ECHOGENICITY OF THROMBOTIC MASSES IN PATIENTS WITH VARICOSE VEINS OF THE LOWER LIMBS COMPLICATED BY ACUTE SUPERFICIAL VENOUS THROMBOSIS
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.20Keywords:
thrombus echogenicity, duplex ultrasound, superficial vein thrombosis, varicose veinsAbstract
Introduction. Previous studies have revealed that measuring thrombus echogenicity could be useful in managing patients with deep vein thrombosis of lower limbs. Our study aimed to analyse the echogenicity of thrombi in subjects with superficial vein thrombosis (SVT) and varicose veins.
Materials and methods. Duplex ultrasound was performed in 50 patients with varicose veins and SVT of both the trunk of the great saphenous vein and the subcutaneous tributaries. A series of images of the thrombi from the trunk and varicose tributaries were captured and analyzed in Adobe Photoshop®, CS6.0 (Adobe Systems, USA), and the grey scale median (GSM) thrombus echogenicity was determined using the „lasso tool” and „histogram”.
Results. Varicose tributary thrombus had a significantly higher echogenicity compared to saphenous trunk thrombus: 69.2±17.2 (95% CI 64.4-74.2) vs. 46.4±14.8 (95% CI 42.2-50.6) GSM units, p<0.0001. GSM values in varicose branches demonstrated a strong positive correlation (r=0.79 [95%CI 0.65-0.87], p<0.0001) with the time since the onset of SVT, while the echogenicity of the thrombus in the trunk had only a moderate correlation (r=0.42 [95%CI 0.16-0.63], p<0.01). In the linear regression model, assessing the dynamics of echogenicity depending on the duration of SVT, the R2 coefficient was three times higher for the tributaries – 0.54 vs. 0.18 for the trunk. Thrombus echogenicity increased with each day from the onset of the disease: by +3.4±0.4 GSM units in tributaries (p<0.0001) and by +1.7±0.5 GSM units in the trunk (p<0.01). There were no significant differences in GSM values in patients of different gender, age and body mass.
Conclusion. Significantly higher echogenicity of the thrombotic masses in the subcutaneous varicose tributary compared with that of the saphenous thrombus, as well as the strong positive correlation of echogenicity with SVT duration, point to the secondary character of involvement of the superficial vein trunks and centripetal progression of thrombosis.
References
London N.J., Nash R., ABC of arterial and venous disease. Varicose veins. B.M.J., 2000; 320(7246):1391-4.
Decousus H., Epinat M., Guillot K. et al., Superficial vein thrombosis: risk factors, diagnosis and treatment. Curr. Opin. Pulm. Med., 2003; 9(5):393-7.
Leon L., Giannoukas A.D., Dodd D. et al., Clinical significance of superficial vein thrombosis. Eur. J. Vasc. Endovasc. Surg., 2005; 29(1):10-7.
Decousus H., Leizorovicz A., Superficial thrombophlebitis of the legs: still a lot to learn. J. Thromb. Haemost., 2005; 3(6):1149-51.
Gjores J.E., Surgical therapy of ascending thrombophlebitis in the saphenous system. Angiology, 1962; 13:241-3.
Totten H.P., The surgical treatment of acute ascending superficial thrombophlebitis. Angiology, 1965; 16:37-42.
Verlato F., Zucchetta P., Prandoni P. et al., An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J. Vasc. Surg., 1999; 30(6):1113-5.
De Maeseneer M.G., Kakkos S.K., Aherne T. et al., Editor’s Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur. J. Vasc. Endovasc. Surg., 2022; 63(2):184-267.
Gloviczki P., Lawrence P.F., Wasan S.M. et al., The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J. Vasc. Surg. Venous. Lymphat. Disord., 2023; 11(2):231-61.e6.
Zhao L., Prior S.J., Kampmann M. et al., Measurement of thrombus resolution using threedimensional ultrasound assessment of deep vein thrombosis volume. J. Vasc. Surg. Venous. Lymphat. Disord., 2014; 2(2):140-7.
Akoglu H., User’s guide to correlation coefficients. Turk. J. Emerg. Med., 2018; 18(3):91-3.
Aburahma A., Noninvasive vascular diagnosis: a practical textbook for clinicians. 4th ed.: Springer International Publishing, 2017, 863 p.
Fowlkes J.B., Strieter R.M., Downing L.J. et al., Ultrasound echogenicity in experimental venous thrombosis. Ultrasound. Med. Biol., 1998; 24(8):1175-82.
Mazetto B.M., Orsi F.L.A., Silveira S.A.F. et al., Residual vein thrombosis echogenicity is associated to the risk of DVT recurrence: a cohort study. Clin. Appl. Thromb. Hemost., 2018; 24(3):477-82.
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