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Vascular Surgeons’ Management of Venous Disease in Canada: Results of a National Survey
Douglas Wooster, MD, FRCSC, FACS, RPVI1, Elisa F. Greco, MD, Vascular Resident1, Sidney Wong, MD, Vascular Resident1, Elizabeth Wooster, M.Ed., PhD Candidate2.
1Department of Surgery, University of Toronto, Toronto, ON, Canada, 2Leadership, Higher and Adult Education, OISE/University of Toronto, Toronto, ON, Canada.
OBJECTIVES:
Venous disease is the most common vascular issue encountered in the community. Vascular surgeons’ (VS) involvement in venous management varies across Canada, but it can represent a large component of practice. Trainee involvement in the management of venous disease is often limited. With the publication of venous guidelines, interest in venous management from generalists and other specialists, advances in endovenous interventions, and changes in payor (government) policies, the role of VS in the management of venous disease needs attention. We sought to obtain an overview of practice patterns and attitudes towards venous disease management by VS in Canada.
METHODS:
A detailed electronic survey was developed similar to published surveys from other countries and sent to practicing VS in Canada. The data was collated and compared to reports from elsewhere to develop a comparative management map for VS management of venous disease.
RESULTS:
82% of respondents were in general vascular practice, while 9% confined their practice to a venous clinic. Venous disease represented between 1 and 25% of practice for 73% of VS. The indications for consultation most commonly seen were: venous ulcer (100%), SVT (82%), and leg swelling (82%). Most (55%) noted an increase in referrals over the last 5 years.
82% of VS state they follow CHEST guidelines for venous disease management; however, they treat SVT with Duplex and selective treatment (64%) or symptomatically (36%). VS believe that primary care physicians (80%) and other specialists (33%) do not understand venous disease well.
Specific training in venous issues was poorly represented in residency training, with poor exposure to support stocking use (60%), sclerotherapy (30%), EV ablation (20%), and IVC filters (11%). Venous-oriented continuing medical education (CME) represents at component of CME for 67% of VS.
CONCLUSIONS:
Despite limited venous training during residency, a large proportion of Canadian VS are involved in venous practice. Most VS state that they incorporate guidelines into their practice. Venous-oriented CME is pursued by most VS in Canada. More detailed data is required to allow comparison to venous practice in other countries and to more fully understand training priorities.
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