# Presentation: 218273

## 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

## National Venous Screening

- Ten times more people have venous disease compared to arterial disease
- 24 million – varicose veins
- 6 million – skin changes
- 1⁄2 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

- The Problem

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## National Venous Screening

- American Venous Forum
- American Vascular Association

- Background

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## National Venous Screening

- 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

- Methods

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- Accommodate 5-7 people / hour

## National Venous Screening

- Gender
- Female: 78%
- Male: 21%
- Race
- Caucasian: 84%
- African-Amer: 8%
- Other: 5%
- Mean age: 59 (26-91)
- Mean BMI: 28 (16-51)

- Results: 476 People – 17 Centers

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- Other demographics
- Diabetes: 7%
- HTN: 31%
- CHF: 2%
- Smoker: 5%  Quit: 38%

- “Blood thinners”
- Warfarin: 5%
- ASA: 21%
- Clopidogril: 2%

- Why are you here today?
- Varicose veins: 43%
- Free screening: 36%
- Swollen leg: 13%
- Blood clot: 3%
- Cosmetic problem: 2%
- Other: 1%

## National Venous Screening

- Results: VTE Risk Assessment

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| Low (0-1) | 4.6% |
| --- | --- |
| Moderate (2) | 18.3% |
| High (3-4) | 39.2% |
| Very high (>5) | 37.7% |

## National Venous Screening

- 5% with obstruction

- Results: Obstruction and Reflux

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|  | CFV | SFJ | PV |
| --- | --- | --- | --- |
| Right leg | 1% | 1% | 2% |
| Left leg | 0.2% | 0.2% | 0.4% |

|  | CFV | SFJ | PV |
| --- | --- | --- | --- |
| Right leg | 12% | 16% | 7% |
| Left leg | 11% | 18% | 10% |

- 40% with reflux

## National Venous Screening

- 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%

- Results: Clinical Class

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## National Venous Screening

- 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)

- Few Comparisons

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## National Venous Screening

- 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

- Observations

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## National Venous Screening

- 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

- Mission

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## National Venous Screening

- 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

-   Goals 2006-2007 and beyond...

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