A new non-invasive screener for the detection of proximal deep vein thrombosis was evaluated in two consecutive series of patients undergoing primary total hip replacement. The system, which utilises computerised strain gauge venous occlusion plethysmography, was simple to use and allowed serial screening of large numbers of patients without complication. Comparison with venography in 112 patients gave a specificity of 96% (106/110) and a sensitivity of 100% (2/2) for clinically important proximal DVT.
Based on this study, a larger management study was performed. After total hip replacement, 516 patients were serially screened and all were followed to at least four months (mean 7.6 months) from surgery. Venography was only requested after a positive screening test. The screener correctly identified proximal and major calf thrombi in this group allowing early treatment. There were no fatal pulmonary emboli.
This initial assessment suggests that computerised strain gauge plethysmography may be useful in identifying those patients with silent venous thrombosis after total replacement.
AgnelliG., CosmiB., RanucciV.. Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery.Arch Intern Med1991; 151: 2167–71.
2.
BarnesR.W., HokansonD.E., WuK.K., HoakJ.C.Detection of deep vein thrombosis with an automated electrically calibrated strain gauge plethysmograph.Surgery1977; 82: 219–23.
3.
BarnesR.W., NixM.L., BarnesC.L.. Perioperative asymptomatic venous thrombosis: role of duplex scanning versus venography.J Vasc Surg1989; 9: 252–60.
BorrisL.C., ChristiansenH.M., LassenM.R., OlsenA., SchøttP.Comparison of real-time B-mode ultrasonography and bilateral ascending phlebography for detection of post-operative deep vein thrombosis following elective hip surgery.Thromb Haemostas1989; 61(3): 363–5.
6.
BrownJ.G., WardP.E., WilkinsonA.J., MollanR.A.B.Impedance plethysmography. A screening procedure to detect deep vein thrombosis.J Bone Joint Surg1987; 69B: 264–7.
7.
BüllerH.R., LensingA.W.A., ten CateJ.W.Deep vein thrombosis: new non-invasive diagnostic tests.Thromb Haemostas1991; 66(1): 133–7.
8.
ComerotaA.J., KatzM.L., GreenwaldL.L., LeefmansE., CzeredarczukM., WhiteJ.V.Venous duplex imaging: should it replace hemodynamic tests for deep vein thrombosis?J Vasc Surg1990; 11: 53–60.
9.
CousonF., BounameauxC., DidierD.. Influence of variability of interpretation of contrast venography for screening of postoperative deep vein thrombosis on the results of a thromboprophylactic study.Thromb Haemostas1993; 70(4): 573–5.
10.
CramerM., BeachK.W., StrandnessD.E.The detection of proximal deep vein thrombosis by strain gauge plethysmography through the use of an outflow/capacitance discriminant line.Bruit1983; 7: 17–21.
11.
CroalS.A., McNallyM.A., MollanR.A.B.Strain gauge plethysmography for the detection of deep vein thrombosis. In: LittleE.G., ed. Clinical aspects of biomedicine: experimental mechanics.Amsterdam: Elsevier Scientific Publications,1992; 313–22.
12.
CroalS.A., McNallyM.A., BirkmyreJ.S., HamiltonC., MollanR.A.B.Strain gauge plethysmography for the detection of deep vein thrombosis.J Biomed Eng1993; 15: 135–9.
13.
DavisF.M., LaurensonV.G., GillepsieW.J.. Deep vein thrombosis after total hip replacement: a comparison of spinal and general anaesthesia.J Bone Joint Surg1989; 71-B: 181–5.
14.
ErikssonB.I., KäleboP., AnthmyrB-A. Prevention of deep vein thrombosis and pulmonary embolism after total hip replacement.J Bone Joint Surg1991; 73-A: 484–93.
15.
FröehlichJ.A., DorfmanG.S., CronanJ.J.. Compression ultrasonography for the detection of deep vein thrombosis in patients who have a fracture of the hip.J Bone Joint Surg1989; 71A: 249–56.
16.
GallusA., RamanK., DarbyT.Venous thrombosis after elective hip replacement: the influence of preventive intermittent calf compression and of surgical technique.Br J Surg1983; 70: 17–9.
17.
Grady-BensonJ.C., OishiC.S., HansonP.B.. Postoperative surveillance for deep vein thrombosis with ultrasonography after total knee arthroplasty.J Bone Joint Surg1994; 76A: 1649–57.
18.
HallböökT., GothlinJ.Strain gauge plethysmography and phlebography in the diagnosis of deep vein thrombosis.Acta Chair Scand1971; 137: 37–53.
19.
HirshJ.Reliability of non-invasive tests for the diagnosis of venous thrombosis.Thromb Haemostas1991; 65(3): 221–2.
20.
HirshJ., HullR.D.Treatment of venous thromboembolism.Chest1986; 89(Suppl): 426–33.
21.
HoekJ.A., NurmohamedM.T., HamelynckK.J.. Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid.Thromb Haemostas1992; 67(1): 28–32.
22.
HopkinsN.F.G., WolfeJ.H.N.Thrombosis and pulmonary embolism.Br Med J1991; 303: 1260–2.
23.
HuismanM.V., BüllerH.R., Ten CateJ.W., VreekenJ.Serial impedance plethysmography for suspected deep vein thrombosis in out-patients. The Amsterdam general practitioner study.N Engl J Med1986; 314: 823–4.
24.
HullR., Van AkenW.G., HirschJ.. Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis.Circulation1976; 53: 696–700.
25.
