Correlation of Truncal Vein Diameter and Clinical Outcomes after Varicose Vein Procedures using the Vascular Quality Initiative Varicose Vein Registry
Dylan Mclaughlin, ScM1, Mitchell R. Weaver, MD1, Loay Kabbani, MD1, Nicole Kennedy, MD, MSE2, Judith C. Lin, MD, MBA1.
1Henry Ford Hospital, Detroit, MI, USA, 2Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA.
OBJECTIVE: Vein ablation for superficial venous reflux has been demonstrated as a successful treatment for patients suffering from chronic venous insufficiency and varicose veins. However, saphenous vein diameter is a poor surrogate marker for assessing its overall benefit and medical necessity for treatment. We investigate the significance of saphenous vein size on clinical disease severity and post-procedural outcomes for varicose vein patients undergoing treatment.
METHODS: We performed a retrospective analysis using the Vascular Quality Initiative Varicose Vein Registry (VQI VVR) of all vein ablation procedures from January 2015 to August 2017 at our tertiary care institution. The largest diameter of great saphenous vein (GSV) being treated was compared with cutoffs of <8mm vs >8mm. Comparison data included patient demographics, past medical history, clinical outcomes, patient reported outcomes, and postoperative complications. Clinical outcomes were assessed by the clinical, etiology, anatomy, and pathophysiology (CEAP) classification and the venous clinical severity score (VCSS). Patient reported outcomes were assessed by heaviness, achiness, swelling, throbbing, itching (HASTI) symptoms and their impact on work and activity.
RESULTS: Of the 777 total GSV procedures identified during the study period, 447 GSV’s were <8mm (Group A) and 330 GSV’s were ≥8mm (Group B). Larger GSV size was correlated with male sex (344 [77.0%], 213 [64.2%], p<0.001) and increased BMI (30.99±6.75 [standard deviation], 32.80±7.54, p<0.001). There was no difference in age, race, insurance, history of superficial phlebitis, history of deep venous thrombosis, history of prior varicose procedures, anticoagulant use, or procedure setting. VCSS (8.51±3.27, 9.38±3.51, p<0.001) and HASTI (17.51±10.59, 19.32±11.86, p=0.026) metrics were significantly increased in Group B compared to Group A. Systemic complications were rare and did not differ between groups.
CONCLUSIONS: Diameter of GSV is correlated with increased clinical severity by clinical and patient reported metrics. Patients with larger vein diameter and varicosities may benefit from long term follow up to assess for successful closure and possible recanalization.
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