The Impact of Endovenous Ablation Assessment Based on Great Saphenous Vein Size, Gender, Clinical Severity, and Patient Reported Outcomes

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J Vasc Surg Venous Lymphat Disord


OBJECTIVE: Policies of insurance carriers have used truncal vein size as a criteria for coverage. The objective of this study was to compare the effect of great saphenous vein (GSV) size > 5 mm versus < 5 mm on patient presentation and clinical outcomes.

METHODS: Patients in a national cohort were prospectively captured in the Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR). From January 2015 to October 2017, the VQI VVR database was queried for all patients undergoing varicose vein procedures. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Venous Clinical Severity Score (VCSS), and patient-reported outcomes (PROs) were compared between GSV size < 5 mm (group 1) versus size > 5 mm (group 2) before and after the procedures. Two-sample Wilcoxon test was performed to assess the difference between the two groups as defined by GSV size. To assess for improvement after procedure in this population, a matched-pairs signed-rank Wilcoxon test was performed for each group separately.

RESULTS: During the study period, 5757 vein ablation procedures were performed for GSV: 770 GSV size < 5 mm and 4987 size > 5 mm. Group 1 were more likely female (81.7% vs 68.4%, P=0.001) and older age (56.8 years vs 55.6 years, P=0.012). CEAP clinical classes were more advanced in group 2 compared to group 1 (P=0.001). Maximal GSV diameter in group 2 was significantly higher (8.32 mm vs 3.86 mm, P=0.001). 64% of group 2 underwent RF thermal ablation compared to 59.2% of group 1 (P=0.001). There were no mortalities in either group. Group 2 had more complications post-procedure (0.6% vs 0%, P=0.027), required post-operative anticoagulation (8.8% vs 5%, P=0.001), developed partial recanalization rate (0.8% vs 0.3%, P=0.001), and missed more work days (2.32 days vs 1.6 days) as compared to group 1. Similar rate of hematoma developed in both groups, but a higher rate of paresthesia in group 1. Both groups had improvement in their VCSS and HASTI scores. The degree of symptomatic improvement between the groups was similar.

CONCLUSIONS: All patients demonstrate improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation regardless of size. Patients with preoperative GSV size > 5 mm have similar improvement in their symptomatology but sustain an increased complication rate. Patients with smaller vein size should not be denied intervention or coverage based on size criteria.

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ePub ahead of print