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The Clinical Implications of Bilaterally Abnormal Impedance Plethysmography

The Clinical Implications of Bilaterally Abnormal Impedance Plethysmography Abstract • Although impedance plethysmography (IPG) is a test of recognized value in the diagnosis of acute proximal deep venous thrombosis (DVT), its meaning in patients with bilaterally abnormal IPGs is unclear. Consequently, we sought to determine the clinical significance of the bilaterally abnormal IPG in hospitalized patients. In a five-month prospective study, 19% (81/425) of all IPGs done at our institution were bilaterally abnormal (55% of all abnormal IPGs). Acute proximal DVT was found in 26% (14/53) of patients with bilaterally abnormal IPGs who underwent further diagnostic testing. Thirty-five percent of the patients with DVT were found to have either bilateral lower extremity DVT or clots in the inferior vena cava. A numerical score, the venous function index (VFI), was computed for the 101 legs for which further definitive diagnostic evaluations for DVT had been completed. The mean VFI of seven for legs with acute proximal DVT was significantly less than the mean VFI of 13 for legs with no DVT. Fifty percent of legs with a VFI less than or equal to five had DVT, whereas only 7% of legs with a VFI greater than 15 had DVT. The bilaterally abnormal IPG is a common clinical occurrence, is frequently associated with acute DVT, and the VFI is helpful in discriminating legs with acute proximal DVT from normal legs in patients with a bilaterally abnormal IPG. (Arch Intern Med 1987;147:125-129) References 1. Wheeler HB, Anderson FA Jr, Cardullo PA, et al: Suspected deep vein thrombosis. Arch Surg 1982;117:1206-1209.Crossref 2. Hull R, Hirsh J, Sackett DL, et al: Cost effectiveness of clinical diagnosis, venography, and noninvasive testing in patients with symptomatic deep vein thrombosis. N Engl J Med 1981;304:1561-1567.Crossref 3. Liapis CD, Santiani B, Kuhns M, et al: Value of impedance plethysmography in suspected venous disease of the lower extremity. Angiology 1981;313:522-525. 4. Hull RD, Hirsh J, Carter CJ, et al: Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis. Ann Intern Med 1985;102:21-28.Crossref 5. Hull R, Taylor DW, Hirsh J, et al: Impedance plethysmography: The relationship between venous filling and sensitivity and specificity for proximal vein thrombosis. Circulation 1978;58:898-902.Crossref 6. Moser KM, LeMoine JR: Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 1981;94:439-444.Crossref 7. Cade JF: High risk of the critically ill for venous thromboembolism. Crit Care Med 1982;10:448.Crossref 8. Wheeler HB, Anderson FA: Impedance plethysmography , in Bernstein EF (ed): Practical Noninvasive Vascular Diagnosis . Chicago, Year Book Medical Publishers Inc, 1982, pp 277-304. 9. Taylor DW, Hull R, Sacket DL, et al: Simplification of the impedance plethysmographic technique without loss of accuracy. Thrombosis Res 1980;17:561-565.Crossref 10. Wheeler HB, Anderson FA Jr: Impedance phlebography: The diagnosis of venous thrombosis by occlusive impedance plethysmography , in Yao JST, Kempczinski RF (eds): Non-invasive Diagnostic Techniques in Vascular Disease . St Louis, CV Mosby Co, 1982, pp 482-496. 11. Rabinov K, Paulin S: Roentgen diagnosis of deep venous thrombosis in the leg. Arch Surg 1972;104:133-144.Crossref 12. Hayt DB, Blatt CJ, Freeman LM: Radionuclide venography: Its place as a modality for the investigation of thromboembolic phenomena. Semin Nucl Med 1977;7:263-281.Crossref 13. Ryo UY, Qazi M, Srikantaswamy S, et al: Radionuclide venography: Correlation with contrast venography. J Nucl Med 1977;18:11-17. 14. Henkin RE, Yao JST, Quinn JL, et al: Radionuclide venography (RNV) in lower extremity venous disease. J Nucl Med 1974;15:171-175. 15. Seager AD, Gibbs JM, David FM: Interpretation of venous occlusion plethysmographic measurements using a simple model. Med Biol Eng Comput 1984;22:12-18.Crossref 16. Cheely R, McCartney WH, Perry JR, et al: The role of noninvasive tests vs pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 1981;70:17-22.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370010123027
Publisher site
See Article on Publisher Site

