Doppler Ultrasonography-Aided Early Diagnosis of Venous Thromboembolism after Total Knee Arthroplasty

Kume, H.; Inoue, Y.; Mitsuoka, A.; Sugano, N.; Morito, T.; Muneta, T.

doi:10.1016/j.ejvs.2010.08.002

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 40, Issue 5 , Pages 664-668, November 2010

Doppler Ultrasonography-Aided Early Diagnosis of Venous Thromboembolism after Total Knee Arthroplasty

H. Kume
- Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
- Corresponding author. Tel.: +81 3 5803 5255; fax: +81 3 3818 7182.
Y. Inoue
- Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
A. Mitsuoka
- Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
N. Sugano
- Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
T. Morito
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
T. Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan

Received 16 December 2009; accepted 3 August 2010. published online 23 August 2010.

Abstract

Objectives

Postoperative deep venous thrombosis (DVT) is usually asymptomatic but can result in a fatal pulmonary embolism (PE). To assess the ability of transcranial Doppler (TCD) ultrasound apparatus to detect venous emboli in patients who had undergone total knee arthroplasty (TKA).

Methods

Forty-eight patients undergoing TKA were examined postoperatively by using compression ultrasonography, computed tomographic angiography, and TCD ultrasonography that detected high-intensity transient signals (HITS) in femoral veins. An original scoring system based on both the number of HITS and the locations of DVT was tested for its accuracy in predicting PE development.

Results

Twenty-three of the 48 patients had DVT postoperatively, and 8 had an asymptomatic PE. The sensitivity and specificity of the HITS assessment alone in identifying PE development were 75% and 92.5%, respectively. The scoring system, however, had a sensitivity of 100% and a specificity of 85% and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.96.

Conclusions

Application of a scoring system based on the detection of both DVT and HITS may be an effective and efficient method of screening for PE after knee arthroplasty.

Keywords: Transcranial Doppler ultrasonography, Deep venous thrombosis, Pulmonary embolism, High-intensity transient signals, Total knee arthroplasty