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

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 SLIDE 6: National Venous Screening

Results: VTE Risk Assessment

Bar chart.

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 SLIDE 7: National Venous Screening

Results: Obstruction and Reflux

5% with obstruction

40% with reflux

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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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