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Is routine scanning for deep-vein thrombosis necessary following endovenous laser ablation and ultrasound-guided sclerotherapy? A statistical perspective in Australian Phlebology practice

A publication by Myers and colleagues in 2006 studying the safety and effectiveness of endovenous laser ablation (EVLA) and ultrasound guided sclerotherapy (UGS) found that venous thromboembolism (VTE) was detected by routine follow-up ultrasound scans within three to five days in 2.3% of procedures. They reported seven thromboembolic events in their 308 patients, consisting of two proximal deep-vein thromboses (DVTs), four distal DVTs and one pulmonary embolus (PE) without evidence of DVT. This was some 10 times greater than previously published rates, where VTE was a rare complication of EVLA and UGS when these treatments were used in isolation or in combination. More recently, Myers and Jolley published a larger series of patients examined three to seven days following UGS alone and found deep venous thrombosis in 1.5%. Leopardi et al. reviewed the safety and efficacy of EVLA compared with surgery and reported DVT in 20/5068 patients (0.4%) after EVLA in 25 studies. Luebke and Brunkwall reviewed the safety of EVLA and UGS, reporting pooled rates of DVT following treatment of 27/9317 or 0.3% after EVLA and 23/9740 or 0.2% after UGS. King et al. followed 924 patients, at 24–48 hours encountering only one proximal DVT, an incidence of 0.1%. Nwaejike et al. reported on 624 patients, with no DVT detected, but one PE – 10 days following EVLA – although their surveillance scanning was within the first 24 hours. In none of these studies was thromboprophylactic medication prescribed, but graduated compression stockings were utilized universally. However, Gibson et al. reported on a series of patients treated with EVLA to the small saphenous vein and discovered a DVT rate of 5.7%, consisting mainly of thrombus within the unlasered stump of vein at the saphenopopliteal junction (SPJ). Clearly, Myers and colleagues found more VTE events than most other workers, and several possible explanations for the variation can be suggested: