![]() ![]() ![]() The proximal LE venous system consists of the external iliac vein (EIV), CFV, FV, profunda femoral vein (PFV) and PV (Figure 2).įigure 2. High-frequency linear transduucer (12-5 MHz) is preferred, but lower-frequency curvilinear (5-2 MHz) may be needed in larger patients where required scanning depth is > 6 cm. Ultrasound gel placement on lower extremity for the common femoral vein (CFV) through femoral vein (FV) portion of the proximal lower extremity deep vein thrombosis (LE DVT) scan. Ultrasound gel should be placed from the groin to the adductor canal (Figure 1).įigure 1.Leg should be placed with knee flexed for scanning the PV.Leg should be placed in external rotation for scanning the CFV and femoral vein (FV).Reverse Trendelenburg position to promote venous distention (if not contraindicated).With intermittent compression at 1- 2 cm intervals from the common femoral vein (CFV) through the trifurcation of the popliteal vein (PV) and that protocol will be discussed in this article. 3,4 Therefore, it is the authors’ preference to utilize a proximal scanning protocol that includes continuous scanning Have good sensitivity for the detection of proximal LE DVTs, there is a small risk of missing focal proximal LE DVTs. While the two-point and three-point protocols POCUS LE DVT protocols focus on the proximal LE veins and include two-point, three-point, and continuous proximal LE protocols. POCUS exams to detect DVT aim to find a lack of compressibility in a deep vein. Therefore, this protocol is not utilized as a POCUS scanning protocol and will not be discussed in this article. Distal LE DVTs have a lower risk ofĮmbolization, and there is a lower sensitivity of compression ultrasound to detect isolated calf vein DVTs. The whole-leg protocol with color and spectral Doppler is time consuming and technically challenging since the calf veins are included. There are multiple scanning protocols, each of which has its own pros and cons. Lower extremity DVTs cannot be ruled out on clinical grounds and can be associated with significant morbidity and mortality. Clinical suspicion of pulmonary embolism.Patients may have a history of recent surgery, trauma, or immobilization.Patients may present with unilateral leg pain and swelling.2 The venous compression ultrasound examination has been shown to have similar accuracy and therefore is an important skill for ![]() Physicians performing POCUS studies for DVT detection found a pooled sensitivity of 96% and specificity of 97%. A 2013 meta-analysis of emergency medicine Physicians trained in point-of-care ultrasound (POCUS) LE DVT studies can perform these studies efficiently and with a high degree of sensitivity and specificity. Services and may not be immediately available. The traditional duplex exam requires accessibility to specialized radiology Although most DVTs will begin in calf veins and resolve spontaneously, the problem occurs when a calf DVT extends into the proximal veins. Most patients with an identified source of pulmonary embolism will haveĪ proximal lower extremity (LE) DVT. 1 DVTs cannot be ruled out on clinical grounds alone based on the lack of sensitivity of physical examination. Of preventable hospital death in the United States. The failure to diagnose DVTs in a timely fashion can lead to significant morbidity and mortality, especially in critically ill patients. Deep venous thrombosis (DVT) is a common disorder in the hospitalized patient. ![]()
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