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. 2023 Jul;11(4):774-782.e1.
doi: 10.1016/j.jvsv.2023.03.013. Epub 2023 Apr 6.

Patients with body mass index ≥25 kg/m2 as a target population for improvement of rate of follow-up duplex venous ultrasound examinations following initial incomplete examinations

Shirin Ferdosian  1 , Isabella Orellana  1 , Gabriel Nager  1 , Joshua Gruber  2 , Leon Wong  1 , Jie Y Zhang  1 , Gregory L Moneta  1 , Khanh P Nguyen  3
Affiliations

Patients with body mass index ≥25 kg/m2 as a target population for improvement of rate of follow-up duplex venous ultrasound examinations following initial incomplete examinations

Shirin Ferdosian et al. J Vasc Surg Venous Lymphat Disord. 2023 Jul.

Abstract

Objective: Obesity is highly prevalent and a major risk factor for deep vein thrombosis (DVT) and chronic venous disease. It can also technically limit duplex ultrasound evaluations for lower extremity DVT. We compared the rates and results of repeat lower extremity venous duplex ultrasound (LEVDUS) after an initial incomplete and negative (IIN) LEVDUS in overweight (body mass index [BMI] ≤25-30 kg/m2) and obese (BMI ≥30 kg/m2) patients with those of patients with a BMI <25 kg/m2 to evaluate whether increasing the rate of follow-up examinations in overweight and obese patients might facilitate improved patient care.

Methods: We performed a retrospective review of 617 patients with an IIN LEVDUS study from December 31, 2017 to December 31, 2020. Demographic and imaging data of the patients with an IIN LEVDUS and the frequency of repeat studies performed within 2 weeks were abstracted from the electronic medical records. The patients were divided into three BMI-based groups: normal (BMI <25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI ≥30 kg/m2).

Results: Of the 617 patients with an IIN LEVDUS, 213 (34.5%) were normal weight, 177 (29%) were overweight, and 227 (37%) were obese. The repeat LEVDUS rates were significantly different across the three weight groups (P < .001). After an IIN LEVDUS, the rate of repeat LEVDUS for the normal weight, overweight, and obese groups was 46% (98 of 213), 28% (50 of 227), and 32% (73 of 227), respectively. The overall rates of thrombosis (both DVT and superficial vein thrombosis) in the repeat LEVDUS examinations were not significantly different among the normal weight (14%), overweight (11%), and obese (18%) patients (P = .431).

Conclusions: Overweight and obese patients (BMI ≥25 kg/m2) received fewer follow-up examinations after an IIN LEVDUS. Follow-up LEVDUS examinations of overweight and obese patients after an IIN LEVDUS study have similar rates of venous thrombosis compared with normal weight patients. Targeting improving usage of follow-up LEVDUS studies for all patients, but especially for those who are overweight and obese, with an IIN LEVDUS through quality improvement efforts could help minimize missed diagnoses of venous thrombosis and improve the quality of patient care.

Keywords: Body mass index; Duplex ultrasound; Lower extremity; Obesity; Venous duplex; Venous thrombosis.

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Figures

Fig 1
Fig 1
Relationship between weight category (normal or underweight vs overweight) and repeat ultrasound (US) after adjusting for covariates. Odds ratios (ORs) were calculated from multivariable logistic regression, with the 95% confidence intervals (CIs). The 95% CI for age was too small to plot, and the difference was not statistically significant. BMI, Body mass index; ref, reference.
Fig 2
Fig 2
Proposed algorithm for incomplete and negative venous duplex ultrasound (US) examination (Exam). We would recommend that all patients with an incomplete and negative ultrasound receive repeat ultrasound examinations, regardless of risk factors.
Supplementary Fig (online only)
Supplementary Fig (online only)
Distribution of body mass indexes (BMIs) of patient cohort in our study. Dashed lines indicate threshold cutoffs for overweight (BMI >25-30 mg/k2) and obese (BMI ≥30 mg/kg2) groups.
See this image and copyright information in PMC

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