Paget-Schroetter Syndrome Research Articles

External Validation of the Saved Score for Venous Thromboembolism Risk Stratification in Patients with Multiple Myeloma Receiving Immunomodulatory Drugs

Background: High thrombogenicity is a well-established phenomenon in multiple myeloma (MM) and can lead to high morbidity and mortality. The risk of venous thromboembolism (VTE) is particularly elevated in the subset of MM patients treated with immunomodulatory drug (IMiD) containing regimens. The National Comprehensive Cancer Network (NCCN) and International Myeloma Working Group (IMWG) have implemented VTE risk assessment models, and recommend prophylactic anticoagulation based on individual patient, disease, or treatment-related factors specifically for MM patients receiving IMiD. With the recent incorporation of the SAVED (PMID 31319391) scoring system in the NCCN guidelines for VTE risk stratification, we sought to externally validate this risk assessment model and evaluate its predictive ability in our MM patient cohort. Methods: We retrospectively evaluated 501 adult patients with either newly diagnosed or relapsed/refractory MM who were newly initiated on an IMiD-based regimen between 2010 and 2019. Patients already on therapeutic or prophylactic anticoagulation were excluded from the study (aspirin was allowed). The SAVED score was calculated at IMiD initiation according to the following five parameters: surgery within last 90 days (+2), Asian race (-3), prior VTE history (+3), age ≥80 years (+1), dexamethasone use (+2 for high dose [>160 mg/30-day], or +1 for standard dose [120-160 mg/30-day]). Patients with SAVED scores of <2 and ≥2 were considered of low and high risk, respectively, for developing VTE after IMiD initiation. Time to VTE was estimated by Kaplan-Meier failure method. Logistic regression model was used to test components of the SAVED score with 1-year VTE status. Model discrimination was assessed via c statistic by calculating the area under the receiver operating characteristic curve (AUC) with bootstrapped 95% confidence interval (CI). Results: The median age of our cohort at the IMiD initiation was 64 years (range 34-89); 264 (53%) patients were male and 378 (75%) were white. IgG and IgA heavy chain subtypes were present in 280 (56%), and 105 (21%) patients respectively, whereas 110 (22%) patients had light chain disease only. The International Staging System (ISS) was I, II, III, and unknown for 161 (32%), 149 (30%), 136 (27%), and 55 (11%) of patients, respectively. Most patients (94%) received lenalidomide, whereas 14 (3%) and 15 (3%) patients were treated with thalidomide and pomalidomide, respectively. The distribution of SAVED covariates is shown in Table 1. The cumulative incidence of VTE at 12-month after IMiD initiation for the entire cohort was 16% (95% CI: 13-20%). Among the 84 patients who developed new VTE after IMiD initiation, 60 (71%) had lower extremity deep venous thrombosis (DVT), 10 (12%) had pulmonary embolism, 9 (11%) had both DVT and PE, and 5 (6%) had upper extremity DVT. The SAVED score stratified 112 patients (22%) as high-risk and 389 patients (78%) as low-risk (similar proportion as the original derivation study). Cumulative incidence of VTE at 6 and 12 months was 31% and 41% in the high-risk group, versus 6% and 9% in the low-risk group, respectively (Figure 1). Each point of SAVED score increase was associated with significantly higher chance of VTE within 1-year post IMiD initiation with excellent discrimination (odds ratio = 2.10 [95% CI 1.71-2.56], c statistic (AUC) = 0.76 [95% CI 0.70-0.81]). Conclusion: Our results successfully externally validated the SAVED model to predict IMiD-associated VTE in a real-life cohort of patients with MM. Patients with SAVED score of ≥2 had significantly higher incidence for VTE. This indicates that more aggressive pharmacologic thromboprophylaxis is needed in this specific patient population. The SAVED score outperformed several other similar VTE prediction models that were also validated in the current cohort (c statistic=0.68 for IMPEDE [PMID: 33997961] and 0.62 for PRISM [PMID: 35772005]). In contrast to other risk models that focused on all patients with MM, the SAVED score was derived and now validated specifically for patients starting IMiD as this it is the only cancer population with a strong guideline recommendation for ambulatory thromboprophylaxis. Future prospective validation would be useful to determine the predictive nature of SAVED while evaluating safety and efficacy of thromboprophylaxis with direct oral anticoagulant in high-risk patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical Factors Associated to VTE in Multiple Myeloma Patients Treated with Daratumumab

