Should all patients undergo postoperative duplex imaging to detect a deep vein thrombosis after varicose vein surgery?
OBJECTIVE
Deep vein thrombosis (DVT) is a serious complication of varicose vein surgery, with attendant risks of pulmonary embolization. Prospective duplex screening identifies DVT in 5% of patients compared to clinical incidence of approximately 1%. Universal duplex screening is costly, and the benefits of diagnosing subclinical DVT are unproven. This study evaluates whether a policy of using clinical indications (leg swelling) to determine the need for duplex imaging is safe after varicose vein surgery.


METHODS
Patients undergoing varicose vein surgery over a 4-year period were studied. Postoperative venous duplex imaging was performed if leg swelling occurred within 6 weeks of surgery. Long-term follow-up was performed to detect any missed occurrence of clinical DVT or pulmonary embolism.


RESULTS
A total of 411 patients had 491 leg operations with 80 bilateral procedures (27%); 29 patients with leg swelling underwent duplex imaging, 5 of whom had duplex-proven DVT. No patient without early clinical signs went on to develop clinical DVT on long-term follow-up.


CONCLUSIONS
A policy of using clinical signs as a triage for duplex imaging detected all clinically significant DVTs and generated manageable workloads for our vascular laboratory.
Bhogal
R H
RH
The Vascular Unit, Worcestershire Royal Hospital, Worcester, UK. balsin@hotmail.com
Nyamekye
I K
IK
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000601:surgery*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*