Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Abstract

Summary:Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson's Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15-0.35 % at 30 days, 0.26-0.50 % at 90 days, and 0.46-0.58 % at one year. At 30 days there was a signifi cantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other signifi cant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments. Keywords: Varicose veins, vascular surgical procedures, thrombosis, embolusThe wide range of reported incidences may be accounted for by the varying length of follow-ups in the studies and by whether routine duplex scanning was performed postoperatively or it was relied upon the development of clinical features of a DVT. The signifi cance of duplex identifi ed DVTs in the absence of clinical signs is uncertain; however, one series examining this problem reported no instances of a patients with early positive duplex fi ndings developing a clinical DVT on long term follow-up [3].The relative risk of DVT following diff erent VV procedures is currently unknown. NICE guidelines have highlighted the lack of large cohorts and high quality evidence, investigating this phenomenon, as the available evidence is limited to comparisons between two procedure types, with relatively small cohorts leading to identifi cation of sporadic events, which preclude in-depth statistical analysis. Currently the only reported comparisons are the ones between RFA and EVLA, which demonstrate no signifi cant diff erence in the incidence of DVT between these two procedures [5,10].

Thromboprophylaxis for varicose vein procedures – A national survey

“…However, prospective studies which systematically detected DVT by means of duplex ultrasound showed that the true incidence might be 5-10 times higher than expected on a clinical basis. 5,14,15 There is also a recognised increased risk of DVT in primary care patients who have varicose veins regardless of surgery. 16 Also in the Republic of Ireland there is no universal health record number meaning that patients who are diagnosed with a VTE in a different hospital from where they had their venous procedure may not be notified to the surgeon who performed it, particularly if the event is diagnosed some time after the procedure.…”

“…Although the DVT may have been present before this, it is clear that formal imaging at for example one week post-op may miss some cases of DVT. 14 The other issue is the difference between endovenous heat-induced thrombosis (EHIT) and formal DVT. EHIT can be divided into four categories, the fourth of which is often classified as a DVT; therefore, some would view EHIT and DVT as both on the same continuum.…”

Varizenchirurgie: Belastender als andere Verfahren?

“…In der Literatur wird ein postoperatives Thrombembolierisiko von ca. 0,5 % beschrieben [7]. Das deckt sich mit unseren Erfahrungen.…”

“…Barker et al [7] beschreibt in den ersten 30 postinterventionellen Tagen jedoch eine niedrigere Inzidenz thrombembolischer Ereignisse nach Schaumsklerosierung und ein insgesamt (nach 90 Tagen) ähnlich hohes Risiko für thrombembolische Ereignisse nach der operativen Sanierung, der endovenösen Therapie und einer Schaumsklerosierung.…”

UK Royal Society of Medicine Venous Forum VTE Advice 2020

“…For patients at high risk, the main focus of the Advice is the duration of prophylaxis, because evidence from the time-incidence of post-procedure VTE supports longer administration of anticoagulants than has hitherto been practiced. 6,7 These include patients with multiple risk factors or a single dominant risk factor (such as personal history of unprovoked VTE). In the new environment of COVID, this will also include patients who have venous interventions who have had or who are at high risk of acquiring COVID, with its intrinsic tendency to thrombotic problems.…”