The results of Endovenous Superficial Venous Ablation for Lower Extremity Swelling
William P. Shutze, Sr., MD1, Paul Dhot2, Ryan Shutze2, Gerald Ogola, Ph.D3, Dennis Gable, MD1.
1The Heart Hospital Baylor Plano, Plano, TX, USA, 2Baylor University Medical Center, Dallas, TX, USA, 3Baylor Scott and White Health, Dallas, TX, USA.
Patients with venous insufficiency and edema are classified as CEAP class 3 (C3). Endovenous ablation (EVA) for superficial venous reflux has not been evaluated for outcomes in C3 patients.
We identified C3 patients in our EVA database treated from 1/21/2015-3/19/2015 and surveyed them the amount of edema (currently and immediately post procedure), the use of compression stockings and current satisfaction with the procedure. Venous severity disease scores (VSDS) were calculated and statistical analysis evaluated risk factors for edema resolution (ER), compression stocking benefit (CSB) and patient satisfaction (PS).
There were 1634 limbs treated by EVA with or without adjunctive segmental varicose vein micro-phlebectomy with 528 limbs being C3. 92 patients (Table 1) accounting for 130 ablations in 128 limb with a VSDS average of 2.7 (range: 1-5.5) responded to the survey (Table 2). At the time of the survey 97 limbs (75.8%) had reduced or resolved swelling, 29 limbs (22.6%) were unchanged and 2 limbs (1.6%) had increased swelling.
Multivariate analysis of age, gender, BMI, diuretic use (DU), micro-phlebectomy and VSDS revealed that VSDS and DU were associated with an increased amount of preoperative edema (p<.01) and patients having MP had less preoperative edema. Microphlebectomy was the only predictive factor for ER (immediate (p=.02) and delayed (p=.01)). Higher VSDS (p=.01) and DU (p=.03) had negative impact on CSB. Micro-phlebectomy predicted high PS with ER (p=.01). Age, gender and BMI had no effect on ER, CSB, or PS.
Venous ablation for edema secondary to superficial venous insufficiency is effective and durable with high PS. Micro-phlebectomy during EVA improves ER and PS. Higher VSDS is predictive of increased preoperative edema but not ER or PS. Age, gender and BMI are not predictive of ER or PS. Overall PS is very high and most patients endorsed the procedure as effective and would undergo EVA again. Further investigation remains to be done regarding risk factors for immediate failure and delayed recurrence of edema.
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