Journal of vascular surgery
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A large multicenter study has recently questioned the overall clinical efficacy of vena caval filters, especially when inserted prophylactically, because of the subsequent development of deep venous thrombosis (DVT) at the insertion site. We examined the incidence of this complication with newer, smaller diameter percutaneous devices. ⋯ There is a continuing and significant incidence of new DVT development ipsilateral to the percutaneous femoral insertion site of vena caval filters. The smaller diameter filters are not associated with a lower incidence of femoral thrombosis.
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The clinical diagnosis of deep vein thrombosis (DVT) is unreliable in more than 50% of cases, and, in recent years, plasma D-dimer assays have been used to predict the presence of DVT with high sensitivity and negative predictive values. This study investigated the use of a rapid whole blood test that could be performed and interpreted by the bedside in addition to a clinically derived risk assessment score (RAS) to determine whether a practical and cost-effective clinical model could be developed for the diagnosis and exclusion of DVT in symptomatic patients. ⋯ A combination of clinical assessment and rapid D-dimer testing provides an effective means of excluding proximal DVT in symptomatic patients. The application of a clinical diagnostic model on the basis of these parameters has the potential for saving a large proportion of unnecessary duplex scans with the associated time and costs.