Jack K Donohue, Emily Mosher, Michael Knapp, Nuzhat Kabir, Nishant Agrawal, Robert Handzel, Natalie D Sridharan, Eric S Hager
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引用次数: 0
Abstract
Objective: Ultrasound-guided foam sclerotherapy is commonly used for superficial venous disease but carries a small risk of deep vein thrombosis (DVT). The management of tibial vein thrombosis after sclerotherapy remains controversial, with practices ranging from anticoagulation and antiplatelet therapy to observation alone. We sought to characterize the natural history of tibial DVTs identified after foam sclerotherapy and evaluate outcomes based on management strategy.
Methods: We retrospectively analyzed patients who underwent physician-compounded foam sclerotherapy (Asclera) at a multi-institutional health care system between January 2016 and January 2022 and developed duplex-diagnosed tibial DVT. Patients underwent standardized follow-up duplex examinations at approximately 2, 4, and 6 weeks after the procedure. Thrombus evolution (resolution, reduction, stability, enlargement, propagation, and embolization) and clinical symptoms were recorded. Outcomes were compared across management groups: antiplatelet therapy, anticoagulation, and observation. Statistical analyses used Kruskal-Wallis and χ2 tests.
Results: Of 877 foam sclerotherapy patients, 622 had follow-up imaging, and 54 patients (55 legs; 9%) developed tibial DVT, forming the study cohort (median age 53 years; 51% female). At initial duplex ultrasound imaging (median 14 days postprocedure), all thrombi were ipsilateral to treatment, with concurrent proximal DVT in 5 cases (4 popliteal and 1 femoral; 9%). Initial management of the tibial thrombus included antiplatelet therapy (55%), anticoagulation (26%), or observation (20%). At final follow-up (median 35 days), thrombus completely resolved in 53%, decreased in 20%, and remained stable in 27%. No patients had enlargement or pulmonary embolism. Symptom resolution was achieved in 87% of patients, with no significant differences between management strategies.
Conclusions: In our series, tibial DVTs after foam sclerotherapy demonstrate a benign clinical course regardless of management strategy. Routine anticoagulation or antiplatelet therapy may not be necessary in asymptomatic patients with isolated distal thrombus. Prospective studies are required to confirm these findings and guide evidence-based recommendations.
期刊介绍:
Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.