Abstract

Abstract • Although impedance plethysmography (IPG) is a test of recognized value in the diagnosis of acute proximal deep venous thrombosis (DVT), its meaning in patients with bilaterally abnormal IPGs is unclear. Consequently, we sought to determine the clinical significance of the bilaterally abnormal IPG in hospitalized patients. In a five-month prospective study, 19% (81/425) of all IPGs done at our institution were bilaterally abnormal (55% of all abnormal IPGs). Acute proximal DVT was found in 26% (14/53) of patients with bilaterally abnormal IPGs who underwent further diagnostic testing. Thirty-five percent of the patients with DVT were found to have either bilateral lower extremity DVT or clots in the inferior vena cava. A numerical score, the venous function index (VFI), was computed for the 101 legs for which further definitive diagnostic evaluations for DVT had been completed. The mean VFI of seven for legs with acute proximal DVT was significantly less than the mean VFI of 13 for legs with no DVT. Fifty percent of legs with a VFI less than or equal to five had DVT, whereas only 7% of legs with a VFI greater than 15 had DVT. The bilaterally abnormal IPG is a common clinical occurrence, is frequently associated with acute DVT, and the VFI is helpful in discriminating legs with acute proximal DVT from normal legs in patients with a bilaterally abnormal IPG. (Arch Intern Med 1987;147:125-129) References 1. Wheeler HB, Anderson FA Jr, Cardullo PA, et al: Suspected deep vein thrombosis. Arch Surg 1982;117:1206-1209.Crossref 2. Hull R, Hirsh J, Sackett DL, et al: Cost effectiveness of clinical diagnosis, venography, and noninvasive testing in patients with symptomatic deep vein thrombosis. N Engl J Med 1981;304:1561-1567.Crossref 3. Liapis CD, Santiani B, Kuhns M, et al: Value of impedance plethysmography in suspected venous disease of the lower extremity. Angiology 1981;313:522-525. 4. Hull RD, Hirsh J, Carter CJ, et al: Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis. Ann Intern Med 1985;102:21-28.Crossref 5. Hull R, Taylor DW, Hirsh J, et al: Impedance plethysmography: The relationship between venous filling and sensitivity and specificity for proximal vein thrombosis. Circulation 1978;58:898-902.Crossref 6. Moser KM, LeMoine JR: Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 1981;94:439-444.Crossref 7. Cade JF: High risk of the critically ill for venous thromboembolism. Crit Care Med 1982;10:448.Crossref 8. Wheeler HB, Anderson FA: Impedance plethysmography , in Bernstein EF (ed): Practical Noninvasive Vascular Diagnosis . Chicago, Year Book Medical Publishers Inc, 1982, pp 277-304. 9. Taylor DW, Hull R, Sacket DL, et al: Simplification of the impedance plethysmographic technique without loss of accuracy. Thrombosis Res 1980;17:561-565.Crossref 10. Wheeler HB, Anderson FA Jr: Impedance phlebography: The diagnosis of venous thrombosis by occlusive impedance plethysmography , in Yao JST, Kempczinski RF (eds): Non-invasive Diagnostic Techniques in Vascular Disease . St Louis, CV Mosby Co, 1982, pp 482-496. 11. Rabinov K, Paulin S: Roentgen diagnosis of deep venous thrombosis in the leg. Arch Surg 1972;104:133-144.Crossref 12. Hayt DB, Blatt CJ, Freeman LM: Radionuclide venography: Its place as a modality for the investigation of thromboembolic phenomena. Semin Nucl Med 1977;7:263-281.Crossref 13. Ryo UY, Qazi M, Srikantaswamy S, et al: Radionuclide venography: Correlation with contrast venography. J Nucl Med 1977;18:11-17. 14. Henkin RE, Yao JST, Quinn JL, et al: Radionuclide venography (RNV) in lower extremity venous disease. J Nucl Med 1974;15:171-175. 15. Seager AD, Gibbs JM, David FM: Interpretation of venous occlusion plethysmographic measurements using a simple model. Med Biol Eng Comput 1984;22:12-18.Crossref 16. Cheely R, McCartney WH, Perry JR, et al: The role of noninvasive tests vs pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 1981;70:17-22.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1987

References

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