Introduction: Hematologic malignancies, especially multiple myeloma (MM), are associated with a high risk for venous thromboembolism (VTE). In MM, multiple factors increase the risk of VTE including, but not limited to, different treatments. The most recognized therapies that increase VTE risk for MM are immunomodulator drugs (IMIDs), steroids, and carfilzomib. Monoclonal antibodies (mAbs), usually in combination with other treatments, have become the therapy of choice for transplant- and non-transplant candidates in newly diagnosed MM (NDMM) as well as those with relapsed and/or refractory disease (RRMM). Daratumumab is an anti-CD38 monoclonal antibody incorporated in several combination regimens, and its specific effect on VTE risk is not well known. Previous studies have tried to identify clinical and therapy-related factors associated with VTE risk, with limited data on VTE risk and monoclonal antibodies (Wang, J Leuk Lymphoma, 2021). This study aims to identify if an increased risk of VTE exists for patients undergoing treatment with daratumumab-based regimens in efforts to develop a future risk assessment model that incorporates mAbs. Methods: We retrospectively reviewed the medical records of consecutively identified patients who received daratumumab, registered in a data warehouse designed to study the interference of monoclonal antibodies and blood typing procedures, at MD Anderson Cancer Center (MDACC) for the treatment of MM between April 2014 and February 2021. The study was approved by the institutional review board at MDACC. Eligible patients were screened for upper and lower extremity deep venous thrombosis (DVT) and pulmonary embolism (PE) through doppler ultrasound and contrast enhanced radiology reports, respectively, within 365 days after the date of the first dose of daratumumab. A natural language processing algorithm was used to determine the likely VTE positive cases and then was confirmed with manual chart review. Patients were divided into two categories, based on the timing of VTE diagnosis relative to the first dose of daratumumab: VTE post-daratumumab versus non-VTE post-daratumumab. The co-variates of interest were derived from three previous VTE risk stratification systems (SAVED, IMPEDE-VTE, and IMWG) and the differences were compared within the two category-VTE groups. All variables of interest were analyzed using descriptive statistics. Chi-square test or Fisher exact test were used to assess the association between categorical variables, and non-parametric methods were used for continuous numeric variables. Variables with statistically significant differences between VTE-category groups (p≤ 0.05) were analyzed using a binary logistic regression to determine their effect on the VTE occurrence. Results: Out of 258 eligible patients, 32 had evidence of VTE post-daratumumab, for a VTE incidence of 12.4% at 12 months from the initiation of daratumumab. The median time to VTE from the first dose of daratumumab was 3.9 months (IQR 1.6 - 6.1 months). Of the variables tested, we identified that the presence of central venous access (PICC), surgery within the previous 90 days before the initiation of daratumumab, and the history of comorbidities (cardiac disease, CKD, acute infection, or immobilization) were more prevalent in patients with VTE (Table 1). In the logistic regression analysis, only the presence of comorbidities (p = 0.007) was significant to the risk of VTE, but PICC line insertion (p = 0.064) and surgery within the previous 90 days (p = 0.078) were not (Figure 1). The odds of having a new VTE was 3.3 (95% CI, 1.4-7.7). Conclusions: The incidence of VTE during daratumumab therapy appears to be high (>10% in 12 months). The use of concurrent chemotherapy and thalidomide-derivative agents did not appear to increase the risk of VTE in those patients. The presence of comorbidities was the only independent factor associated to the risk of VTE in that cohort. This study suggests that while the incidence of VTE in MM patients is high, the main contributing risk factors for VTE are dynamic and the interplay between those factors changes along the disease course. After validation, these findings could influence and improve current VTE risk assessment models and update primary thromboprophylaxis guidance for improved patient outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

