Replacement of Venography in Suspected Venous Thrombosis by Impedance Plethysmography and125I-Fibrinogen Leg Scanning

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Abstract
Noninvasive diagnostic testing is gaining acceptance in the evaluation of patients with clinically suspected venous thrombosis. Although clinically useful, these tests have limitations and the safety of basing therapeutic decisions on their outcome was not assessed. Symptomatic patients (322) were studied to ascertain the safety of replacing venography with impedance plethysmography and leg scanning. To provide a diagnostic reference, venography was performed in all patients but anticoagulants were withheld if the noninvasive tests were negative irrespective of the results of venography. None of the 163 patients with negative noninvasive tests died or developed clinical pulmonary embolism during 3 mo. follow-up, confirming the safety of this approach. In 2, clinically evident postvenographic venous thrombosis developed, confirmed by repetition of these objective tests. The positive predictive values indicate that therapeutic decisions can be based on a positive noninvasive outcome in patients without clinical disorders known to produce false-positive results.