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Risk of Deep Venous Thrombosis with the Use of Foamed Sclerosant for Symptomatic Superficial Venous Insufficiency
Patrick T Beyer, Thekla Bacharach, Anand Dayama, Jean Panneton, David Dexter
Eastern Virginia Medical School, Norfolk, VA

INTRODUCTION: Thrombus extension from the superficial to the deep system during thermal ablation has been well described. There are several treatment paradigms for this complication that remain controversial. There is limited published data on the incidence of deep venous thrombosis (DVT) when utilizing foamed sclerosant for the treatment of superficial and perforator venous reflux. The purpose of this study is to report the outcomes with foam sclerotherapy for superficial venous insufficiency at our institution. We also aimed to compare the incidence of DVT after pre-compounded foam sclerotherapy or physician compounded foam sclerotherapy for superficial venous insufficiency.
METHODS: A retrospective data review was performed of all patients who underwent foam sclerotherapy for superficial venous insufficiency at a multi-center vascular surgery practice from January of 2017 and December of 2019. Data collected included patient demographics, comorbidities, procedural details, and peri-procedural outcomes at 1 week and 4 weeks follow-up. ANOVA, Studentís T test and Chi2 statistical testing was done for appropriate univariate analysis utilizing SPSS (IBM). Statistical analysis was performed using the x 2 test, Student t-test and ANOVA where appropriate.
RESULTS: 450 patients underwent foam sclerotherapy at our institution between January 2017 and December 2019. 269 (59.8%) were female, 342 (76%) were white, 91 (20.2%) were black and the mean age was 60.3 +/- 13.7 years. The mean BMI was 31.6 +/- 8.6. Venous disease was classified as C3 237 (52.7%) and C6 144 (32%) using the CEAP classification. 236 (52.4%) patients received pre-compounded foam sclerosant. 214 (47.6%) patients received physician compounded foam sclerosant. 96 (21.3%) patients had a prior history of DVT and 40 (8.9%) had a prior history of PE. 133 (29.6%) patients were on some form of antiplatelet medication prior to the index procedure, while 67 (14.9%) patients were on anticoagulation pre-operatively. 140 (31.1%) patients underwent foam sclerotherapy alone, 197 (43.8%) patients underwent foam sclerotherapy and Laser or RadioFrequency Ablation, 74 (16.4%) underwent foam sclerotherapy and phlebectomy, and 39 (8.7%) underwent all three procedures. There were 48 (10.7%) acute DVTs diagnosed at 1 week follow-up. 35 (7.8%) DVTs were defined as foam extension from the treated vein into the deep system while 13 (2.9%) DVTs were identified as remote from the injection site. 19 DVTs occurred in patients who underwent foam sclerotherapy alone with a DVT rate of 19/140 (13.5%). 21 DVTs occurred in patients who underwent foam sclerotherapy and EVLT with a DVT rate of 21/197 (10.7%). 4 DVTs occurred in each of the groups who underwent foam sclerotherapy and phlebectomy 4/74 (5.4%) and all three procedures 4/39 (10.3%) respectively. 8/48 (16.7%) of the DVTs were remote from the injection site and associated with EVLT classifying them as true EHITs. Of the 48 DVTs, 19 (39.6%) were treated with anticoagulation for an average of 6.1 weeks.
CONCLUSIONS: This study demonstrates real-world experience with physician compounded foam and pre-compounded foam sclerosant treatment. The DVT rates are higher than those classically described with thermal techniques. Routine postoperative surveillance has helped identify these events and determine the management of these complications.


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