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Editorials |

Lower Extremity Venography : Still the Gold Standard

Mark W. Rolfe, MD, FCCP; David A. Solomon, MD, FCCP
Author and Funding Information

Affiliations: Tampa, FL 
 ,  Dr. Rolfe is Assistant Professor of Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine and Dr. Solomon is Professor of Medicine and Director, Division of Pulmonary, Critical Care, and Occupational Medicine, University of South Florida College of Medicine, Tampa, FL.

Correspondence to: Mark W. Rolfe, MD, FCCP, 13000 N. Bruce B. Downs Blvd 111C, Tampa, FL



Chest. 1999;116(4):853-854. doi:10.1378/chest.116.4.853
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Extract

The article by Girard et al published in this issue of CHEST (see page 903) is a retrospective review that is unlikely to be repeated. The data were collected between 1984 and 1988 and presented at an annual meeting in 1990. The data were not submitted for peer review until nearly a decade later.

The population examined in this study consisted of patients with angiographically proven pulmonary emboli (PE). No data are presented to be able to ascertain the results of ventilation/perfusion (V̇/Q̇) scans that may have proceeded the angiograms. Patients with a diagnostic pulmonary angiogram then underwent bilateral lower-extremity venography. Since the treatment for deep venous thrombosis (DVT) and PE are the same, why do venography at all? The authors state that it was a practice in France at the time of this investigation to look for free-floating thrombi (FFT) and, if present, to place an inferior vena cava filter to prevent potentially lethal recurrent emboli. Although this practice is debated,13 given the frequency of PE due to FFT, it would be reasonable in certain high-risk patients (those with a large pulmonary clot load plus FFT, for example). Unfortunately, FFT is not clearly defined by the authors. Were the clots moving within the vein, or did FFT represent only fresh clot that had not yet attached to the vessel wall? Is venography superior to ultrasound in determining this?


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