Ultra-sonographic Findings and Associated Factors of Deep Vein Thrombosis among Adult Patients Attending Muhimbili Hospitals, Dar es Salaam, Tanzania

Abstract

Background Deep vein thrombosis of the lower limbs is a global problem and affects mostly hospitalized immobilized patients including women who are pregnant or in peuperium. The initial modality of choice for imaging this disease is Duplex Doppler Ultrasound scan. Objective: Assessment of ultrasonographic findings and associated factors of deep vein thrombosis among adult patients attending Muhimbili Hospitals from June-December 2015. Methodology: A descriptive cross-sectional study involved 89 patients with symptoms suggesting DVT referred for Doppler USS at Muhimbili National hospital and Muhimbili Orthopedic Institute. A questionnaire was used to collect demographic data, associated factors, and clinical information. Lower limb Duplex USS scans were performed in both transverse and longitudinal planes, with patients in both supine and prone positions; from the groin to the foot, for the two lower limbs. Sonographic findings were filled in special ultrasonographic findings recording form. Statistical analysis was performed using computer program statistical package for social sciences (SPSS) version 20; Chi-square test was performed and a p-value of <0.05 was used as a measure of statistical significance. Results Lower limb swelling and tenderness were the most prevalent symptoms (95.5%). DVT was found in 22 (24.7%) of participants by Duplex USS; Acute, chronic, and acute on chronic DVT occurred in 6 (27.3%), 15 (68.2%), and 1(4.5%) respectively. DVT sonographic findings were vascular incompressibility (19.1%), flow abnormalities (24.7%), absence of respiratory phasicity (24.7%), non augmentation (23.6%), and maintained blood flow with valsava maneuver (24.7%). Thrombus occurred most commonly in the common femoral vein (30.3%) and least in popliteal vein (15.2%). Prevalence of DVT was significantly higher among women who were pregnant or in the puperium period (55.6% vs 13.0%, p=0.004), and in immobilized patients (53.8% vs 12.7%, p=0.000). DVT was not significantly higher among males (32.4% vs. 20.0%, p=0.189) and in patients aged less than 60 years (26.2% vs. 21.4%, p=0.626). Oral contraceptives use or its duration, previous surgery, and stroke were not risk factors for DVT. Acute DVT was significantly found in popliteal vein (60.0% vs. 9.1%, p=0.024), anterior tibial veins (100.0% vs. 22.2%, p=0.026), posterior tibial vein (100.0% vs. 22.2%, p=0.026), and peroneal veins (100.0% vs. 22.2%, p=0.026). Chronic DVT was significantly not found in anterior tibial vein (100.0% vs. 15.8%, p=0.013), posterior tibial vein (100.0% vs. 15.8%, p=0.013), and peroneal veins (100.0% vs. 15.8%, p=0.013) . Conclusion DVT was observed in 24.7% of participants and were significantly associated with history pregnancy or in puperium period (55.6% vs. 13.0%, p=0.004), and in immobilized patients (53.8% vs. 12.7%, p=0.000). Chronic thrombus was the most frequent type (68%). The most frequent location of acute DVT were popliteal vein (p=0.024), anterior tibial veins (p=0.026), and peroneal veins (p=0.026). There was no venous anatomical location which was significantly associated with chronic DVT. DVT was significantly observed among women either pregnant or in puperium period (p=0.004) and immobilized patients (p=0.000) Recommendations: The study used a small sample and was conducted at tertiary hospitals in Tanzania; hence results cannot be generalized to general community signifying the need for large, multicentre study.