Oral Abstract

Abstracts

Session: Oral Abstracts - "Abstracts on the Bayou…not your ‘Bread and Butter’ VLM: but could it be?"

Ambulatory Phlebectomy Mobile App in the Treatment of Superficial Venous Disease

Thursday, October 13, 2022

4:41 PM – 4:54 PM US CDT

Location: Celestin D/E (Live Stream)

Presenting Author(s)

John Blebea, MD, MBA

Clinical Professor of Surgery
Central Michigan University
Central Michigan University
Saginaw, MI

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KH

Kenneth Harper, MD, FACS, RPhS

Medical Director
Vein Specialists of the South
Mercer University School of Medicine
Macon, Georgia

Disclosure: Medtronic (Self) : Independent Contractor (Products and Services: Ultrasound Education), Ultrasound Course (Products and Services: Ultrasound Education)
PM

Paul McNeil

Disclosure: Disclosure information not submitted.
James D. Albert, MD RPVI FAVLS

President and Founder
Albert Vein Institute
Colorado Springs, Colorado

Disclosure: Disclosure information not submitted.
NS

Norma Smith

Disclosure: Disclosure information not submitted.
MM

Mark Meissner, MD

Research Fundamentals Speaker
University of Washington
University of Washington School of Medicine
Seattle, Washington

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Keith Moore, MD, DABVLM, RVT, RVSWCC, RPVI, RPhS, CLT-LANA

Practice Management Speaker
CVR Atlanta
Lawrenceville, Georgia

Disclosure: Disclosure information not submitted.
SC

Sandra Carr

Disclosure: Disclosure information not submitted.
Kathleen Gibson, MD, FACS, FAVLS

Program faculty
Lake Washington Vascular Surgeons
Bellevue, Washington

Disclosure: Boston Scientific (Self) : Consultant/Advisory Board (Products and Services: Varithena), Research Grant (Products and Services: Varithena); Gore (Self) : Consultant/Advisory Board (Products and Services: Stent), Research Grant (Products and Services: Stent); Jannsen (Self) : Speaker/Honoraria (Products and Services: Xarelto); Medtronic (Self) : Consultant/Advisory Board (Products and Services: Venaseal,VeClose,Abre stent), Research Grant (Products and Services: Venaseal,VeClose,Abre stent), Speaker/Honoraria (Products and Services: Venaseal,VeClose,Abre stent); Mercator (Self) : Research Grant (Products and Services: Balloon); PHILIPS (Self) : Speaker/Honoraria (Products and Services: IVUS); Vesper (Self) : Research Grant (Products and Services: venous stent)
TH

Todd Hanen

Disclosure: Disclosure information not submitted.
MS

Marlin W. Schul, MD, RVT, FAVLS, DABLM, DFAVF

Indiana University School of Medicine
Dorthan, Alabama

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction, Objectives, and/or Purpose: Introduction Ambulatory phlebectomy is an important component in the treatment of superficial venous disease. Prior reporting and payment have been based only on the number of phlebectomies rather than their location and correlation with underlying pathology. We developed a mobile cell phone application through which physicians recorded phlebectomy procedures.

Methods: The AVLS Phlebectomy Tracker app was developed and provided to physicians free of charge for reporting phlebectomy procedures. It included eight web pages describing the involved vein, number and location of phlebectomies, concomitant adjunctive procedures, and the time taken for completion. Data was analyzed in a manner blinded to provider and patient.

Results: During the 7 month period from December 2021 to July 2022, a total of 1,196 phlebectomy cases were performed by 27 physicians and details submitted via the app. The majority of patients were women (68%, 810/1,196) and the group had an average age of 57 + 14 years. The right leg was affected in 51% (607/1,196), the left in 48% (576/1,186) and bilaterally in 1% (13/1,196) of cases. The CEAP scores for the affected limb were: mean CEAP score for the affected limb was 2.5 + 0.8 with the distribution being: C6-6 (0.5%); C5-11 (0.9%); C4-129 (11%); C3-246 (20%); C2-815 (67%); and C1-1 (0.1%).

A total of 21,132 phlebectomy incisions were performed where all the sites were identified with the majority located below the knee (11,061; 52%) followed by the thigh (8,178; 39%), knee (1,708; 8%) and foot (185; 1%). The location of the excisional sites were further localized to 14 anatomic locations along the leg.They corresponded to the distribution of the great saphenous vein in 46%, small saphenous in 7%, anterior accessory saphenous vein in 7%, posterior accessory in 1% (44) and other tributaries in 40%.

The average time to perform the entire phlebectomy procedure was 67 + 40 minutes with a median time of 60 minutes but a wide range of 5 to 255 minutes. This reflected the wide variation in the number of incisions performed. The mean number of phlebectomy incisions or sites per patient was 34 + 25 and with a median of 27 but a range from 1 to 146 incisions. The average operative time per incision was 3.3 + 5.3 minutes with a median time of 2.0 minutes.

Conclusion(s):

Conclusions: A smart phone mobile app was developed that was effective in rapidly obtaining relevant clinical procedural data in a large number of patients. The results provide a detailed mapping of phlebectomy sites in 14 anatomic locations along the length of the leg. The large variation in both the number and time needed for performance of a phlebectomy procedure indicates great variability and suggests that reimbursement policies should be based on something other than merely the number of incisional sites.