PB0445 - Ultrasound shear wave elastography evaluation of acute deep vein thrombosis as a predictor for thrombus resolution

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Damon E. Houghton, MD, MS

Vascular Medicine Specialist
Mayo Clinic
Rochester, Minnesota, United States

Co-Author(s)

WW

Waldemar E. Wysokinski

Cardiologist & Vascular Medicine Specialist
Mayo Clinic
Rochester, Minnesota, United States
YW

Yuqi Wang

Research Associate
Mayo Clinic
Rochester, Minnesota, United States
ET

Edwin Takahashi

Interventional Radiologist
Mayo Clinic
Rochester, Minnesota, United States
HB

Haraldur Bjarnason

Interventional Radiologist
Mayo Clinic
Rochester, Minnesota, United States
AL

Alexander Lekah

Radiologist
Mayo Clinic
Rochester, Minnesota, United States
GH

Gina Hesley

Radiology
Mayo Clinic
Rochester, Minnesota, United States
MU

Matthew Urban

Associate Consultant
Mayo Clinic
Rochester, Minnesota, United States

Background: Resolution of acute deep vein thrombosis (DVT) is an important but understudied goal of treatment to prevent post-thrombotic syndrome.

Aims: Evaluate ultrasound shear wave elastography (SWE) thrombus characteristics in vivo to predict DVT resolution with treatment.

Methods: Eligible adults with an acute lower extremity DVT were recruited to undergo SWE of proximal vein segments. Exclusion criteria: anticoagulation at the time of the DVT, known DVT diagnosed within the last 3 months, planned systemic or catheter-directed thrombolysis, cast immobilization of the extremity, or contraindication for a standard course of therapeutic anticoagulation. Subjects underwent follow-up ultrasound at 3 months and thrombus resolution was graded independently by 2 vascular radiologists.

Results: A total of 43 proximal vein segments in 16 patients were evaluated with SWE after a diagnosis of acute DVT in subjects who returned for a follow-up ultrasound after a mean of 95 days (range 84-117 days). Initial acute DVT was occlusive in 31 vein segments (72%) and non-occlusive in 12 (28%)(Figure 1). Using the maximum SWE measurement of shear wave speed (SWS) at each site, mean SWS results overall were 2.88 m/s (median 3.00 m/s) with a range (1.44 – 4.36 m/s), demonstrating significant variability in thrombus characteristics. No difference was found in SWS measurements by extent (occlusive or non-occlusive) of initial DVT (mean 2.84 m/s vs 2.90 m/s, p=0.62). Higher SWS were found in subjects with no or partial resolution compared to subjects with total resolution (Figure 2: 3.22 m/s vs 2.64 m/s, p=0.002).

Conclusion(s): Ultrasound SWE measurements of DVT are heterogeneous within (by vein segment) and among study participants, indicating variability in thrombus characteristics among clinically diagnosed acute DVT. Higher SWS measurements at the time of acute DVT diagnosis were associated with incomplete thrombus resolution, indicating that SWS may be a useful prognostic imaging biomarker.