VENOUS DUPLEX SCANNING FOR UNILATERAL SYMPTOMS - WHEN DO WE NEED A CONTRALATERAL EVALUATION

Objectives: Determine the need for bilateral duplex scanning (DS) in p atients with unilateral symptoms of acute DVT of the leg. Design: Pros pective study. Materials: One thousand, one hundred and sixty-one cons ecutive patients with recent unilateral symptoms of pain or swelling. Methods: Bilateral DS were performed and demographic data including ri sk factors for DVT were entered into a computerised database. Results: Of the 250 cases (22%) of acute DVT, thrombus was confined to the sym ptomatic limb in 80% (200/250) and to the asymptomatic limb (AL) in 5% (12/250), while bilateral DVT was found in 15% (38/250). The manageme nt was not altered by the contralateral DS findings in any patient wit h bilateral thrombus. Ten of the 12 cases of DVT confined to the AL we re localised to the infrapopliteal level; advanced malignancy, recent joint surgery or hypercoagluability were noted in nine patients, inclu ding all those requiring treatment. Conclusions: In the presence of un ilateral symptoms of DVT, we recommend DS of the symptomatic extremity only; bilateral examination should be confined to patients with norma l duplex findings in the symptomatic limb following recent joint surge ry, or-in the presence of advanced malignancy or hypercoagulability. B ilateral DS would therefore be required in approximately 11% of cases with unilateral symptoms of DVT.