Introduction

Although not one of the original six American College of Emergency Physicians indicated exams, evaluation for deep vein thrombosis (DVT) is one of the most useful exams for critical care physicians. There are approximately 250,000 new diagnoses of DVT per year and 50,000 deaths from thromboembolic disease annually (1, 2). The estimated rate of propagation from DVT to pulmonary embolism ranges from 10% to 50% (1, 2). Because the incidence of DVT is so high and because this disease is so prevalent in critical and acute care settings, the ability to rule in or rule out DVT at the bedside is a particularly powerful tool. The simplified compression technique described in this chapter evaluates for DVT at two anatomic sites of the lower extremity venous system. This protocol has been evaluated in multiple randomized controlled studies and has become a well-accepted protocol used for decision making in conjunction with clinical pre-test probability assessments (3–12).

Focused questions for DVT ultrasound

The questions for DVT ultrasound are as follows:

1. Does the common femoral vein fully compress?

2. Does the popliteal vein fully compress?

Anatomy

The anatomy of the lower extremity should be reviewed so the DVT compression ultrasound exam can be done properly. The ileac vein becomes the common femoral vein (CFV) as it leaves the pelvis. The most proximal tributary of the CFV is the greater saphenous vein (GSV) (Figure 8.1).