Prognostic value of shear wave elastography parameters and comorbidities for remote outcomes of lower limb deep vein thrombosis

Aim. To assess the prognostic value of shear wave elastography parameters in lower limb deep vein thrombosis for remote outcomes, taking into account comorbidities, and to propose a program for individual assessment of the probability of post-hospital one-year outcomes.

Material and methods. Duplex scanning of lower limb veins supplemented by two-dimensional shear wave elastography was performed in 153 patients with iliac and femoral vein thrombosis using an Aixplorer ultrasound system (Supersonic Imagine, France) on the first, third, and sixth days of hospitalization. Post-hospital outcomes were recorded for 6-12 months after discharge. Logistic regression analysis was used to identify the most significant variables for adverse outcomes (recanalization, rethrombosis, and death). Using these variables, we developed a program for assessing the probability of post-hospital one-year outcomes of lower limb deep vein thrombosis (DVT).

Results. Multifold cross-validation showed that 13 following variables were significant for predicting post-hospital outcomes of iliac vein thrombosis: average, maximum, and minimum Young’s moduli of iliac and femoral vein thrombi on the first day of hospitalization; period from the symptoms’ onset to hospitalization; length of thrombus floating apex; concomitant diseases (stroke, coronary artery disease (CAD), cancer, previous venous thromboembolic events, recent injuries or surgery before DVT). In femoral vein thrombosis, 14 following variables were significant: on the first day of hospitalization, the average Young’s moduli of thrombi in the femoral, popliteal, and posterior tibial veins; the maximum Young’s moduli of thrombus in the femoral and popliteal veins; the presence and severity of pulmonary embolism; surgical treatment of DVT; period from the symptoms’ onset of to hospitalization; concomitant diseases (stroke, coronary artery disease, cancer, prior venous thromboembolic events, recent injuries or surgery before DVT).

Conclusion. The death probability within a year after discharge from the hospital in patients with proximal lower limb DVT increases with stroke, coronary artery disease, and cancer, while the probability of rethrombosis — with injuries, surgery, and prior venous thromboembolism. The ultrasound marker of rethrombosis was determined by the increased average Young’s modulus of the proximal venous thrombus part, while recanalization — by the maximum Young’s modulus of the femoral vein thrombus on the first day of hospitalization.

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