Caring for patients with venous insufficiency during the COVID-19 pandemic at a tertiary care center

In December 2019, coronavirus disease 2019 (COVID-19) was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread and has resulted in a global pandemic.

With the current recommendations of social distancing and stay-at-home orders, the pandemic has significantly affected medical practice. Although most venous insufficiency cases will be considered elective, delaying care can result in complications such as deep vein thrombosis or stasis ulcer. Furthermore, it has been confirmed that early endovenous ablation of superficial venous reflux will result in faster wound healing.¹ Consequently, it is crucial to weigh the risk of delaying these cases to reduce viral transmission with the benefit of reducing venous disease-related complications. In accordance with state, federal, and medical society recommendations, our institution has instituted drastic practice changes. These involved rescheduling of all elective procedures, including venous cases, and postponing all venous insufficiency ultrasound studies. Patients with suspected venous stasis ulcers or deep vein thrombosis are allowed to undergo appropriate testing and, in some cases, to be seen in the clinic. All postponed office visits, vascular laboratory studies, and procedures have been recorded in a database to allow for rescheduling once the COVID-19–related restrictions have been lifted. In accordance with the recent modifications of the Health Insurance Portability and Accountability Act rules to accommodate the COVID-19–related healthcare changes,² we have instituted additional steps to accommodate nonurgent venous cases. First, patients are asked to e-mail us photographs showing their area of concern. Second, for a select group of patients with access to compatible social media services, we have allowed for video calls to providers. Third, we began incorporating secured video conference call services provided by EPIC, which has facilitated live evaluation of patients’ concerns. All nonurgent patients are treated conservatively with compression, elevation, and exercise. Since the peak in Minnesota is projected to be in July 2020, our leadership has asked proceduralists to review all rescheduled and pending cases and provide insight regarding their urgency.² Cases with venous insufficiency–related intractable stasis ulcers will be considered on a case-by-case basis.

During the first month of the COVID-19–related practice changes, 29 vein procedures were rescheduled and 15 new consultations were performed using telehealth methods. Four patients with stasis ulcers have been monitored for progression, three of whom have been approved for procedures. Although venous insufficiency is not an immediately limb-threatening disease, the COVID-19–related delay in care will certainly affect patients’ quality of life. We believe that our measures will help mitigate the effects of COVID-19 on the care of patients with venous disease.