The Impact of Great Saphenous Vein Size on Gender, Clinical Severity, and Outcome of Patients Undergoing Vein Ablation for Varicose Veins

Abstract

Policies of insurance carriers have used truncal vein size as a criterion for coverage. The objective of this study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on the patient’s presentation and clinical outcomes. Patients in a national cohort were prospectively captured in the Vascular Quality Initiative Varicose Vein Registry. From January 2015 to October 2017, the Vascular Quality Initiative Varicose Vein Registry database was queried for all patients undergoing varicose vein procedures. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class, Venous Clinical Severity Score, and patient-reported outcomes were compared for GSV size <5 mm (group 1) vs 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 the procedure in this population, a matched pairs signed rank Wilcoxon test was performed for each group separately. During the study period, 5757 vein ablation procedures were performed for GSV: 770 GSV size <5 mm and 4987 GSV size ≥5 mm. Group 1 patients were more likely to be female (81.7% vs 68.4%; P = .001) and older (56.8 years vs 55.6 years; P = .012). CEAP scores were higher in group 2 compared with group 1 (P = .001). Maximal GSV diameter in group 2 was significantly higher (8.32 mm vs 3.86 mm; P = .001); 64% of group 2 underwent radiofrequency thermal ablation compared with 59.2% of group 1 (P = .001). There were no deaths in either group. Group 2 had more complications after the procedure (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%; P = .001), developed partial recanalization rate (0.8% vs 0.3%; P = .001), and missed more work days (2.32 days vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but there was a higher rate of paresthesia in group 1. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, and itching) score. The degree of symptomatic improvement between the groups was similar (Table). All patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation regardless of size. Patients with preoperative GSV size ≥5 mm had similar improvement in symptoms but sustained an increased complication rate. Patients with smaller vein size should not be denied intervention or coverage on the basis of size criteria.TableVenous Clinical Severity Score (VCSS) and heaviness, achiness, swelling, throbbing, and itching (HASTI) improvements based on great saphenous vein (GSV) sizeGroup 1, GSV <5 mmGroup 2, GSV ≥5 mmP valueVCSS improvement2.783.16.833HASTI improvement5.615.71.719 Open table in a new tab