No Difference in Venous Thromboembolism Outcomes after COVID-19 and Influenza Vaccinations

Background: Despite several large studies showing no increased risk for overall venous thromboembolism (VTE) after COVID-19 vaccination, lingering concern remains among some patients and physicians. This may be due to large observational studies that have shown higher rates of VTE after COVID-19 vaccination compared to influenza vaccinations. Methods: The aim of this study was to compare VTE rates after COVID-19 and influenza vaccinations in a large cohort in the United States with robust multivariable adjustment of comorbidities to exclude residual confounding. Adult COVID-19 vaccinated (Pfizer, Moderna, or Janssen) patients between 11/1/2020 and 11/1/2021 and influenza vaccinated patients between 7/1/2019 and 4/1/2020 were analyzed using electronic medical records. The primary outcome was imaging confirmed acute VTE (upper or lower extremity deep vein thrombosis or pulmonary embolism) occurring within 90-days after the vaccination. Results: A total of 1,146,024 vaccinations were identified with influenza (N=354,015) or COVID-19 vaccines (n=792,009: Pfizer, n= 452,950, Moderna, n= 290,606, and Janssen (Johnson & Johnson), n= 48,453). The mean age of patients with COVID-19 and influenza vaccinations was numerically similar (56.8 vs 57.0). Most vaccinated patients were female (56.1%), and most were white (88.6%). Small, but statistically significant differences were found in nearly all baseline comorbidities between the two types of vaccines (Table 1). Mean Charlson comorbidity scores were higher in influenza vaccinated patients compared to COVID-19 vaccinated patients (1.53 vs 1.34, p<0.001). In the 90 days after vaccination, a total of 443 VTE events occurred after influenza vaccination and 793 occurred after COVID-19 vaccination (0.13% vs 0.10%, p<0.001). The unadjusted hazard ratio (HR) demonstrated a higher risk of VTE after influenza vaccination when compared to COVID-19 vaccinations (HR 1.22, 95% CI 1.08-1.37). The time to first VTE by type of vaccine is shown in the Figure. After multivariable adjustment (all significant comorbidity differences in Table) there was no statistically significant difference in VTE rates between the COVID-19 and influenza vaccines (aHR 0.97, 95% CI 0.83-1.13). Conclusion: In this large cohort of COVID-19 vaccinated patients in the United States, the risk of VTE after vaccination after accounting for differences in comorbidities was no different than a pre-COVID-19 historical cohort of influenza vaccinated patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Successful treatment of an adolescent patient with acute subclavian vein occlusion using the Cleaner thrombectomy device

Paget-Schroetter Syndrome is a rare condition characterized by the thrombosis of the axillary and/or subclavian vein due to repetitive activity of the upper extremity. This effect results in exertion-induced deep venous thrombosis (DVT) of the upper extremity. In the literature, it has been reported more frequently among the adult population. We aimed to introduce a 15-year-old female patient who suffered an acute DVT of the left upper extremity, and her successful treatment using the Cleaner thrombectomy device.

