Abstract:
BACKGROUND:The sensitivity of d-dimer (DD) in detecting deep venous thrombosis (DVT) is remarkably high; however, many institutions send patients immediately for a venous duplex ultrasound (VDU). This study was designed to examine the appropriate utilization of DD and VDU in a high-volume hospital. METHODS:A retrospective study was conducted on consecutive patients who presented to a high-volume emergency department (ED) with lower extremity limb swelling/pain over a 30-day period, who were sent for VDU during an evaluation for DVT. VDU data were merged with electronic DD laboratory results. The enzyme-linked immunosorbent assay method was used to provide DD values and thresholds. Values above 0.60 mg/fibrinogen equivalent unit (FEU) were considered abnormal. RESULTS:We reviewed the medical records of 517 ED patients in the month of June 2013. After applying the Wells criteria, 157 patients (30.4%) were excluded because of a history of DVT or pulmonary embolism, having been screened for shortness of breath, or sent for surveillance-leaving 360 for analysis. The average age was 59.3 ± 16.5 years with more women (210, 58.3%) and the majority reported limb pain or swelling (73.9%). DD was performed on 51 patients with an average value of 3.6 ± 5.4 mg/FEU, of which 43 (84.3%) were positive. DD identified all positive and negative DVT patients (100% sensitivity and negative predictive value), but also included 40 false positives (16.7% specificity). On the other hand, 309 patients were sent directly to VDU without DD; of those, 43 (13.9%) were positive for DVT. However, 266 (86.1%) patients were negative for DVT by VDU without DD and these were deemed improper by our current study protocol. Potential charge savings were calculated as VDU for all (360 × $1000 = $360,000), DD for all (360 × $145 = $52,200), and VDU for both true and false positives (estimated to be about 25% of the cases; 90 × $1000 = $90,000); this equals a charge savings of $217,800 and would avoid unnecessary VDUs. CONCLUSIONS:Based on the results of our study, we suggest that the DD test be utilized during the initial work-up for patients with limb swelling/pain in the emergency room. Appropriate utilization of DD, as well as other clinical criteria, may limit the over-utilization and added cost of VDU, without a negative impact on patient care. The results of DD tests should be utilized to limit the number of patients sent for VDU to only those patients with a positive DD or other significant underlying concerns.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Mousa AY,Broce M,Gill G,Kali M,Yacoub M,AbuRahma AFdoi
10.1016/j.avsg.2014.07.032subject
Has Abstractpub_date
2015-02-01 00:00:00pages
311-7issue
2eissn
0890-5096issn
1615-5947pii
S0890-5096(14)00527-5journal_volume
29pub_type
杂志文章abstract::Despite the improvement in endovascular techniques, one aspect of aneurysmal disease that continues to be challenging is the management of aortoiliac aneurysms. Sacrificing the hypogastric artery (HGA) for effective treatment is not without sequelae, which may include buttocks claudication, colonic ischemia, spinal co...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2014.10.019
更新日期:2015-02-01 00:00:00
abstract::From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femor...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60832-7
更新日期:1990-11-01 00:00:00
abstract:BACKGROUND:Peripheral arterial disease (PAD) is an underdiagnosed and undertreated disease because it remains asymptomatic for so long. The ankle-brachial index (ABI) is a valid method for detecting PAD in lower extremities. ABI ≤0.90 indicates incident PAD. Recent studies have found that subjects with borderline ABI v...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.11.004
更新日期:2016-04-01 00:00:00
abstract::A 42-year-old black man, a physician, presented with a three week history of intermittent right arm and leg numbness and weakness, lasting about five minutes. This was not associated with headache, visual changes, seizures, aphasia or loss of consciousness. There was no history of head trauma, migraines, or previous a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015304
更新日期:1991-07-01 00:00:00
abstract::This report describes a case of defecation syncope secondary to functional inferior vena cava (IVC) obstruction. Preoperative hemodynamic assessment revealed a marked decrease in blood pressure and IVC obstruction when the patient performed a Valsalva maneuver. The intraoperative approach included continuous hemodynam...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02002893
更新日期:1993-07-01 00:00:00
abstract::Despite high initial technical success, the long-term durability of endovascular abdominal aortic aneurysm repair (EVAR) continues to be a concern. Following EVAR, patients can experience endoleaks, device migration, device fractures, or aneurysm growth that may require intervention. The purpose of this study was to r...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2007.10.003
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Doppler ultrasound (DUS) and computed tomography angiography (CTA) are the most commonly used imaging modalities for carotid disease. The aim of this study was to test the accuracy and reproducibility of CTA-derived measurements of carotid stenosis and compare them with those obtained by DUS. METHODS:Images...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.01.102
更新日期:2018-08-01 00:00:00
abstract::The inferior mesenteric artery (IMA) is the nutrient artery for the descending colon. Colon ischemia after repair of abdominal aortic aneurysm (AAA) can be prevented by routine or elective revascularization of the IMA. In case of occlusion of the IMA, revascularization of the internal iliac artery (IIA) has been recom...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100160010050
更新日期:2001-03-01 00:00:00
abstract::Remote endarterectomy is a minimally invasive technique for revascularization that shortens hospital length of stay and reduces patient morbidity and mortality. With the use of the MollRing Cutter (Vascular Architects, Inc., San Jose, CA), a modification of the single ring stripper, the surgeon is able to cut the endo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0005-z
更新日期:2001-09-01 00:00:00
abstract::This prospective study was undertaken to evaluate the role of duplex Doppler (DD) scanning in the diagnosis of masses of suspected vascular origin at the carotid bifurcation. We also assessed the different DD signs of carotid body tumors, especially the difference in resistance index (RI) in the external carotid arter...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02001007
更新日期:1993-03-01 00:00:00
abstract::Primary popliteal venous aneurysm is a rare condition. To date, approximately 150 cases have been reported. In the present article, we report a 59-year-old man who presented with a swelling of the left popliteal fossa. Duplex ultrasound scan revealed a saccular aneurysm of the popliteal vein, with a diameter of 2.5 × ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2011.11.027
