Correlation the rate of opening of the vein after medical treatment in lower extremity deep venous thrombosis with the elastography value of the thrombus

Aim: In this study, we aimed to correlate the rate of opening of the vein after medical treatment in lower extremity deep venous thrombosis detected in acute and subacute phase and without flow with the elastography value of thrombus. Material and Methods: Patients who applied to Yuzuncu Yil University Medical Faculty Internal Medicine Department between December 2017 and February 2019, in whom deep venous thrombosis detected in acute and subacute phase(<1 month) and without flow by color doppler ultrasound (US) evaluation in Radiology department included in the study. Patients with chronic DVT, patients with acute and subacute phase but has flow, patients with active bleeding (gastric / duodenal ulcer, cerebrovascular bleeding) which cannot be given medical treatment, patients with a history of haemorrhagic stroke in the past year, pregnant patients, patients with hemophiliac diseases and bleeding-coagulation profile disorder were excluded from the study. 75 patients were included in the study. Firstly, lower extremity doppler US examination was performed to the patients. In the Doppler US examination, the lower extremity deep venous system was evaluated for DVT from both main iliac veins to the level of the feet. The presence of thrombus, thrombus stage and anatomic localization were reported. Later, ARFI elastography technique was used to measure the venous thrombus which was the most prominent site, and the best localization. Then, the patients were given standard medical treatment. Doppler US was performed to evaluate the response of the pre-treated thrombosis segments to the treatments at the 1st and 3rd month control. In the evaluation of recanalization, the rate of openness in thrombosis vein was grouped as thrombosed and partial-fully open. Results : In the first month control, the mean elasto value of the group with partial-fully opening was 1.77 m / s and the standard deviation was 0.49. The minimum and maximum velocity values were 1.09 m / sec and 3.03 m / sec, respectively. The mean elasto value of the thrombosed group was 2.21 m / s and the standard deviation was 0.54 and the minimum and maximum velocity values were 1.24 m / sec and 3.36 m / sec, respectively. According to the independent T test performed between the two groups, the findings were statistically significant (p <0.001). According to ROC analysis, the area under the curve was 72.2 % (60-84%). When the cut-off value for shear wave velocity in trombosed group and partial-fully open group was considered as 1.85 m/s, sensitivity of the diagnostic test was 71.4 %, and specificity was 72.7 %. In the third month control, the mean elasto value of the group with partial-fully opening was 1.77 m / s and the standard deviation was 0.46. The minimum and maximum velocity values were 1.09 m / sec and 3.03 m / sec, respectively. The mean elasto value of the thrombosed group was 2.52 m / s and the standard deviation was 0.48 and the minimum and maximum velocity values were 1.74 m / sec and 3.36 m / sec, respectively. According to the independent T test performed between the two groups, the findings were statistically significant (p <0.001). According to ROC analysis, the area under the curve was 88% (81-95%). When the cut-off value for shear wave velocity in trombosed group and partial-fully open group was considered as 2.23 m/s, sensitivity of the diagnostic test was 80 %, and specificity was 80 %. Conclusion: In our study using ARFI elastography technique, we found that the response of the thrombus, which has high elastography value, to the medical treatment is less. Because thrombus has become more resistant due to the increase of collagen fibers over time due to normal physiological process of thrombus, the possibility of dissolution by medical treatment decreases. Thus, it can be foreseen that thrombus with high elastography values at the time of diagnosis will have less response to medical treatment. In addition, alternative treatment methods may be considered in thrombus which has high elastography values, because of the low rate response of medical treatment. Key Words: Deep vein thrombus, ARFI elastography, ultrasound, medical treatment