8400 Distal Ureteral Resection with Ureteroneocystotomy; A Case of Robotic Assisted Laparoscopic Management of Ureteral Endometriosis

<h3>Study Objective</h3> Video presentation showing distal ureterectomy and reimplantation. <h3>Design</h3> Case presentation with showing procedural techniques in detail. <h3>Setting</h3> Tertiary academic teaching hospital. <h3>Patients or Participants</h3> 39-y.o. G6P3033 with past medical history of upper extremity deep venous thrombosis and surgical history of tubal ligation as well as endometrial ablation for menorrhagia, presented to the emergency room with right lower quadrant pain and was found to have right hydronephrosis and a 1.6 cm right ureterovesical junction mass on CT scan. She underwent a cystoscopy and right ureteric balloon dilation with stent placement with no evidence of bladder endometriosis. MRI showed a 1.6cm nodule at a low-intensity signal in T2-weighted sequences, suspicious for ureteral endometriosis. <h3>Interventions</h3> She underwent diagnostic laparoscopy with total hysterectomy and bilateral salpingectomy, robotic assisted distal ureterectomy with ureteroneocytotomy and stent placement. Her anticoagulation was held 48h prior to the surgery and re-initiated the day after her surgery. <h3>Measurements and Main Results</h3> The stent was discounted at 8 weeks post-operative. At 12 weeks post-operative she had an ultrasound done with normal fin dings and resolved hydronephrosis. <h3>Conclusion</h3> Preoperative planning and multidisciplinary team approach to management of severe endometriosis affecting the ureter is of paramount importance. While medical management is often the first-line therapy for endometriosis, urinary tract involvement often represents advanced stage of the disease, thereby timely diagnosis and appropriate surgical intervention is required to avoid permanent kidney injury.

Axillary vein thrombosis 30 h after caesarean section: a case report and literature review

BackgroundAxillary vein thrombosis is a very rare disorder. However, a case of axillary vein thrombosis shortly after caesarean section has not been reported previously. We report a case of axillary vein thrombosis 30 h after caesarean section due to an unidentified aetiology.CaseA 37-year-old multiparous woman developed swelling and pain of the forearm and hand 30 h after undergoing a caesarean section. Doppler ultrasonography revealed a 14.9 mm × 5.3 mm thrombosis in the left axillary vein although a prophylaxis of anticoagulation was administrated. After an adjusted-dose of low-molecular-weight heparin (LMWH) was administered, the patient recovered and was discharged.ConclusionObstetricians should be fully aware of the possibility of upper extremity deep vein thrombosis (DVT) despite its rarity, especially after the surgery. Lying in the lateral decubitus position for long periods postoperatively should be avoided as much as possible.

THE CLOT THICKENS: THE CASE OF A YOUNG MALE WITH RECURRENT PULMONARY EMBOLISMS

THE CLOT THICKENS: THE CASE OF A YOUNG MALE WITH RECURRENT PULMONARY EMBOLISMS

PAGET-SCHROETTER SYNDROME: "EFFORT THROMBOSIS” DISCOVERED AFTER AIR TRAVEL

PAGET-SCHROETTER SYNDROME: "EFFORT THROMBOSIS” DISCOVERED AFTER AIR TRAVEL

WORK HARD OR SMART? A CASE OF EFFORT-RELATED SUBCLAVIAN THROMBOSIS

WORK HARD OR SMART? A CASE OF EFFORT-RELATED SUBCLAVIAN THROMBOSIS

Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies.

Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.

A narrative review of the surgical management of Paget-Schroetter syndrome: case series and long-term follow-up.

Paget-Schroetter syndrome (PSS) is an uncommon disorder which causes thrombosis of the subclavian vein (SV). This is due to compression of the SV by the surrounding anatomical structures. The optimal management of PSS remains subject to debate, with endovascular intervention and open surgical decompression being favoured current options. This review article evaluates both approaches to the management of PSS, while also presenting a case series with long-term follow-up of patients that underwent open surgical intervention for PSS. The clinical outcomes of PSS patients undergoing different 4 surgical approaches to perform surgical decompression are included. A literature review, across publications from PubMed, Embase, and Web of Science, was conducted with specific criteria to facilitate evaluation of both open surgical and endovascular approaches to the management of PSS. Evaluation of data from the included case series and available literature suggests that endovascular thrombolytic devices offer better clinical results, however, SV decompression is still required for successful resolution. An approach to PSS encompassing endovascular intervention followed by surgical anatomical decompression may provide optimal outcomes as both intrinsic lesions and extrinsic compression of the SV is treated. However, further prospective investigation into this field is warranted.

