Abstract
A long chapter, but an easy, reasonable procedure, provided some clues are followed.
Vascular probes are not fully suitable for vascular assessment in the critically ill.
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References
Davidson BL, Elliott CG, Lensing AW (1992) Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group. Ann Intern Med 117(9):735–738
Cronan JJ (1993) Venous thromboembolic disease: the role of ultrasound, state of the art. Radiology 186:619–630
Lichtenstein D, Jardin F (1997) Diagnosis of internal jugular vein thrombosis. Intensive Care Med 23:1188–1190
Lensing AWA, Doris CI, McGrath FP et al (1997) A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis. Arch Intern Med 157:765–768
Bernardi E, Camporese G, Bueller H, Siragusa S, Imberti D, Berchio A et al (2008) Serial two-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis. A randomized controlled trial. JAMA 300(14):1653–1659
Perlin SJ (1992) Pulmonary embolism during compression ultrasound of the lower extremity. Radiology 184:165–166
Lichtenstein D, Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. Chest 134:117–125
Alpert JS, Smith R, Carlson J, Ockene IS, Dexter L, Dalen JE (1976) Mortality in patients treated for pulmonary embolism. JAMA 236:1477–1480
Moser KM, LeMoine JR (1981) Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 94:439–444
Appelman PT, De Jong TE, Lampmann LE (1987) Deep venous thrombosis of the leg: ultrasound findings. Radiology 163:743–746
Cronan JJ, Dorfman GS, Grusmark J (1988) Lower-extremity deep venous thrombosis: further experience with and refinements of ultrasound assessment. Radiology 168:101–107
Meibers DJ, Baldridge ED, Ruoff BA, Karkow WS, Cranley JJ (1988) The significance of calf muscle venous thrombosis. J Vasc Surg 12:143–149
Philbrick JT, Becker DM (1988) Calf deep venous thrombosis: a wolf in sheep’s clothing? Arch Intern Med 148:2131–2138
Browse NL, Thomas ML (1974) Source of non-lethal pulmonary emboli. Lancet 1(7851):258–259
De Weese JA (1978) Ilio-femoral venous thrombectomy. In: Bergan JJ, Yao ST (eds) Venous problems. Mosby Year Book, St. Louis, pp 423–433
Mavor GE, Galloway JMD (1969) Iliofemoral venous thrombosis: pathological considerations and surgical management. Br J Surg 56:45–59
Yucel EK, Fisher JS, Egglin TK, Geller SC, Waltman AC (1991) Isolated calf venous thrombosis: diagnosis with compression ultrasound. Radiology 179:443–446
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The lower femoral vein. Detection, compression (V-point), and escape sign. Transversal scan at the right lower femoral vein. The femur is easily detected. Inside, tubular structures are isolated. One has marked coarse calcifi cations and should be the artery. The other is larger, ovoid more than round, and should be the femoral vein. Carmen maneuver (seconds 3–8) has correctly showed these were tubes – defi nitely the vascular pair, what else? The simple observation shows that the supposed vein has a marked echogenicity and is irregular and motionless: the thrombosis is quite certain. On compression (see at the bottom of the image the print of the Doppler hand through the posterior skin (seconds 25–34)), all soft tissues shrink. From skin to vein, they shrink from 4 to 2.5 cm. During this compression, the vein “escapes” a travel of 5 mm, while its cross-section remains 7–8 mm. Positive escape sign. This is, defi nitely, an occlusive deep venous lower femoral thrombosis (MOV 2736 kb)
Calf analysis. How it is done practically, what the operator can see on the screen, and how the vessels appear without and then under compression. 0”: the product is applied. 3”–6”: the probe is applied, then Carmen maneuver, and then stabilized. 7”: vision of the landmarks, two bones, one interosseous membrane, the tibial posterior muscle vessels. 12”: the eye of the operator does not leave the screen. 16”: the Doppler hand comes, and both thumbs join. 20”: the Doppler hand is at correct height. 28” and 35”: two compressions. 41”–46”: fi rst compression with full venous collapse. 52”–58”: second compression. For experts, the anterior tibial group is visible, much smaller, just anterior to the membrane and touching it. Note that the vessels are standstill spontaneously, but the compression, which collapses the veins, makes the artery systolic (roughly 110 bpm): functional artery (MOV 2736 kb)
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Lichtenstein, D.A. (2016). The BLUE-Protocol, Venous Part: Deep Venous Thrombosis in the Critically Ill. Technique and Results for the Diagnosis of Acute Pulmonary Embolism. In: Lung Ultrasound in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-15371-1_18
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DOI: https://doi.org/10.1007/978-3-319-15371-1_18
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