Upper extremity venous thrombosis diagnosed by duplex scanning

Article Abstract:

Thrombosis occurs when clotting elements and cell debris accumulate and attach to a point on the interior wall of a blood vessel. Thrombosis in veins of the arm occurred only rarely prior to the increased popularity of attaining venous access (for administering medications) using the subclavian vein, which extends from the axillary vein in the arm and continues along the clavicle to the area of the breast bone. Duplex ultrasound (a combination of real-time ultrasound and pulse-gated Doppler study) provides detailed images of the vessel wall structure and is a noninvasive procedure that can accurately diagnose venous thrombosis in the leg. The results of duplex scanning in diagnosing venous thrombi of the upper extremity are reported. A review of 693 upper extremity duplex scans identified acute venous thrombosis in 123 patients; 85 of these involved the axillary or subclavian veins of the upper extremity. At the time of scanning, patients complained of swelling (77 percent), pain (66 percent), and/or tenderness (50 percent). The most commonly identified risk factor for development of thrombosis was the use of a central venous catheter (61 percent). Follow-up available on 61 patients with axillar-subclavian venous thrombosis (ASVT) showed that five patients (8 percent) had a pulmonary embolism, and two of these patients died. At an average follow-up of two years, 49 percent of the patients with ASVT had died, and one-third of the remaining patients had residual postthrombotic syndrome (arm symptoms, often pain and numbness). It is concluded that duplex scanning provides a safe, reliable method of evaluating patients with venous thrombosis of the upper extremity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diagnosis, Thrombophlebitis, Thrombosis, Subclavian vein

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Duplex scanning for arterial trauma

Article Abstract:

There is no definitive protocol for the management of blunt and penetrating wounds that do not show the classic signs of injury to an artery (hemorrhage or distal ischemia, lack of blood supply to the area normally served by the artery). The incidence of actual injury without these signs being present is low, but the consequences of missed vascular injury are not clear. Duplex ultrasound, a noninvasive technique combining realtime ultrasound and pulse-gated Doppler study, shows details of the vessel wall structure and measures blood flow. This scan has been found to be helpful in the diagnosis of experimental arterial injuries. The possible role of Duplex scanning in screening for arterial injury was evaluated. A retrospective review was undertaken of 89 patients who underwent duplex scanning for suspected arterial injury (93 injuries). The site of injury was the extremities in 73 patients and the neck or chest region in 17 patients. Sixty scans were performed because the injury was near a vascular structure; four (6.7 percent) revealed a vascular injury. Of the 19 scans performed to evaluate clinical signs of injury, 13 (68 percent) were positive. Arteriography (X-ray examination of the blood vessels with injection of contrast dye) was performed in all cases of abnormal duplex scans; four false-negative scans (4.3 percent) were recorded. However, no major injuries were missed and no false positive scans were recorded. These findings suggest that Duplex sonography is reliable for the diagnosis and identification of sites of arterial injury, and that it may assist in screening trauma patients for possible occult (hidden) vascular injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Wounds and injuries, Arteries

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Current status of duplex Doppler ultrasound in the examination of the abdominal vasculature

Article Abstract:

Duplex ultrasound is a combination of B-mode ultrasound (an imaging process that works by measuring and recording reflection of sound waves) and Doppler study (a technique used to monitor the behavior of structures in motion such as blood flow). Duplex ultrasound is used to diagnosis many vascular disorders, but is less often used in the examination of abdominal vessels. Duplex scanning of the abdomen is technically difficult. Because of the depth of the major abdominal blood vessels, image resolution is sacrificed for greater tissue penetration. Images may be obscured by overlying bowel gas or fat tissue in obese patients. Also, the vascular anatomy is complex, and may have been previously altered by surgery. The advantages of duplex ultrasound are the lack of toxic side effects, and its ability to provide information on both anatomy and physiology. Use of this technique in renal (kidney) vascular disease, mesenteric ischemia, and portal hypertension (high blood pressure) is discussed. For renal vascular disease, duplex ultrasound may be used to detect renal hypertension, but this is limited by technical problems. In mesenteric ischemia, duplex scanning provides information on physiology that is not available using arteriography alone. Duplex scanning is accurate in evaluating portal hypertension, and may be valuable for centers that treat many patients with this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood vessels, Abdomen

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