Few studies have investigated outcomes following truncal endovenous ablation in patients with combined deep and superficial reflux and no studies have evaluated patient-reported outcomes.
We investigated short and long-term clinical and patient reported outcomes (PROs) among patients with and without deep venous reflux undergoing truncal endovenous ablation from 2015-2019 in the Vascular Quality Initiative. Pre-procedural and post-procedural comparisons were performed using t-test, χ, or their non-parametric counterpart when appropriate. Multivariable logistic regression models were used to assess for confounding.
A total of 4881 patients were included, of which 2254 (46.2%) had combined deep and superficial reflux. Median follow up was 336.5 days. Patients with deep reflux were less likely to be female (65.9% vs 69.9%, p=.003), more likely to be Caucasian (90.2% vs 86.5%, p=0.003) and had no difference in BMI (30.6±7.5 vs 30.6±7.2, p=0.904). Additionally, no difference was seen in rates of prior varicose vein treatments, number of pregnancies, or history of DVT however patients without deep reflux were more likely to be on anticoagulation at the time of the procedure (10.9% vs 8.1%, p<0.001). Patients without deep reflux had slightly higher median pre-procedural VCSS scores (8 (IQR 6-10) vs 7 (IQR 6-10), p=0.005) as well as post-procedural VCSS scores (5 (IQR 3-7) vs 4 (IQR 2-6), p<0.001). Median change in VCSS from pre- to post-procedure was lower for patients without deep reflux (3 (IQR 1-5.5) vs 3.5 (IQR 1-6), p=0.006). Total symptom score was higher for patients without deep reflux both pre (median 14, IQR 10-19, vs median 13.5, IQR 9.5-18, p=0.005) and post-procedurally (median 4, IQR 1-9, vs median 3.25, IQR 1-7, p<0.001) but no difference was seen in change in symptom score (median 8, IQR 4-13, vs median 9, IQR 4-13, p=0.172). Patients with deep reflux had substantially higher rates of complications (10.4% vs 3.0%, p<0.001) with a particular increase in proximal thrombus extension (3.1% vs 1.1%, p<0.001). After controlling for confounding, this estimate of effect size for any complication increased (OR 5.72, 95% CI 2.21-14.81, p<0.001).
No significant difference is seen in total symptom improvement when patients undergo truncal endovenous ablation with concomitant deep venous reflux, although a larger improvement was seen in VCSS score in these patients. Patients with deep venous reflux had a significantly increased rate of complications independent of confounding variables and should be counseled appropriately prior to the decision for treatment.
Copyright © 2020. Published by Elsevier Inc.