[Medical, social, economic value of the rational use of non-invasive studies for diagnosing phlebitis. Experience of the Regional Hospital Center of Nimes from 1984 to 1988]. / Intérêt médical, social, économique de l'utilisation rationnelle des explorations non vulnérantes pour le diagnostic de phlébite. Expérience du Centre Hospitalier Régional de Nîmes de 1984 à 1988.

Continuous wave Doppler, and B-Mode ultrasound allow the diagnosis of deep venous thrombosis with a 96% sensitivity, and a 98% specificity versus venography (1). Therefore, these methods can be extensively used for the detection of deep venous thrombosis, following a new diagnostic algorithm: X ray venography is used only for the assessment of topographic extent of iliac and caval thrombosis, and when non invasive methods give equivocal results. As a result, the number of X ray venographies significantly decreased since 1984 (7) in Nîmes University Hospital. About 75% of patients with a deep venous thrombosis (diagnosed by non invasive methods) were treated without necessity of X ray venography.

[Non-invasive methods for vascular studies in the diagnosis of deep venous thrombosis]. / Les méthodes non vulnérantes d'exploration vasculaire pour le diagnostic de la thrombose veineuse profonde.

The sonographic diagnosis of deep venous thrombosis must be made up of a functional continuous wave Doppler study of the whole deep venous system of the limbs, including leg veins, as well as saphenous veins. Then, high resolution B-mode real time sonography is used for the detection of direct (echogenic thrombus) or indirect (incompressible vein) signs of thrombosis. This noninvasive approach offers a good sensitivity (about 96%) and a high level of specificity (about 98%). Moreover, B-mode sonography can ensure the differential diagnosis (hematoma, extrinsic compression...) in most cases. So, X-Ray venography is required only when an interventional therapy is planned (thrombectomy, fibrinolysis, inferior vena cava interruption...), or when the noninvasive techniques are not able to show the upper limit of the thrombosis (especially for iliac veins or inferior vena cava), or when there is still a doubt about deep venous thrombosis. Therefore, the number of X Ray venographies can be consistently reduced, thus decreasing both cost and risks.

Social and economical effectiveness of non-invasive vascular examinations in the clinical management of thrombo-embolic disease.

In a retrospective study about the seven past years in our Hospital Center, we found that the number of X-ray venographies increased strongly from year to year until non-invasive examinations (Doppler and plethysmography and Real-time B-mode sonography) were widely used with a high sensitivity and specificity level. A new diagnostic algorhythm was then introduced in the clinical practice, X-ray venography being required mainly when an invasive treatment (thrombectomy, thrombolysis, vena cava interruption...) was planed, but not for the positive diagnosis. Thereafter, the number of X-ray venographies decreased. In that way, the cost of the diagnosis was significantly reduced as were risks and discomfort for the patient.

[Pre- and postoperative Doppler ultrasound findings in coarctation of the aorta]. / Données de l'ultrasonographie en mode Doppler pré- et post-opératoire dans les coarctations de l'aorte.

A retrospective study was done about 73 patients who had undergone a surgical operation for correction of coarctation of the aorta, between 1975 and 1985. Among these patients, 45 had both pre- and post-operative continuous wave Doppler ultrasound examination of cervical, upper, and lower limbs arteries, with pressure measurement. The age was under 14 years for 18 patients, between 14 and 25 for 10 patients, and more than 25 for the remaining 17 patients. The surgical procedure was resection with end-to-end anastomosis for 27 patients, tube graft insertion for 8 patients, dacron patch for 7 patients, subclavian arterioplasty or shunt for the others. Systolic Pressure Index and femoral Pulsatility Index showed a highly significant increase after operation (P less than 0.001) (tables I, II) regardless of the age or the surgical technique, thus demonstrating a satisfying hemodynamic efficiency of the correction (fig. 1-6) (2-6, 9). Nevertheless, 17 patients had, after operation, a greater than 15 Hg mm pressure gradient between left and right arm: the retrospective study showed that most of them had congenital abnormalities involving the left subclavian artery and/or had undergone a surgical procedure using the left subclavian artery for arterioplasty (10).

Real-time B-mode ultrasonography for better specificity in the noninvasive diagnosis of deep venous thrombosis.

In order to evaluate the usefulness of B-mode ultrasonography in the diagnosis of deep vein thrombosis, a prospective study was performed on 145 patients. Each patient was examined with occlusive venous plethysmography, continuous wave Doppler, real-time B-mode ultrasonography, and radiographic contrast phlebography. The diagnostic sensitivity and specificity versus phlebography were 91 and 82.1 per cent, respectively, for plethysmography, 92 and 86.6 per cent for Doppler, and 94 and 100 per cent for B-mode sonographic scanning. The combined noninvasive approach reached a 96 per cent sensitivity. B-mode ultrasonography demonstrated a mass in eight cases, and showed a superficial venous thrombosis in four cases, among the 45 patients without deep vein thrombosis. B-mode ultrasonography, therefore, appears to be very useful in obtaining a better specificity and differential diagnosis.