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Outpatient venography can be performed safely

Key clinical point: Office-based iliac venography and stent placement may replace the need to perform these procedures in the hospital.

Major finding: Outpatient venography had the same therapeutic results and carried no greater risk as the same procedure done in an inpatient setting.

Data source: 245 patients who had undergone venography for the correction of suspected iliac vein stenosis in an office-based setting.

Disclosures: The researchers reported having no financial disclosures.

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Efficacy studies needed

There are more than 500 office-based labs. Complicated endovascular procedures are performed in this setting with results comparable or better than hospital-based procedures with extremely high patient satisfaction. Experience with complicated venous procedures in the office has been limited because there is no reimbursement for use of intravascular ultrasound (IVUS) in the office. This may change in January as the Centers for Medicare & Medicaid Services may start reimbursing the use of IVUS in office. IVUS is an important element in endovascular management of venous obstruction.

Researchers from Brooklyn, N.Y., performed 285 venous angioplasties and stent placements in an office setting. There was a 2% incidence of thrombosis that occurred in patients with a previous history of deep venous thrombosis. This subset of patients would naturally be at a higher risk for thrombosis. There was one bleeding complication after 30 days, which was successfully managed by nonoperative means. The complication rate was comparable to the procedures done in the hospital setting. One would expect similar complication rates when the same operator is doing the procedure at two different sites. However, the indications for these procedures are not well defined in the literature and there are very few studies showing long-term results. Accordingly, there is a real need for a prospective randomized study to determine the indications and efficacy of these procedures.

Dr. Krishna Jain is clinical associate professor of surgery, Western Michigan University School of Medicine, Kalamazoo. He is an associate medical editor of Vascular Specialist.


 

FROM THE JOURNAL OF VASCULAR SURGERY: VENOUS AND LYMPHATIC DISORDERS

References

Venoplasties and stenting carried out in an office-based setting have the same therapeutic results and carry no greater risk as the same procedure done in an inpatient setting, researchers reported.

Dr. Arkady Ganelin and researchers from the Total Vascular Center in Brooklyn, N.Y. evaluated 245 patients who had undergone venography for the correction of suspected iliac vein stenosis at their office-based center. Overall, 90 women and 47 men underwent unilateral intervention and 23 women and 14 men underwent bilateral intervention.

There was a low incidence of complications such as thrombosis (2%), a figure that was similar to an inpatient setting, the researchers reported (J Vasc Surg: Venous and Lym Dis. 2015 doi: 10.1016/j.jvsv.2015.03.007).

One patient had a retroperitoneal hematoma, which occurred more than 30 days after the procedure. The average pain score was 2 out of 10 on the Likert scale.

“Our initial experience with conducting office-based procedures that were formerly only inpatient procedures has demonstrated that an office-based procedure can be safely performed with minimal complications,” the study authors wrote.

The financial burden of U.S. health care has been continuously increasing and the shift of endovascular procedures from the hospital to an office-based setting is the natural next step, they said.

If the results are sustained over the long term, office-based iliac venography and stent placement may replace the need of performing these procedures in the hospital, they concluded.

This conclusion, however, poses the question of which option would be chosen by a patient, they added.

The researchers reported having no financial disclosures.

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