HullR.D., HirshJ., CartonC.J.. Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis.Ann Intern Med1985; 102: 21–8.
26.
HumeM., TurnerR.H., KuriakoseT.X., SurprenantJ.Venous thrombosis after total hip replacement.J Bone Joint Surg1976; 58-A: 933–9.
27.
KakkarV.V., LawrenceD.Haemodynamic and clinical assessment after therapy for acute deep vein thrombosis.Am J Surg1985; 150: 54–63.
28.
KäleboP., AnthmyrB-A, ErikssonB.I., ZachrissonB.E.Phlebographic findings in venous thrombosis following total hip replacement.Acta Radiol1990; 31: 259–63.
29.
KraayM.J., GoldbergV.M., HerbenerT.E.Vascular ultrasonography for deep vein thrombosis after total knee arthroplasty.Clin Orthop1993; 286: 18–26.
30.
LassenM.R., BorrisL.C.Mobilisation after hip surgery and efficacy of thromboprophylaxis.Lancet1991; 337: 618–20.
31.
LassenM.R., BorrisL.C., ChristiansenH.M.Prevention of thromboembolism in 190 hip arthroplasties: comparison of LMW heparin and placebo.Acta Orthop Scand1991; 62: 33–8.
32.
LaverickM.D., McGivernR.C., CroalS.A.. A computerised system of screening for deep vein thrombosis.Thromb Res1992; 66: 207–14.
33.
LensingA.W.A., BüllerH.R., PrandoniP.. Contrast venography, the gold standard for the diagnosis of deep vein thrombosis: improvement in observer agreement.Thromb Haemostas1992; 67: 8–12.
34.
MattosM.A., LondreyG.L., LeutzD.W.. Color-flow duplex scanning for the surveillance and diagnosis of acute deep vein thrombosis.J Vasc Surg1992; 15: 366–76.
35.
McGivernR.C., LaverickM.D., BirkmyreJ.S., MollanR.A.B., KernohanW.G.Computer aided screening for deep venous thrombosis.Automedica1990; 13: 239–44.
36.
McNallyM.A., KernohanW.G., CroalS.A., MollanR.A.B.Deep vein thrombosis in orthopaedic patients: improving the specificity of diagnosis.Clin Orthop1993; 295: 275–80.
37.
McNallyM.A., MollanR.A.B., BuxtonM.J.Reducing the cost of postoperative deep vein thrombosis.J Management in Medicine1993; 7: 23–9.
38.
McNallyM.A., McAlindenM.G., O'ConnellB., MollanR.A.B.The postphlebitic syndrome after hip arthroplasty.Acta Orthop Scand1994; 65: 595–8.
39.
ModigJ., HjelmstedtA.S., SahlstedtB., MaripuuE.Comparative influences of epidural and general anaesthesia on deep vein thrombosis and pulmonary embolism after total hip replacement.Acta Chir Scand1981; 147: 125–30.
40.
ModigJ.Influence of regional anaesthesia, local anaesthetics and sympathicomimetics on the pathophysiology of deep vein thrombosis.Acta Chir Scand Supp1989; 550: 119–27.
41.
NylanderG.Phlebographic diagnosis of acute deep leg thrombosis.Acta Chir Scand1968; 387(suppl) 30–7.
42.
PrandoniP., LensingA.W.A., HuismanM.V.. A new computerised impedance plethysmograph: accuracy in the detection of proximal deep vein thrombosis in symptomatic out-patients.Thromb Haemostas1991a; 65(3): 229–32.
43.
PrandoniP., LensingA.W.A., BüllerH.R.. Failure of computerised impedance plethysmography in the diagnostic management of patients with clinically suspected deep-vein thrombosis.Thromb Haemostas1991b; 65(3): 233–6.
44.
RabinovK., PaulinS.Roentgen diagnosis of venous thrombosis of the leg.Arch Surg1972; 104: 134–44.
45.
RobertsL.M., FuF.H., McClainE.J., FergusonA.B.A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty.Clin Orthop1984; 187: 205–10.
46.
SandlerD.A., MartinJ.F.Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?J Roy Soc Med1989; 82: 203–5.
47.
SikorskiJ.M., HampsonW.G., StaddonG.E.The natural history and aetiology of deep vein thrombosis after total hip replacement.J Bone Joint Surg1981; 63-B: 171–7.
48.
SolisM.M., RanvalT.J., NixM.L.. Is anticoagulation indicated for asymptomatic postoperative calf vein thrombosis?J Vasc Surg1992; 16: 414–8.
49.
TurnerC.E., LandonG.C., TullosH.S., NobleP.C.Thromboembolism after joint replacement: rapid mobilization with ultrasound surveillance.Orthop Trans1992-93; 16: 712.
50.
TurnerI.C., McNallyM.A., O'ConnellB.M., KernohanW.G., MollanR.A.B.A numerical model of deep vein thrombosis detection using venous occlusion plethysmography.Med Biol Eng Comp (in press).
51.
WardN.Ethical issues in randomised prevention trials.Br Med J1993; 306: 563–5.
52.
WidmerL.K., ZempE., WidmerM.T.. Late results in deep vein thrombosis of the lower extremity.Vasa1985; 14: 264–8.
53.
WoolsonS.T., PottorffG.Venous ultrasonography in the detection of proximal vein thrombosis after total knee arthroplasty.Clin Orthop1991; 273: 131–5.
54.
ZachrissonB.E., JansenH.J.Phlebographic signs in fresh postoperative venous thrombosis of the lower extremity.Acta Radiol Diag1973; 14: 82–6.
