 2008; 15: 493-498
        • Bernardi E.
        Serial 2-point ultrasonography plus d-dimer vs whole-leg color-coded doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial.
        JAMA. 2008; 300: 1653
        • Blaivas M
        • Lambert MJ
        • Harwood RA
        • Wood JP
        • Konicki J.
        Lower-extremity doppler for deep venous thrombosis—can emergency physicians be accurate and fast?.
        Acad Emerg Med. 2000; 7: 120-126
        • Poppiti R
        • Papanicolaou G
        • Perese S
        • Weaver FA.
        Limited B-mode venous imaging versus complete color-flow duplex venous scanning for detection of proximal deep venous thrombosis.
        J Vasc Surg. 1995; 22: 553-557
        • Stone MB
        • Rempell JS
        • Kimberly HH.
        Practical Ultrasound Series: Deep Venous Thrombosis. American College of Emergency Physicians.
        Apple Books, 2014: 18-20
        • Ashar T
        • Jayarama K
        • Yun R.
        Bedside ultrasound for detection of deep vein thrombosis: the two-point compression method.
        Isr J Emerg Med. 2006; 6: 36-43
        • Crisp JG
        • Lovato LM
        • Jang TB.
        Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department.
        Ann of Emerg Med. 2010; 56: 601-610
        • Pedraza García J
        • Valle Alonso J
        • Ceballos García P
        • et al.
        Comparison of the accuracy of emergency department-performed point-of-care-ultrasound (POCUS) in the diagnosis of lower-extremity deep vein thrombosis.
        J Emerg Med. 2018; 54: 656-664
        • Dehbozorgi A
        • Damghani F
        • Mousavi-Roknabadi R
        • Sharifi M
        • Sajjadi S
        • Hosseini-Marvast S.
        Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department.
        J Res Med Sci. 2019; 24: 80
        • Theodoro D
        • Blaivas M
        • Duggal S
        • Snyder G
        • Lucas M.
        Real-time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT).
        Am J Emerg Med. 2004; 22: 197-200
        • Zuker-Herman R
        • Ayalon Dangur I
        • Berant R
        • et al.
        Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis.
        J Thromb Thrombolysis. 2018; 45: 99-105
        • Palareti G.
        How I treat isolated distal deep vein thrombosis (IDDVT).
        Blood. 2014; 123: 1802-1809
        • Krupski WC
        • Bass A
        • Dilley RB
        • Bernstein EF
        • Otis SM.
        Propagation of deep venous thrombosis identified by duplex ultrasonography.
        J Vasc Surg. 1990; 12: 467-475
        • Cosmi B.
        Management of superficial vein thrombosis.
        J Thromb Haemost. 2015; 13: 1175-1183
        • Kabashneh S
        • Singh V
        • Alkassis S.
        A comprehensive literature review on the management of distal deep vein thrombosis.
        Cureus. 2020; 12: e8048
        • Adhikari S
        • Zeger W
        • Thom C
        • Fields JM.
        Isolated deep venous thrombosis: implications for 2-point compression ultrasonography of the lower extremity.
        Ann Emerg Med. 2015; 66: 262-266
        • Situ-LaCasse E
        • Guirguis H
        • Friedman L
        • et al.
        Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?.
        World J Emerg Med. 2019; 10: 205-209
        • Palareti G
        • Schellong S.
        Isolated distal deep vein thrombosis: what we know and what we are doing.
        J Thromb Haemost. 2012; 10: 11-19
        • Kirkilesis G
        • Kakkos SK
        • Bicknell C
        • Salim S
        • Kakavia K.
        Treatment of distal deep vein thrombosis.
        Cochrane Database Syst Rev. 2020; CD013422
        • Downs MR
        • Doxey B
        • Roberts K.
        What is the best treatment of isolated calf deep vein thrombosis?.
        Evid Based Pract. 2020; 23: 34
        • Kearon C
        • Akl EA
        • Ornelas J
        • et al.
        Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
        Chest. 2016; 149: 315-352
        • Mattos MA
        • Melendres G
        • Sumner DS
        • et al.
        Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study.
        J Vasc Surg. 1996; 24: 738-744
        • Karande GY
        • Hedgire SS
        • Sanchez Y
        • et al.
        Advanced imaging in acute and chronic deep vein thrombosis.
        Cardiovasc Diagn Ther. 2016; 6: 493-507