Postdoctoral Research Fellow Division of Vascular Surgery, Penn State Heart and Vascular Institute Hershey, Pennsylvania, United States
Objective: The study was designed to assess the clinical and patient reported outcomes (PROs) of varicose vein management by ablation based on the length of the treated great saphenous vein.
Methods: Vascular Quality Initiative (VQI) varicose vein registry was utilized from 2014 to 2021. Patients with available long-term follow-up within a year and with C2 or more severe disease undergoing intervention for unilateral limb by thermal or laser ablation for great saphenous vein in calf, thigh or both were included. The patients were classified into three study groups based on the tertiles of length of the treated vein segment: Group I ( < 30 cm), Group II (≥30 to < 45cm) and Group III (≥45 cm). Clinical outcomes were studied by clinical, anatomical, etiology, and pathophysiology (CEAP) classification and venous clinical severity score (VCSS). PROs were examined by 7 metrics. Preprocedural and postprocedural comparisons were performed using one-way analysis of variance for continuous variables, and categorical variables were analyzed using Pearson’s chi-squared test.
Results: Total of 9,837 patients were studied. The average age of the selected patient population was 56 ±13 years with 3,223 (32.7%) males and 6,614 (67.2%) females, and 7,971 (81.03%) were Caucasian patients. C3 disease was most prevalent in all study groups (Group I: 45% vs Group II: 47% vs Group III: 42%). Group I had the best post-procedural CEAP improvement for C2 (61.5%) and C3 (53%) classes to C0-C1 class. Group III was found to have the highest failure of ≥C4 disease improvement (50% vs Group I: 45.6% vs Group II: 37.8%%, p < 0.001), instead an increase in progression of disease from preprocedural CEAP class was observed. Overall ≥C4 disease improvement peaked for Group II (44%) with marginal difference for Group I (34%) and III (35%). Group III was seen to have the least VCSS (3.98 vs Group I: 4.78 vs Group II: 4.56, p < 0.001) and PRO (8.41 vs Group I: 9.88 vs Group II: 9.29, p < 0.001) mean score improvements. Among the PROs, all were found to least improve for Group III, however, no difference between itching (p=0.792) and appearance (p=0.290) was observed among the groups.
Conclusions: The longer length of the treated great saphenous vein segment is associated with overall less improvement in clinical outcomes and PROs. Patients treated for lengthier vein segments should be followed up to ensure adequate disease regression and satisfactory patient outcomes.