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Feasibility of a National Screening Program for Venous Disease

Surgeon General's Workshop on Deep Vein Thrombosis

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 SLIDE 1: Feasibility of a National Screening Program for Venous Disease

Robert B. McLafferty, M.D.
Professor of Surgery
Division of Vascular Surgery
Department of Surgery
Southern Illinois University
Springfield, Illinois

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 SLIDE 2: National Venous Screening

The Problem

Photograph of ulcerated foot.

  • Ten times more people have venous disease compared to arterial disease
    • 24 million – varicose veins
    • 6 million – skin changes
    • ½ million – stasis ulcers
  • DVT: 1 in 20 persons over lifetime
  • DVT: 600,000 hospital admissions
  • PE: third most common cause of hospital death; 650,000 annually

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 SLIDE 3: National Venous Screening

Background

  • American Venous Forum (graphic of AVF Logo)
  • American Vascular Association (graphic of AVA Logo)

Graphic of the United States with symbols representing 17 screening sites.

Graphic of AVA products.

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 SLIDE 4: National Venous Screening

Methods

  • Venous Screening Instrument
    • Demographic questions
    • VTE risk assessment / score
      • (Caprini, et al)
    • Screening venous duplex (CFV, SFJ, PV)
      • Reflux
      • Obstruction
    • Lower extremity inspection (Class 1 – 6 )
    • Exit interview/ report card
    • Accommodate 5-7 people / hour

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 SLIDE 5: National Venous Screening

Results: 476 People – 17 Centers

Gender

  • Female: 78%
  • Male: 21%

Race

  • Caucasian: 84%
  • African-Amer: 8%
  • Other: 5%

Mean age: 59 (26-91)

Mean BMI: 28 (16-51)

Other demographics

  • Diabetes: 7%
  • HTN: 31%
  • CHF: 2%
  • Smoker: 5%
  • Quit: 38%

“Blood thinners”

  • Warfarin: 5%
  • ASA: 21%
  • Clopidogril: 2%

Why are you here today?

  • Varicose veins: 43%
  • Free screening: 36%
  • Swollen leg: 13%
  • Blood clot: 3%
  • Cosmetic problem: 2%
  • Other: 1%

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 SLIDE 6: National Venous Screening

Results: VTE Risk Assessment

Bar chart.

 12345678910111213
total points4.618.319.419.814.48.85.44.62.70.840.84 0.21
 
Low (0-1)4.6%
Moderate (2)18.3%
High (3-4)39.2%
Very high (>5)37.7%

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 SLIDE 7: National Venous Screening

Results: Obstruction and Reflux

5% with obstruction

 CFVSFJPV
Right leg1%1%2%
Left leg0.2%0.2%0.4%
40% with reflux
 CFVSFJPV
Right leg12%16%7%
Left leg11%18%10%

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 SLIDE 8: National Venous Screening

Results: Clinical Class

  • Class 0 (none) 15%
  • Class 1 (spider veins) 33%
  • Class 2 (varicose veins) 32%
  • Class 3 (swollen leg) 11%
  • Class 4 (skin changes) 8%
  • Class 5 (healed ulcer) 1%
  • Class 6 (ulcer) 0.2%

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 SLIDE 9: National Venous Screening

Few Comparisons

  • Increasing VTE risk points more likely to have SFJ or PV reflux (p=0.01)
  • Caucasians more likely to be in high/very high VTE risk category compared to African-Americans (p=0.02)
  • Significant correlation between VTE risk points and clinical class (r=0.16, p=0.002)
  • Those with reflux more likely to have higher class rating (p=0.0001)

 

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 SLIDE 10: National Venous Screening

Observations

  • Abbreviated duplex screening exam is validated – significantly more likely to have reflux with increasing CEAP clinical class
  • Scope of the risk and presence of venous disease necessitates continued action in the public arena
  • Given the prevalence for the risk and presence of venous disease, public and private support is needed
  • A National Venous Screening Program is feasible on a widespread scale and may lead to saving lives

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 SLIDE 11: National Venous Screening

Mission

  • To provide a free comprehensive national screening program to the public that:
    • educates about venous thromboembolism, varicose veins, and chronic venous insufficiency
    • identifies those at risk for VTE, the presence of venous obstruction or reflux, and the presence of chronic venous insufficiency.
    • empowers those to inform their physician and family of their risk or presence of venous disease

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 SLIDE 12: National Venous Screening

Goals 2006-2007 and beyond...

  • Venous screening to occur in every state
  • Welcome government / industry partners
  • Facilitate increased interaction with screening sites
  • Provide more information for primary care physicians through education and empower-ment of people screened

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