Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

General Session III - Superficial Venous Disease

General Session III - Superficial Venous Disease

Quickshot: Tibial Vein Thrombosis After Foam Sclerotherapy: A Single Institution Case Series

Monday, March 4, 2024

11:23 AM – 11:29 AM EST

Location: Tampa Bay Ballroom Salons 1-4

Objective: Tibial vein thrombosis after ultrasound guided foam sclerotherapy (USGS) is an uncommon but recognized complication, but the clinical significance of these provoked DVTs remains unclear and current management varies considerably. Our group sought to characterize the behavior of tibial DVTs after UGFS across all treatment modalities, including anticoagulation (AC), antiplatelet therapy, or observation only, hypothesizing no significant difference in behavior between the 3 treatment groups.

Methods: A retrospective analysis was performed of patients that developed tibial DVTs after UGFS between 2012 and 2022. Patient demographics, procedural details and clinical and radiographic outcomes recorded and analyzed. Patients were stratified into three groups based on treatment types including antiplatelet therapy, AC, and observation only.

Results: Of the 2130 patients who underwent UGFS, 58 developed tibial DVTs (28 female, 30 male). Average age was 53.4 years (SD=12.4) and average BMI 30.2 (SD=7). Comorbidities of this population included hypertension (n=22, 37.9%), diabetes (n=10, 17.2%), DVT history (n=9, 15.5%), and hypercoagulable diagnosis (n=3, 5.2%). Twenty-two patients (37.9%) were treated for CEAP class 2(C2), 23(39.7%) C3, 4(6.9%) C4, 1(1.7%) C4b, 3(5.2%) C5, and 5(8.6%) C6. An average of 6.5cc (SD 3.8) of 1% Polidocanol foam was injected (Range 1mL-25mL). The tibial DVT was identified by duplex two weeks post injection. In addition to the 59 tibial DVTs, 7 developed a concomitant proximal DVT (femoral (2) or popliteal (5)). At the initial visit 14 days (SD 7) post-procedure, 32 (55.2%) patients were symptomatic (28 pain, 4 swelling) and 26 (44.9%) asymptomatic. Management was left to the discretion of the treating physician and included antiplatelet agents (n=31, 53.4%), AC (n=15, 25.9%), and observation (n=12, 20.7%). All patients underwent repeat duplex approximately 2 weeks later to assess for propagation or regression of the thrombus. A third duplex was then performed approximately 30 days from initial post-procedure duplex. Of the 58 tibial DVTs, 30 completely resolved (13(41.9%) antiplatelet, 11(66.7%) AC, 7(58.%) observation), 11 (6(19.4%) antiplatelet, 4(26.7%) AC, 1(8.3%) observation) partially resolved, and 17 (12(38.7%) antiplatelet, 1(6.7%) AC, 4(33.3%) observation) remained unchanged from prior visit. Only 7(12%) remained symptomatic (Table 1).

Conclusions: This preliminary analysis suggests that provoked tibial DVTs after UGFS are clinically benign and rarely propagate. There does not appear to be an advantage of AC, antiplatelet agents or observation in the treatment of tibial DVT.

Abstract Podium Presenter(s)

Emily Mosher, MD

Integrated Vascular Surgery Resident
UPMC
Pittsburgh, Pennsylvania, United States