Pathophysiology and diagnosis of deep venous thrombosis
Identifieur interne : 004962 ( Istex/Corpus ); précédent : 004961; suivant : 004963Pathophysiology and diagnosis of deep venous thrombosis
Auteurs : Bruce R. LineSource :
- Seminars in Nuclear Medicine [ 0001-2998 ] ; 2001.
Abstract
Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. 99mTc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.
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DOI: 10.1053/snuc.2001.21406
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Pathophysiology and diagnosis of deep venous thrombosis</title><author><name sortKey="Line, Bruce R" sort="Line, Bruce R" uniqKey="Line B" first="Bruce R." last="Line">Bruce R. Line</name><affiliation><mods:affiliation>University of Maryland Medical College, Division of Nuclear Medicine, University of Maryland Medical Systems, Baltimore, MD. USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:9C330584C39EDA1BD985F02E8DB9B68B4150C48E</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1053/snuc.2001.21406</idno><idno type="url">https://api.istex.fr/document/9C330584C39EDA1BD985F02E8DB9B68B4150C48E/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">004962</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">004962</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Pathophysiology and diagnosis of deep venous thrombosis</title><author><name sortKey="Line, Bruce R" sort="Line, Bruce R" uniqKey="Line B" first="Bruce R." last="Line">Bruce R. Line</name><affiliation><mods:affiliation>University of Maryland Medical College, Division of Nuclear Medicine, University of Maryland Medical Systems, Baltimore, MD. USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Seminars in Nuclear Medicine</title><title level="j" type="abbrev">YSNUC</title><idno type="ISSN">0001-2998</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="90">90</biblScope><biblScope unit="page" to="101">101</biblScope></imprint><idno type="ISSN">0001-2998</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0001-2998</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. 99mTc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>venous</json:string><json:string>thrombosis</json:string><json:string>thrombus</json:string><json:string>venous thrombosis</json:string><json:string>coagulation</json:string><json:string>ultrasound</json:string><json:string>surg</json:string><json:string>obstruction</json:string><json:string>thromboembolism</json:string><json:string>anticoagulant</json:string><json:string>embolism</json:string><json:string>fibrinolytic</json:string><json:string>asymptomatic</json:string><json:string>antithrombin</json:string><json:string>fibrinogen</json:string><json:string>hirsh</json:string><json:string>heparin</json:string><json:string>plethysmography</json:string><json:string>venography</json:string><json:string>radiology</json:string><json:string>platelet</json:string><json:string>impedance</json:string><json:string>lancet</json:string><json:string>popliteal</json:string><json:string>venous thromboembolism</json:string><json:string>deep venous thrombosis</json:string><json:string>proximal vein thrombosis</json:string><json:string>postoperative</json:string><json:string>embolus</json:string><json:string>femoral</json:string><json:string>impedance plethysmography</json:string><json:string>clin</json:string><json:string>insufficiency</json:string><json:string>venous obstruction</json:string><json:string>calf vein thrombi</json:string><json:string>calf vein thrombosis</json:string><json:string>noninvasive</json:string><json:string>duplex</json:string><json:string>deep vein thrombosis</json:string><json:string>venous stasis</json:string><json:string>vasc surg</json:string><json:string>doppler</json:string><json:string>proximal</json:string><json:string>natural history</json:string><json:string>tissue factor</json:string><json:string>chronic venous insufficiency</json:string><json:string>acute venous thrombosis</json:string><json:string>asymptomatic patients</json:string><json:string>venous scintigraphy</json:string><json:string>clot</json:string><json:string>pulmonary embolism</json:string><json:string>oral contraceptives</json:string><json:string>venous outflow</json:string><json:string>clinical probability</json:string><json:string>coagulation factors</json:string><json:string>endothelial cells</json:string><json:string>endothelial</json:string><json:string>recurrence</json:string><json:string>duplex scanning</json:string><json:string>blood coagulation</json:string><json:string>arch surg</json:string><json:string>fibrinolytic system</json:string><json:string>vein wall</json:string><json:string>fibrinolytic activity</json:string><json:string>lower extremities</json:string><json:string>lower limbs</json:string><json:string>recurrence rate</json:string><json:string>blood viscosity</json:string><json:string>fresh