PMC5554577_01
Lower extremity ultrasound findings upon initial evaluation. (a) Uncompressed right superficial femoral vein patent. (b) Compressed right superficial femoral vein completely collapsed. (c) Uncompressed left superficial femoral vein at 8.3 mm. (d) Compressed left superficial femoral vein at 8.2 mm.
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The ultrasound assessments began six days after initiation of rivaroxaban therapy (Figures 1(a)-1(d)) and then again at 9 months. Figures 1(a)-1(d) demonstrated our initial/baseline ultrasound findings which correspond to six days following initiation of rivaroxaban therapy. The right mid-SFV appeared patent without compression (Figure 1(a)) and fully collapsed upon compression (Figure 1(b)), indicating no presence of thrombi. The left SFV measured 8.3 millimeters, before compression with the ultrasound transducer (Figure 1(c)), and manual compression of the vessel measured 8.2 millimeters (Figure 1(d)), indicating the presence of a thrombus.
Left lower extremity vein percent occlusion. (a) Progression of vein occlusion of left CFV. (b) Progression of vein occlusion of left proximal SFV. (c) Progression of vein occlusion of left mid-SFV. (d) Progression of vein occlusion of left distal SFV. (e) Progression of vein occlusion of left popliteal vein.
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Finally, after bridging to warfarin therapy, another ultrasound was performed which demonstrated vast improvements (see Figures 2(a)-2(e)). The left common femoral vein (CFV) DVT resolved at the 9th-month mark (Figure 2(a)), and the left proximal SFV thrombosis resolved at the one-year mark (Figure 2(b)). When the patient was switched to warfarin treatment, there was an approximately 13% improvement in the left distal SFV and a 20% improvement of the left mid-SFV in a period of just 16 days (Figures 2(c) and 2(d)). The most drastic change in percent occlusion was of the left popliteal vein, which underwent a rapid and complete resolution of the thrombosis within 16 days of warfarin treatment after a slow but steady decline in the size of the thrombus with rivaroxaban therapy alone (Figure 2(e)).