Clinical Assessment of Endovenous Thermal Ablation Combined With Concomitant Phlebectomy for the Treatment of Lower Limb Varicose Veins With or Without Poor Glycemic Control

Abstract

In this study of >500 patients, with 33% classified as having diabetes, varicose vein treatment with thermal ablation and stab phlebectomy was safe and effective, regardless of glycemic control. This study retrospectively evaluated 501 patients treated for unilateral symptomatic varicose veins with combined thermal ablation and stab phlebectomy. Of the cohort, 164 (33%) had had a diagnosis of type 2 diabetes mellitus. These patients were further subdivided into those with good glycemic control (hemoglobin A1c [HbA1c] <7%; n = 93) and those with poor glycemic control (HbA1c ≥7%; n = 71). All the patients were followed up for 1 year, and the venous clinical severity score was used before and after the procedure. The group demographics were comparable expect for the greater occurrence of venous ulcerations, C6 disease, in the poor glycemic control group. All the patients, with and without good glycemic control, had had good outcomes in terms of edema and pain improvement, ulcer healing, and quality of life parameters. Venous surgeons clearly must weigh the benefits and risks of performing interventions on patients with diabetes and poor glycemic control. These patients have a much higher risk of less than satisfactory outcomes, cardiac and anesthetic complications, and infection. In my practice, I would be turning cartwheels if my patients were able to maintain a HbA1c of <7%, which is not even the most desirable rate of control. For patients with venous ulcerations, any improvement in the anti-inflammatory state caused by diabetes can only aid in the healing process. I am left wondering about the measurement and accuracy of the glycemic control in this study. Were measurements of HbA1c performed, revealing changes in glycemic control that could have influenced the outcomes, or was the HbA1c only measured at the intervention? What level of HbA1c was considered prohibitive? Were the glycemic levels more difficult to control to begin with for the venous ulcer patients with diabetes as a direct result of the ulcer? Finally, was this an older group with more longstanding diabetes and the resulting inflammation and oxidative stress?