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:The goal of this study was to describe and review the results of a technique in which reconstruction of the common and profunda femoral arteries is combined with a femoro-femoral crossover graft using the same synthetic graft. A synthetic bifurcated graft (such as the ones used for aortobifemoral reconstruct...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.10.014
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Isolated bilateral profunda femoris artery aneurysm (PFAA) is a very rare entity. Most of the cases are unilateral and occur with synchronous aneurysms elsewhere. Symptoms range from none to limb ischemia or hemorrhage because of rupture. METHODS:We present a rare case of PFAA. In contrast to the general ru...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.02.025
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh. METHODS:We studied 139 consecutive patients...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.05.004
更新日期:2017-10-01 00:00:00
abstract::Extrahepatic portal vein aneurysm is a rare clinical entity. The two most common locations for aneurysmal formation are at the confluence of the superior mesenteric vein (SMV) and the splenic vein, and at main portal vein trunk, just above the SMV-splenic vein confluence. In this article, two cases of extrahepatic por...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.02.046
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Venous resection during pancreaticoduodenectomy for the excision of pancreatic cancer allows for a more complete resection with negative margins, which increases survival. When the resected vein is greater than 3 cm, reconstruction with an interposition graft is recommended. However, consensus regarding the ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.11.008
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:To report the prevalence of silent brain infarcts (SBI) at magnetic resonance imaging (MRI) before and after surgery for asymptomatic high grade carotid stenosis. METHODS:This is a single center retrospective observational study. Asymptomatic patients who underwent carotid endarterectomy between October 201...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.10.067
更新日期:2017-08-01 00:00:00
abstract::Primary subclavian vein stents are not recommended for venous thoracic outlet syndrome before surgical decompression by first rib resection due to a high risk of fracture because they are compressed between the clavicle and first rib. After rib removal, however, stent insertion has been advocated for venous restenosis...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.064
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:We report 2 cases of patients undergoing endovascular aneurysm repair (EVAR) using reentry devices to recanalize unilateral iliac artery occlusions and complete a bifurcated endovascular repair. METHODS:Patient 1 is a 70-year-old male with an enlarging 6.5-cm abdominal aortic aneurysm (AAA) and disabling le...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.05.008
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Renal vein aneurysms (RVAs) are uncommon entities, which are usually incidental findings or may cause mild nonspecific symptoms. Modern radiological imaging, mainly multislice computed tomography (CT), has substantially contributed to a prompt and accurate diagnosis. Treatment may range from watchful waiting...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.08.075
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Loss of critical endothelial cell function and subsequent vascular smooth muscle cell (VSMC) migration is central to the pathology of injury-induced neointimal hyperplasia and recurrent stenosis. Thrombomodulin (TM), well known for its function as an endothelial surface anticoagulant, may have an unknown dir...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.10.002
更新日期:2016-01-01 00:00:00
abstract::We describe the technique using high-volume three-dimensional coils to "augment" an insufficient stent-graft landing zone. This was performed to preserve hypogastric artery perfusion in the case of common iliac artery aneurysm which resides next to the internal iliac artery. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.03.191
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Patient-centered research requires active engagement of patients. The vascular Ehlers-Danlos Syndrome (vEDS) research collaborative was established to ascertain patient-centered vEDS research priorities and to engage affected individuals as research partners. Evaluation of access to information and interest ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.06.010
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:In abdominal aortic aneurysm (AAA), pathophysiology deterioration of the medial aortic layer plays a critical role. Key players in vessel wall degeneration are reactive oxygen species (ROS), smooth muscle cell apoptosis, and extracellular matrix degeneration by matrix metalloproteinase-9 (MMP-9). Lipocalin-2...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.11.006
更新日期:2019-05-01 00:00:00
abstract::Infected or mycotic aneurysms (MAs) of the aorta and adjacent arteries are rare and difficult to treat. We report a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic and iliac pseudoaneurysm during preoperative workup. Based on the presented case, we postulate that the agressive nature ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2017.05.034
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:High glucose (HG)-induced endothelial dysfunction is a common pathologic process of vascular disease in patients with diabetes. HoxA9EC is a transcriptional regulator of genes involved in the stabilization of endothelial function. We sought to elucidate the effect of HG on HoxA9EC expression in human umbilic...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.05.011
更新日期:2012-10-01 00:00:00
abstract::The aim of this study was to evaluate the 30-day outcome of carotid endarterectomy in patients with contralateral carotid artery occlusion and compare it to that in patients with patent contralateral carotid artery. We compared 2,959 carotid endarterectomies performed in patients with patent contralateral internal car...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2006.06.003
更新日期:2007-01-01 00:00:00
abstract::To determine the prevalence, demographics and morbidity of vein patch rupture, the authors polled members of the Western Vascular Society. Forty-eight surgeons (53% of the members) reported an experience with 23,873 carotid operations. A vein patch was used in 1,760 operations (7.4%), and rupture of the patch occurred...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02021782
更新日期:1991-01-01 00:00:00
abstract::We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.061
更新日期:2015-10-01 00:00:00
abstract::Advanced complicated atherosclerotic lesions have been related to many factors, including inflammation, infectious agents, and growth factors. Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP), inflammation, and growth factors have been associated with severe atherosclerotic lesions in necropsy material in rece...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9076-1
更新日期:2006-09-01 00:00:00