Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):128-136. doi: 10.1016/j.jvsv.2020.04.017. Epub 2020 Apr 27.
The policies of insurance carriers have used the truncal vein size as a criterion for coverage. The objective of the present study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on patient 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 who had undergone varicose vein procedures. The CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, Venous Clinical Severity Score, and patient-reported outcomes were compared by GSV size (<5 mm, group 1; ≥5 mm, group 2) before and after the procedures. A 2-sample Wilcoxon test was performed to assess the differences between the 2 groups stratified by GSV size. To assess for postoperative improvement, a matched-pairs Wilcoxon signed rank test was performed for each group separately.
During the study period, 5757 vein ablation procedures had been performed for GSV: 770 for GSV size <5 mm and 4987 for GSV size ≥5 mm. Patients in group 1 were more likely to be women (81.7% vs 68.4%; P = .001) and older (56.8 vs 55.6 years; P = .012). The CEAP clinical class was more advanced in group 2 than in group 1 (P = .001). The maximal GSV diameter in group 2 was significantly greater than in group 1 (8.32 vs 3.86 mm; P = .001); 64% of group 2 and 59.2% of group 1 had undergone radiofrequency thermal ablation (P = .001). No mortalities occurred in either group. Group 2 had more complications postoperatively (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%, P = .001), developed partial recanalization (0.8% vs 0.3%; P = .001), and missed more work days (2.32 vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but group 1 had a higher rate of paresthesia. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, itching) score. The degree of symptomatic improvement between the 2 groups was similar.
All patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation, regardless of GSV size. Patients with a preoperative GSV size ≥5 mm experienced similar improvement in symptoms but an increased complication rate. Patients with a smaller vein size should not be denied intervention or coverage by vein size.
保险公司的政策将隐静脉大小用作承保标准。本研究的目的是比较大隐静脉（GSV）大小≥5mm与<5mm对患者表现和临床结局的影响。
从 2015 年 1 月至 2017 年 10 月，前瞻性地在血管质量倡议静脉曲张学组注册库中纳入全国队列患者。查询血管质量倡议静脉曲张学组注册库，以获取所有接受静脉曲张手术的患者数据。比较术前和术后根据 GSV 大小（<5mm，组 1；≥5mm，组 2）的 CEAP（临床、病因、解剖、病理生理）分类、静脉临床严重程度评分和患者报告的结局。采用两样本 Wilcoxon 检验评估两组间的差异。为评估术后改善情况，对每组分别进行配对样本 Wilcoxon 符号秩检验。
在研究期间，对 5757 例 GSV 消融术进行了分析：GSV 大小<5mm 为 770 例，GSV 大小≥5mm 为 4987 例。组 1 中女性（81.7% vs 68.4%；P=0.001）和年龄较大（56.8 岁 vs 55.6 岁；P=0.012）的患者更常见。组 2 的 CEAP 临床分级比组 1 更严重（P=0.001）。组 2 的最大 GSV 直径明显大于组 1（8.32 毫米 vs 3.86 毫米；P=0.001）；组 2 中有 64%和组 1 中有 59.2%接受了射频热消融（P=0.001）。两组均无死亡病例。组 2 术后并发症更多（0.6% vs 0%；P=0.027），需要术后抗凝治疗（8.8% vs 5%；P=0.001），发生部分再通（0.8% vs 0.3%；P=0.001），缺勤天数更多（2.32 天 vs 1.6 天）。与组 1 相比，两组的血肿发生率相似，但组 1 的感觉异常发生率更高。两组的静脉临床严重程度评分和 HASTI（沉重感、疼痛、肿胀、悸动、瘙痒）评分均有改善。两组症状改善程度相似。
无论 GSV 大小如何，所有患者在静脉内消融术后的临床结局和患者报告的结局均有改善。术前 GSV 大小≥5mm 的患者症状改善相似，但并发症发生率增加。静脉尺寸较小的患者不应因静脉尺寸而被拒绝干预或承保。