Upper-Extremity Deep Venous Thrombosis after Whole Blood Donation—A Case Report

AbstractUpper-extremity deep venous thrombosis (UEDVT) after whole blood donation is rarely reported. Blood donation has a low rate of complications and is typically safe. A small percentage of blood donors experience donation-related events such as UEDVT, which are extremely rare. We are reporting a rare case of a UEDVT following blood donation. This is an extremely rare event; only five cases were reported to our knowledge. A 22-year-old Caucasian woman with a past medical history of provoked pulmonary embolism completed 6 months of apixaban and negative thrombophilia workup presented to the hospital with complaints of progressive pain and swelling in her right arm. The patient reports donating blood using her right arm in January 2021. Phlebotomy duration for blood donation was approximately 10minutes. She reported pain and swelling several days after blood donation. Subsequently, a duplex ultrasound showed a thrombus in the right brachial vein. The patient was started on apixaban for 6 months. Although most whole blood donors do not experience complications, DVT is a rare complication from whole blood donation with severe consequences. It should be considered in a donor with worsening pain and swelling.

Long-Term Outcomes of Nonoperative and Surgical Management of Paget-Schroetter Syndrome

Purpose: In Paget-Schroetter Syndrome (PSS), subclavian vein thrombosis is caused by external compression of the subclavian vein at the costoclavicular junction. Paget-Schroetter Syndrome can be treated nonoperatively, surgically, or with a combination of treatments. Nonoperative management consists, in most cases, of anticoagulation (AC) or catheter-directed thrombolysis (CDT). With surgical management, decompression of the subclavian vein is performed by resection of the first rib. No prospective randomized trials are available to determine whether nonoperative or surgical management is superior. We report our long-term outcomes of both nonoperative and surgically treated patients. Materials and Methods: We retrospectively analyzed all patients with PSS who were treated between January 1990 and December 2015. Patients were divided based on primary nonoperative or primary surgical therapy. Long-term outcomes regarding functional outcomes were assessed by questionnaires using the “Disability of the Arm, Shoulder, and Hand” (DASH) questionnaire, a modified Villalta score, and a disease-specific question regarding lifestyle changes. Results: In total, 91 patients (95 limbs) were included. Seventy patients (73 limbs) were treated nonoperatively and 21 patients (22 limbs) surgically. Questionnaires were returned by 67 patients (70 limbs). The mean follow-up was 184 months (range, 43–459 months). All functional outcomes were better in the surgical group compared with the nonoperatively treated group (DASH general 3.11 vs 9.86; DASH work 0.35 vs 11.47; DASH sport 5.85 vs 17.98, and modified Villalta score 1.11 vs 3.20 points). Surgically treated patients were more likely to be able to continue their original lifestyle and sports activities (84% vs 40%, p=0.005). Patients with recurrence of thrombosis or the need for surgical intervention after primary nonoperative management reported worse functional outcomes. Conclusion: Surgical management of PSS with immediate CDT followed by first rib resection leads to excellent functional outcomes with low risk of complications. The results of nonoperative management in our non-matched retrospective comparative series were satisfactory, but resulted in worse functional outcomes and more patients needing to adjust their lifestyle compared with surgically treated patients. Clinical Impact Patients with Paget-Schroetter Syndrome and their attending physicians are burdened by the lack of evidence concerning the optimal treatment of this entity. Case series comparing the outcomes of non-operative treatment with surgical treatment are scarce and often not focussed on functional outcomes. Data from this series can aid in the shared decision making after diagnosis of Paget-Schroetter Syndrome. Functional outcomes of non-operative management can be satisfying although high demand patient who are not willing to alter their daily activities are probably better off with surgical management.

