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Education, Teaching, and Quality Improvement |

Obtaining Accurate Thromboembolism Rates Post-Endovenous Laser Ablation and Sclerotherapy Procedures for Treatment of Chronic Venous Insufficiency

Chris McGreevey, MS; Christopher Bulger, MD
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Vein Clinics of America, Downers Grove, IL


Chest. 2013;144(4_MeetingAbstracts):575A. doi:10.1378/chest.1704896
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Abstract

SESSION TITLE: Patient Safety Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Review and analyze the incidence of Deep Venous Thrombosis (DVT), Pulmonary embolism (PE), and Superficial Venous Thrombosis (SVT) after endovenous laser ablation (ELA), ultrasound-guided foam sclerotherapy (UGS), and visually-guided liquid sclerotherapy (VGS)in order to provide better informed consent to patients. Our clinical observations demonstrate the post-treatment thrombus incidents occur within 1 and 30 days of thermal or chemical ablation procedures using a large population of patients across 46 physicians’ office-based surgery practices in 14 states.

METHODS: This study is a retrospective observation review of thrombotic complication rates in a single specialty group practice, over the course of two years 2010-2011 after implementing ICAVL-based Ultrasound protocols to examine the Deep Venous System of the lower extremities. 189,221 total procedures were performed during this time. Incidence of the specific thrombotic complication rates are expressed both in terms of total procedures performed and related to the specific procedures. Endovenous heat induced thrombus (EHIT Class 1, 2, 3, 4) events post-ELA were stratified, and noted both independently and combined (e.g., EHIT 2, 3, 4 combined with DVT events; EHIT 1 combined with SVT events).

RESULTS: The venous thromboembolism rate for ELA is 0.5% overall with a 0.2% DVT, 0.2% SVT and 0.05% PE rates. Sclerotherapy complication rates are 0.05% DVT, 0.1% SVT, and 0.01% PE. Specific visually-guided sclerotherapy to treat the patient’s surface veins demonstrate venous thromboembolism (VTE) rates of 0.03%.

CONCLUSIONS: The thrombotic incident rates, after endovenous ablative procedures for treatment of CVI, are less than certain previously reported sources.

CLINICAL IMPLICATIONS: Though these complications can carry significant morbidity associated with them, these procedures remain safe, and continued informed consent relies on sharing up-to-date information with the patient.

DISCLOSURE: The following authors have nothing to disclose: Chris McGreevey, Christopher Bulger

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