clots</json:string><json:string>blood flow</json:string><json:string>thrombus formation</json:string><json:string>objective testing</json:string><json:string>normal veins</json:string><json:string>popliteal vein</json:string><json:string>calf veins</json:string><json:string>symptomatic patients</json:string><json:string>pulmonary emboli</json:string><json:string>deep veins</json:string><json:string>deep venous system</json:string><json:string>eddy currents</json:string><json:string>thromb haemost</json:string><json:string>significant number</json:string><json:string>syndrome</json:string><json:string>imaging</json:string><json:string>limb</json:string><json:string>valve</json:string><json:string>edema</json:string></teeft></keywords><author><json:item><name>Bruce R. Line MD</name><affiliations><json:string>University of Maryland Medical College, Division of Nuclear Medicine, University of Maryland Medical Systems, Baltimore, MD. USA</json:string></affiliations></json:item></author><articleId><json:string>01800386</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. 99mTc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.</abstract><qualityIndicators><score>8</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2805</abstractCharCount><pdfWordCount>7618</pdfWordCount><pdfCharCount>47722</pdfCharCount><pdfPageCount>12</pdfPageCount><abstractWordCount>416</abstractWordCount></qualityIndicators><title>Pathophysiology and diagnosis of deep venous thrombosis</title><pii><json:string>S0001-2998(01)80038-6</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Fed Proc</title><language><json:string>unknown</json:string></language><volume>25</volume><pages><first>42</first><last>51</last></pages></serie><host><title>Seminars in Nuclear Medicine</title><language><json:string>unknown</json:string></language><publicationDate>2001</publicationDate><issn><json:string>0001-2998</json:string></issn><pii><json:string>S0001-2998(01)X8036-7</json:string></pii><volume>31</volume><issue>2</issue><pages><first>90</first><last>101</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>radiology, nuclear medicine & medical imaging</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>nuclear medicine & medical imaging</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1053/snuc.2001.21406</json:string></doi><id>9C330584C39EDA1BD985F02E8DB9B68B4150C48E</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/9C330584C39EDA1BD985F02E8DB9B68B4150C48E/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/9C330584C39EDA1BD985F02E8DB9B68B4150C48E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/9C330584C39EDA1BD985F02E8DB9B68B4150C48E/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Pathophysiology and diagnosis of deep venous thrombosis</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©2001 W.B. Saunders Company</p></availability><date>2001</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Pathophysiology and diagnosis of deep venous thrombosis</title><author xml:id="author-0000"><persName><forename type="first">Bruce R.</forename><surname>Line</surname></persName><roleName type="degree">MD</roleName><note type="biography">Address reprint requests to Bruce R. Line, MD, Department of Diagnostic Radiology, 22 South Greene St, Baltimore, MD 21201-1595.</note><affiliation>Address reprint requests to Bruce R. Line, MD, Department of Diagnostic Radiology, 22 South Greene St, Baltimore, MD 21201-1595.</affiliation><affiliation>University of Maryland Medical College, Division of Nuclear Medicine, University of Maryland Medical Systems, Baltimore, MD. USA</affiliation></author><idno type="istex">9C330584C39EDA1BD985F02E8DB9B68B4150C48E</idno><idno type="DOI">10.1053/snuc.2001.21406</idno><idno type="PII">S0001-2998(01)80038-6</idno><idno type="ArticleID">01800386</idno></analytic><monogr><title level="j">Seminars in Nuclear Medicine</title><title level="j" type="abbrev">YSNUC</title><idno type="pISSN">0001-2998</idno><idno type="PII">S0001-2998(01)X8036-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001"></date><biblScope unit="volume">31</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="90">90</biblScope><biblScope unit="page" to="101">101</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. 99mTc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.</p></abstract></profileDesc><revisionDesc><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/9C330584C39EDA1BD985F02E8DB9B68B4150C48E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"></istex:docType><istex:document><article version="5.0" xml:lang="en" docsubtype="fla"><item-info><jid>YSNUC</jid><aid>01800386</aid><ce:pii>S0001-2998(01)80038-6</ce:pii><ce:doi>10.1053/snuc.2001.21406</ce:doi><ce:copyright type="unknown" year="2001">W.B. Saunders Company</ce:copyright></item-info><head><ce:title>Pathophysiology and diagnosis of deep venous thrombosis</ce:title><ce:author-group><ce:author><ce:degrees>MD</ce:degrees><ce:given-name>Bruce R.