Paget-Schroetter Syndrome in Nonathletic 31-Year-Old Female Without Hypercoagulopathy

Paget-Schroetter syndrome is an infrequent event in which an upper-extremity thrombosis forms typically after strenuous overhead activities, such as weight-lifting, swimming, pitching, and wrestling. This occurs most frequently in athletic men in their second or third decade of life and may be associated with thoracic outlet anatomical abnormalities that result in venous compression and increased risk for repetitive microtrauma leading to thrombosis. An atypical presentation in a 31-year-old nonathletic woman information technology worker without hypercoagulability is presented here.

Single insult origin of Paget-Schroetter syndrome in adolescent successfully treated with balloon angioplasty and AngioJet thrombectomy system

Single insult origin of Paget-Schroetter syndrome in adolescent successfully treated with balloon angioplasty and AngioJet thrombectomy system

UNPROVOKED UPPER EXTREMITY DEEP VEIN THROMBOSIS IN PATIENT WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT

Upper extremity deep vein thrombosis is less common than in the lower extremity site. Such conditions can appear primarily or secondary to other conditions such as thrombophilia. One of the unique forms of acquired autoimmune thrombophilia is antiphospholipid syndrome (APS). We describe a 25 years old female admitted with sudden swelling, redness, and pain in her left arm. Venous ultrasound confirmed the diagnosis of thrombosis in the left subclavian vein, left axillary vein, left proximal brachial vein, and left proximal basilic vein. The patient was known to have a spontaneous miscarriage in the second pregnancy at eight weeks of gestation. Screening for autoimmune and antibody phospholipid was done, and primary APS was confirmed. She has been treated with a subcutaneous injection of fondaparinux 2.5 mg for five days and oral rivaroxaban 15 mg twice daily for 21 days. But four months later, the patient came with a thrombus in the subclavian vein due to inadequate treatment, then long-term treatment with vitamin K antagonist warfarin proceeded.

Idiopathic upper extremity deep vein thrombosis: A systematic review.

Idiopathic upper extremity deep vein thrombosis (UEDVT) management is controversial and ranges from anticoagulation alone to the addition of further interventions such as thrombolysis and decompressive surgery. The objective of this systematic review was to assess the effects of anticoagulation alone compared to anticoagulation with additional interventions such as thrombolysis or decompressive surgery on the incidence of recurrent UEDVT and post-thrombotic syndrome (PTS) in patients with idiopathic UEDVT (including those associated with the oral contraceptive pill). A systematic search was conducted for studies which focused on acute UEDVT treatment defined as therapies starting within 4 weeks of symptom onset. We limited studies to those that recruited 10 or more subjects and involved at least 6 weeks to 12 months anticoagulation alone or together with additional interventions with at least 6-month follow-up. Primary outcomes were symptomatic recurrent radiologically confirmed UEDVT and PTS. Secondary outcomes were symptomatic venous thromboembolism, bleeding and mortality. We found seven studies which reported recurrent UEDVT rates and five that reported PTS rates. All studies were retrospective or cross-sectional. None compared anticoagulation alone to anticoagulation with additional intervention. Study heterogeneity precluded meta-analysis and risk of bias was moderate to serious. Recurrent UEDVT occurred in 0% to 12% post-anticoagulation alone and 0% to 23% post-additional interventions. PTS rates varied from 4% to 32% without severe PTS. Only limited studies reported on our secondary outcomes. There is limited evidence behind idiopathic UEDVT management. Prospective comparative studies in this area are essential.

