Author/Editor		Blinc, Aleš; Šabovič, Mišo
Title		Neinvazivna diagnostika venske tromboze
Translated title		Noninvasive diagnosis of deep venous thrombosis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 2
Publication year		2000
Volume		str. 15-22
Language		slo
Abstract		The pre-test probability of venous thrombosis is determined clinically from a combination of risk factors, symptoms and signs of venous thrombosis. Appropriate objective tests are then chosen depending on the pre-test probability of venous thrombosis, which may be low, medium or high. Most often, objective testing consists of a combination of venous ultrasonography and testing to determine the plasma concentration of D-dimer. Impedance plethysmography and radionuclide tests of venous patency are used only rarely. Contemporary ultrasound examination of veins combines morphological imaging (B-mode) with colour Doppler flow mapping. The most reliable ultrasonographic criterion for the diagnosis of femoral and popliteal venous thrombosis is incomplete compressibility of the vein by the probe. Compression ultrasound is supplemented by visualisation of the thrombus, examining the morphology of veins and Doppler flow mapping. If proximal venous thrombosis of the limb is confirmed by ultrasonography, anticoagulation treatment is initiated. In the case of a low pre-test probability of venous thrombosis, a negative D-dimer test is sufficient to exclude the diagnosis. In the case of a medium pre-test probability of venous thrombosis, a negative D-dimer test is sufficient to exclude the diagnosis. In the case of a medium pre-test probability, a negative ultrasonographic examination and a negative D-dimer test are required to be able to exclude venous thrombosis. If the test D-dimer test is positive, ultrasonographic examination of the veins must be repeated three times a week before venous thrombosis can be excluded. (Abstract truncated at 2000 characters.)
Summary		S klinično oceno dejavnikov tveganja, simptomov in znakov venske tromboze lahko dokaj natančno določimo predtestno verjetnost venske tromboze. Glede na nizko, srednje ali visoko predtestno verjetnost venske tromboze se odločamo za objektivne diagnostične preiskave, najpogosteje za ultrazvočno preiskavo ven, dopolnjeno s testiranjem na koncentracijo D-dimera v plazmi. Impedančno pletizmografijo ali radioizotopske preiskave ven uporabljamo le še redko. Sodobni ultrazvočni pregled ven združuje slikovni prikaz (B-mode) in barvni doplerski prikaz toka krvi. Najzanesljivejše ultrazvočno merilo za ugotavljanje femoralne in poplitealne venske tromboze je nepopolna stisljivost vene ob pritisku z ultrazvočno sondo. Preiskavo stisljivosti ven dopolnjujemo s prikazom tromba, morfologije ven, ter ocenjevanjem pulznega doplerskega signala. Če z ultrazvočno preiskavo potrdimo prisotnost proksimalne venske tromboze uda, pričnemo z antikoagulacijskim zdravljenjem. Pri nizki predtestni verjetnosti venske tromboze za izključitev diagnoze zadostuje negativen test na D-dimer, pri srednji predtestni verjetnosti pa negativen izvid ultrazvočne preiskave ven in negativen izvid testa na D-dimer. Če je test na D-dimer pozitiven, moramo ultrazvočno preiskavo ven ponoviti 3-krat v tednu dni, preden lahko izključimo proksimalno vensko trombozo uda. Pri visoki predtestni verjetnosti venske tromboze moramo ne glede na izvid testa na D-dimer serijsko ponavljati ultrazvočno preiskavo ali pa opraviti kontrastno venografijo, da lahko izključimo proksimalno vensko trombozo uda.
Descriptors		THROMBOPHLEBITIS RISK FACTORS ULTRASONOGRAPHY, DOPPLER, DUPLEX PLETHYSMOGRAPHY, IMPEDANCE PHLEBOGRAPHY