</ce:given-name><ce:surname>Line</ce:surname><ce:cross-ref refid="cor1"><ce:sup loc="post">*</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="aff1"><ce:textfn>University of Maryland Medical College, Division of Nuclear Medicine, University of Maryland Medical Systems, Baltimore, MD. USA</ce:textfn></ce:affiliation><ce:correspondence id="cor1"><ce:label>*</ce:label><ce:text>Address reprint requests to Bruce R. Line, MD, Department of Diagnostic Radiology, 22 South Greene St, Baltimore, MD 21201-1595.</ce:text></ce:correspondence></ce:author-group><ce:abstract id="ab1" class="author" xml:lang="en"><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010">Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. <ce:sup loc="post">99m</ce:sup>Tc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.</ce:simple-para></ce:abstract-sec></ce:abstract></head><tail view="all"><ce:bibliography view="all" id="bibliography.0010"><ce:section-title>References</ce:section-title><ce:bibliography-sec id="bibliography-sec.0010"><ce:bib-reference id="bib1"><ce:label>1.</ce:label><sb:reference><sb:contribution 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USA</affiliation><description>Address reprint requests to Bruce R. Line, MD, Department of Diagnostic Radiology, 22 South Greene St, Baltimore, MD 21201-1595.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States. The causes of thrombosis include vessel wall damage, stasis or low flow, and hypercoagulability. These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems. The symptoms and signs of venous thrombosis are caused by obstruction to venous outflow, vascular inflammation, or pulmonary embolization. About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. Physicians cannot rely on signs and symptoms to make the diagnosis of DVT and must depend on imaging studies to guide treatment. Patients with proximal vein thrombosis who are inadequately treated have a 47% frequency of recurrent venous thromboembolism over 3 months. In contrast, clinically detectable recurrence occurs in less than 2% of patients with proximal vein thrombosis if an adequate anticoagulant response is achieved. Of the diagnostic procedures for DVT, venography is the only invasive test of proven value, and ultrasonographic (US) studies are the most commonly used noninvasive modality. Other procedures are occasionally used to diagnose DVT, including impedance plethysmography, computed tomography, and magnetic resonance imaging. US examinations are noninvasive, they are rapidly obtained, and they can be performed serially. In symptomatic patients, venous US is sensitive and specific for proximal DVT; however, US is insensitive to calf vein thrombosis and to asymptomatic DVT occurring after surgery. Patients with symptoms of recurrent DVT also can present a difficult diagnostic problem. Only about 20% to 30% of these individuals actually have the disease; the rest have symptoms arising from chronic venous insufficiency or from any of the causes of lower extremity pain. After an acute episode, up to 50% of patients have compression ultrasound abnormalities for 6 months that are indistinguishable from the original findings of DVT. Hence, there are a significant number of patients and clinical circumstances in which the diagnosis of DVT is difficult. 99mTc-radiolabeled peptides that target the molecular biology of thrombosis should aid in the management of the disease, particularly in asymptomatic patients at high risk, in patients with recurrent symptoms, in patients with active DVT in the calf and/or pelvis, and in patients with intermediate- or low-probability lung scans.</abstract><relatedItem type="host"><titleInfo><title>Seminars in Nuclear Medicine</title></titleInfo><titleInfo type="abbreviated"><title>YSNUC</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200104</dateIssued></originInfo><identifier type="ISSN">0001-2998</identifier><identifier type="PII">S0001-2998(01)X8036-7</identifier><part><date>200104</date><detail type="issue"><title>Vascular and Thromboembolic Disease</title></detail><detail type="volume"><number>31</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>87</start><end>170</end></extent><extent unit="pages"><start>90</start><end>101</end></extent></part></relatedItem><identifier type="istex">9C330584C39EDA1BD985F02E8DB9B68B4150C48E</identifier><identifier type="DOI">10.1053/snuc.2001.21406</identifier><identifier type="PII">S0001-2998(01)80038-6</identifier><identifier type="ArticleID">01800386</identifier><accessCondition type="use and reproduction" contentType="copyright">©2001 W.B. Saunders Company</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>W.B. Saunders Company, ©2001</recordOrigin></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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