Is the fibrotic parietal thickening a reliable parameter for diagnosing previous asymptomatic deep vein thrombosis? Published online 18 September 2015 - Ann. Ital. Chir., 86, 5, 2015 427 Ann. Ital. Chir., 2015 86: 427-431 Published online 18 September 2015 pii: S0003469X15023672 www.annitalchir .com Pervenuto in Redazione: Dicembre 2014. Accettato per la pubblicazione Giugno 2015. Correspondence to: Gennaro Quarto M.D., Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Oasi Sacro Cuore 79/18, Giugliano in Campania, Naples, Italy (e-mail: gquarto@unina.it) Gennaro Quarto*/****, Giuseppe Genovese**/****, Marco Apperti***/****, Bruno Amato*, Giacomo Benassai*, Ermenegildo Furino* *Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy **Founding President of SIF (Società Italiana di Flebologia - Italian Society of Phlebology) ***President of S.I.F. (Società Italiana di Flebologia - Italian Society of Phlebology) ****C.I.R.F.F. (Centro Interuniversitario di Ricerca e Formazione in Flebologia - Interuniversitary Centre for Research and Education in Phlebology). Is the fibrotic parietal thickening a reliable parameter for diagnosing asymptomatic deep vein thrombosis? AIM: Research of a starting point to debate about the possibility of identifying a unique sign of previous DVT. MATERIAL OF STUDY: A retrospective study involving 202 outpatients with venous insufficiency of the lower limbs (CEAP classes C 4/6), classified according to the affected venous district. Patients positive for deep vein thrombosis (DVT) were subjected to Compression Ultra Sound test (CUS test) with measurement of the wall thickness at the point of forma- tion of the thrombus and at fixed points of common femoral and popliteal veins used also in the patients with nega- tive history of DVT RESULTS: Among total group, only 19 patients (9.40%) had an history of DVT. No one of them had a superficial incon- tinence. The measurement of wall thickness in positive DVT history patients (group A) resulted in an average value of 1.10 mm (s.d=0.06), while the average value obtained in negative DVT history (group B) was 0.55 mm (s.d.= 0.20). However, in 13 patients wall thickness was > 1mm (mean: 1.04 mm). The difference between the averages of group A and B was statistically significant (p <0.05). DISCUSSION: In all positive DVT history patients and in 13 ones with negative history we found an increase in wall thickness, with a value > 1 mm. Can the wall thickening more than 1 mm be considered an indicator of previous DVT? Can it be considered a “marker” for thrombophilia status? CONCLUSIONS: The usefulness of a sign of previous DVT (even if asymptomatic), detected during a routine Doppler ultrasound check of lower limbs, could be a warning bell to investigate thrombophilia status. KEY WORDS: Chronic Venous Insufficiency, Duplex ultrasound, Hypercoagulability, Post-thrombotic Syndrome, Venous Thromboembolism Introduction The aim of our study is to identify a measurable and reproducible parameter (like the carotid Intima-Media Thickness (IMT) is for cardiovascular risk) useful to determine whether a patient developed a previous deep vein thrombosis; this could be useful especially in cases in which clinical history is negative, but the patient expe- riences symptoms and signs attributable to a post- phlebitic syndrome. In the international scientific litera- ture there are no studies focused on this aspect of this syndrome. The term posthrombotic syndrome (PTS) indicates a sit- uation of chronic venous insufficiency, clinically mani- fested in patients with an history of deep vein throm- bosis (DVT); PTS is the most common complication of DVT. 20% to 50% of patients with DVT develop PTS. READ-ONLY COPY PRINTING PROHIBITED