Highlights
- •20% of patients with saphenous vein ablation (VA) had deep venous reflux (DVR).
- •Patients with DVR were more likely to develop endovenous heat-induced thrombosis (EHIT) II-III (26.3% vs. 3.6%).
- •Post-thrombotic DVR patients had more severe disease than those with primary DVR.
Background
Venous ablation (VA) of the saphenous vein is the most common procedure performed
for venous insufficiency. The incidence of concomitant deep venous reflux (DVR) in
patients undergoing VA is unknown. Our hypothesis is that patients undergoing saphenous
VA with concomitant DVR exhibit a higher clinical, etiology, anatomy, and pathophysiology
(CEAP) stage and less relief after VA compared to patients without DVR.
Methods
Electronic medical records of patients treated with saphenous VA at a tertiary care
center from March 2012 to June 2016 were reviewed. Patients were divided into 2 groups
based on presence or absence of DVR on initial ultrasound (US) before saphenous VA.
Patient characteristics and outcomes were compared. A telephone survey was conducted
to assess long-term symptomatic relief, compliance with compression, and pain medication
use. Subgroup analysis of patients with post-thrombotic versus primary DVR was performed.
Results
362 patients underwent 497 ablations, and the incidence of DVR (>1 sec) was 20% (N = 71). Patients with DVR were significantly more likely to be male (46.4% vs. 32.1%,
P = 0.021) and of Black race (21.2% vs. 5.5%, P = 0.0001) compared to patients without DVR. Patients with DVR were more likely to
have a history of deep vein thrombosis (DVT) (15.1% vs. 7.9%, P = 0.045), but there was no difference in other comorbidities. There was no significant
difference in presenting symptoms, CEAP stage, or symptom severity based on numeric
rating scale (NRS) (0-10) for pain and swelling. Clinical success of saphenous VA
was comparable between the 2 groups, but patients with DVR were more likely to develop
endovenous heat-induced thrombosis (EHIT) II-IV (6% vs. 1%, P = 0.002). After a mean follow-up of 26 months, there was still no difference in pain
or swelling scores, but patients with DVR were more likely to use compression stockings
and used them more frequently. Only 11 of 71 patients with DVR had a history of DVT.
Patients with post-thrombotic DVR were significantly older than patients with primary
DVR (67.3 vs. 57.2, P = 0.038) and exhibited a trend toward more advanced venous disease (C4-C6: 45.4%
vs. 33.3%, P = 0.439).
Conclusions
In this study, 20% of patients undergoing saphenous VA demonstrated DVR, which was
more common in Black men. Presence of DVR is associated with increased risk of EHIT
after saphenous VA but does not seem to impact disease severity or clinical relief
after ablation. Larger studies are needed to understand outcome differences between
post-thrombotic and primary DVR.
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Article info
Publication history
Published online: January 20, 2023
Accepted:
November 26,
2022
Received:
June 6,
2022
Footnotes
Presentation Information: This study was presented at the 34th American Venous Forum annual meeting, Orlando, Florida, February 23 - 26, 2022.
Identification
Copyright
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