E1425. Evaluation of Venous Insufficiency on Modified Lower Extremity Deep Venous Thrombosis Ultrasound Protocol
  1. Hanna Tomsan; Mercy Catholic Medical Center
  2. Oleg Teytelboym; Mercy Catholic Medical Center
  3. Aparna Srinivasa Babu; Mercy Catholic Medical Center
  4. Gerard Berry; Mercy Catholic Medical Center
The purpose of this retrospective study was to determine the incidence of superficial venous reflux in symptomatic patients with negative deep venous thrombosis (DVT) on lower extremity duplex venous ultrasound.

Materials and Methods:
We conducted a retrospective chart review of 1475 symptomatic patients, either hospitalized, or evaluated in the Emergency Department (ED) at our academic medical center, who underwent ultrasound of lower extremities for suspected DVT between August 2019 and April 2020. Our new modified DVT ultrasound protocol includes assessment for great saphenous vein (GSV) reflux in patients with at least one sign of venous insufficiency (varicose veins, leg edema, skin discoloration, leg ulcers). Patients with positive DVT or patients not evaluated for reflux were excluded. All remaining reports were categorized as: 1) showing incidental venous reflux 2) negative, or 3) demonstrating other incidental findings. Medical records of patients with reflux were further reviewed to determine the age, sex, reflux laterality, extent, and duration. Descriptive statistics including means, percentages, and 95% confidence intervals (CI) were calculated for positive venous reflux and incidental findings.

Of 1475 DVT studies undertaken, 1310 were excluded due to positive DVT or absent evaluation for venous reflux. In the remaining study cohort (n=165) a total of 34.5% (n=57) had incidental findings. The frequency of incidental venous reflux (>500ms) was 21.2% (95% CI [15.0-27.5%], n=35). Other non-thrombotic findings were seen in 13.3% of patients (95% CI [8.1-18.5%], n=22), and included Baker's cyst (13, 7.9%), lymphadenopathy (4, 2.4%), prior GSV ablation (2, 1.2%), AV fistula (1, 0.6%), arterial thrombosis (1, 0.6%), joint effusion (1, 0.6%). Venous reflux was bilateral in 37.1% (n=13), and unilateral in 62.8% (n=22), with mean duration of 2668 ms.

Superficial venous reflux was detected in 21% of patients with negative DVT on modified duplex venous ultrasound. Our data supports screening for reflux in these studies to uncover a significant number of patients with venous insufficiency. The suggested updated lower extremity DVT ultrasound protocol will help to improve the diagnosis of chronic venous insufficiency. It will serve as a starting point for further detailed outpatient ultrasound evaluation and possible treatment, including minimally invasive interventional techniques.