A Case of Cancer Associated Upper Extremity Deep Vein Thrombosis with A Paget-Schroetter Syndrome-like Presentation

A Case of Cancer Associated Upper Extremity Deep Vein Thrombosis with A Paget-Schroetter Syndrome-like Presentation

EP-567 Stress Thrombosis - A case of spontaneous DVT of upper extremity

BackgroundPrimary spontaneous upper extremity deep vein thrombosis is rare with an estimated annual incidence of 1 to 2 cases per 100,000 population. The majority of cases are secondary and related to central venous cannulation (eg, central line, pacemaker) or prothrombotic states. On the offset of COVID-19 pandemic such cases could become a common entity.Case ReportAn elderly diabetic and hypertensive female patient presented with a history of acute onset swelling, heaviness, tingling and numbness of left upper limb since 1 week. Examination revealed, diffuse swelling of left upper limb extending to neck with small dilated veins in left upper chest. A provisional diagnosis of left upper limb DVT was made based on Constants criteria and was confirmed on Duplex scanning.The patient was started on LMWH for anticoagulation. Evaluation for occult cancers was unremarkable. Patient showed symptomatic improvement and recanalisation of thrombosed veins was noted on repeat duplex scan.ConclusionUpper extremity DVT (UEDVT), once a rare entity, can be seldom thought of, due to widespread interventions and ongoing COVID-19 pandemic. Focus on evaluation of occult malignancy rather for hypercoagulable states which do not change the management. This case report highlights the importance of early recognition of UEDVT and stresses on the evidence that no added benefit is achieved by performing expensive tests to rule out prothrombotic states. Early diagnosis based on Constants criteria and anticoagulation would save time and prevent grave complications.

Efficacy and safety of sonographer discretion to terminate a venous duplex ultrasound for diagnosis of deep vein thrombosis in coronavirus disease 2019 patients

ObjectiveSonographers performing venous duplex ultrasound (VDUS) of patients with coronavirus disease 2019 (COVID-19) have an increased risk of exposure owing to their close contact with these patients for an extended period. The objective of the present study was to evaluate the efficacy of a modified COVID-19 VDUS protocol to reduce sonographer exposure to COVID-19 patients. MethodsWe performed a single-center retrospective review. Patients who had undergone VDUS under the modified COVID-19 protocol between March 1, 2020, and June 30, 2020, with a confirmed or presumed COVID-19 diagnosis at the VDUS were included. The modified COVID-19 protocol was defined as the ability of the sonographer to terminate the examination on detection of an acute deep vein thrombosis (DVT). The primary outcome measures were the number of anatomic deep venous segments recorded by the sonographer, which was used as a surrogate measure for sonographer exposure time, and the number of acute DVTs found on follow-up examinations in segments not visualized at the index VDUS. ResultsA total of 160 lower extremity VDUS (LEVDUS) scans and 72 upper extremity VDUS (UEVDUS) scans were performed using the modified COVID-19 protocol. The index VDUS had found an acute DVT for 44 of 160 patients (27.5%) who had undergone LEVDUS and 26 of 72 (36.6%) who had undergone UEVDUS. On follow-up imaging, 7 of 38 LEVDUS scans (17.9%) and 1 of 10 UEVDUS scans (10%) had demonstrated a new acute DVT. Malignancy and surgery 30 days before imaging were significantly associated with acute lower extremity DVT, and mechanical ventilation and extracorporeal membrane oxygenation were associated with acute upper extremity DVT. On the index VDUS, the average was 10.6 of 12 total visualized segments on LEVDUS and 6.4 of 10 total segments on UEVDUS. Of the index VDUS scans, 35.6% of the LEVDUS and 78.6% of the UEVDUS scans had been abbreviated. The index VDUS scans that were positive for acute DVT had had significantly fewer visualized segments for both lower (8.4 vs 11.5; P < .0001) and upper (4.2 vs 7.6) extremities (P < .0001). On the follow-up examinations, only one of eight new acute DVTs had been found in a patient whose index VDUS had been abbreviated and the corresponding segment not assessed. These findings did not affect the patient’s clinical course. ConclusionsThe modified COVID-19 VDUS protocol reduced sonographers’ potential exposure time to COVID-19. Additionally, the clinical efficacy was maintained, with no missed DVTs, despite the abbreviation of the VDUS examinations.