Clinical and hemodynamic outcome of morbidly obese patients with severe chronic venous insufficiency with and without bariatric surgery

Abstract

ObjectiveObesity is associated with several medical problems, including chronic venous insufficiency resistant to usual conservative measures. Venous intervention in patients with a body mass index (BMI) >30 kg/m2 is associated with a higher anesthetic risk and recurrence rate. The aim of the present study was to compare the severity of venous insufficiency in terms of the clinical findings and hemodynamics between morbidly obese patients who had and had not undergone bariatric surgery (BS). MethodsA total of 123 patients with morbid obesity and severe venous manifestations were included in the present study. The patients were divided into two groups. Group A included 72 patients who had undergone BS, and group B included 51 patients who had not undergone BS. Assessments were performed using both disease-specific and physician-generated tools and duplex ultrasonography. ResultsOf the 123 patients, 66% were men. The mean patient age was 44 ± 8.2 years. All the patients were followed up for 1 year. The mean BMI for group A had decreased from 50.1 ± 5.6 kg/m2 to 32.9 ± 4.2 kg/m2 (P = .0001). However, the mean BMI for group B had increased from 49.2 ± 6.1 kg/m2 to 50 ± 5.7 kg/m2 (P = .16). For the patients with a history of venous ulcer, the Charing Cross Venous Ulceration Questionnaire score for group A had decreased 77.5 to 36.8 (P = .0001) compared with a decrease in group B from 77.34 to 75.36 (P = .13). In group A, the median Venous Disability Score had improved from 2 to 0 and the median Venous Clinical Severity Score from 8.6 to 2.1 compared with nonsignificant changes in group B. The number of patients with venous claudication had decreased from 8 to 2 (P = .036) in group A compared with no changes in group B. For group A, the mean 36-item short-form heath survey score had increased from 48 ± 6.8 to 81 ± 4.4 (P = .001) compared with an increase from 52 ± 8.8 to 59 ± 1.2 (P = .52) in group B. The mean common femoral vein diameter had decreased significantly in group A (7.3 ± 1.3 mm) compared with that in group B (8.93 ± 1.08; P = .0001). The peak venous velocity showed higher values for the patients who had undergone BS (group A, 14.9 ± 2.5 cm/s; group B, 10.75 ± 2.05 cm/s; P = .0001). Higher mean velocities and a lower diameter resulted in a higher wall shear stress in group A compared with that in group B (2.2 ± 1.1 dyn/cm2 vs 1.16 ± 0.52 dyn/cm2; P = .0001). ConclusionsThe patients who had lost weight after BS experienced noticeable improvements in chronic venous insufficiency compared with the patients who had not lost weight, including an increased rate of ulcer healing, a decreased incidence of venous claudication, and improved quality of life.