From a recent letter to the editor of Emergency Medicine News:
We read with great interest the article by Christine Butts, MD, “Should D-dimer be Added to Limited Ultrasounds in DVT Patients?” After a combined 60 years in emergency medicine, my partner and I, who now specialize in leg vein and lymphatic diagnosis and treatment, have great concerns regarding this type of patient.
Typical ultrasound protocols use the 8 MHz transducer to visualize the deep veins of the leg to rule out DVT. We have found using the 13 MHz transducer, which is what we use to visualize the superficial veins of the lower leg (GSV, AAGSV, SSV), that 10 percent of our patients have evidence of prior superficial thrombophlebitis, which was completely unknown to them.
DVT was ruled out in several of our patients who had ultrasounds to rule out acute DVT, but they had completely occluded GSVs and SSVs that were missed. We have found that clots in the superficial veins can and do grow into the deep veins despite appropriate treatment with aspirin within two days. Given that 50 percent of PEs have no identifiable source, we posit that it is time to challenge the misconceptions that the lower leg superficial clots are not problematic, they cannot grow into the deep veins, they cannot embolize, and superficial thrombophlebitis is always painful and recognizable.
We have been misled for a long time. We need to realize that lower leg superficial clots are a problem, they can grow into the deeper veins, they can embolize, and therefore we need to look for them!
Susan Kanehann, MD
Stephen P. Rivard, MD
Dr. Butts responds:
Thank you so much for your comments. You raise some excellent points. Have you considered looking at this in a more formal way (a trial of some kind)? It could definitely add another layer to a topic that is already in flux.
Read the original article by clicking HERE!
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