VCSS Has A Reasonable Ability To Detect Improvement After Venous Interventions Across 5 Years Of Follow-up
Halbert Bai, MPH, Jason B. Storch, BA, Jenny Chen, BA, Adriana Pero, BA, Jay Sanghvi, MS, Keva Li, BA, Nithya Krishnamurthy, BA, Anna B. Williams, Windsor Ting, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
OBJECTIVES: Venous Clinical Severity Score (VCSS) is the standard tool for evaluating treatment efficacy and outcomes of patients with chronic venous disease. Yet, there has been no study that has studied the precision of VCSS in capturing clinical improvement in the long term. This study sought to investigate how well VCSS performs in capturing patient improvement across five years of follow-up in a large clinical registry. METHODS: 433 patients who underwent iliofemoral vein stenting for chronic proximal venous outflow obstruction (PVOO) followed for at least 1-year after the index procedure from August 2011 to June 2021 were retrospectively analyzed. Change in VCSS and clinical assessment scores (CAS) were used to quantify improvement after venous interventions. CAS compares the patient outcomes to before the index procedure longitudinally across their treatment course. Patients are rated worse (-1), no change (0), mildly improved (+1), significantly improved (+2), asymptomatic (+3) at every follow-up visit as compared to their disease severity at initial presentation. This study defined improvement as CAS > 0 and no improvement as CAS ≤ 0. VCSS was then compared to CAS. Receiver operative characteristic (ROC) curve and area under the curve (AUC) were used to evaluate VCSS for its ability to discriminate between improvement and no improvement after intervention at each year of follow-up. RESULTS: At 1-year, change in VCSS was able to detect clinical improvement at a sensitivity of 74.9% and specificity of 70.0% (AUC=0.764). At 2-years, VCSS change had a sensitivity of 70.7% and specificity of 66.7% (AUC=0.753). At 3-years follow-up, VCSS change had a sensitivity of 76.2% and specificity of 58.1% (AUC=0.715). At 4-years, VCSS change had a sensitivity of 57.7% and specificity of 87.5% (AUC=0.782). At 5-years, VCSS change had a sensitivity of 71.4% and specificity of 61.5% (AUC=0.704). CONCLUSIONS: Change in VCSS shows a reasonable ability to detect improvement after venous interventions across years of follow-up. 
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