Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):113-121.e3. doi: 10.1016/j.jvsv.2020.05.008. Epub 2020 May 26.
Venous insufficiency is commonly bilateral, and patients often prefer single-episode care compared with staged procedures. Few studies have investigated clinical outcomes after unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Here, we report data from the Vascular Quality Initiative regarding truncal venous ablation for chronic venous insufficiency.
Using data from the Vascular Quality Initiative, we investigated immediate postoperative as well as long-term clinical and patient-reported outcomes of patients undergoing unilateral vs bilateral truncal endovenous ablation from 2015 to 2019. We further investigated outcomes between staged bilateral and concurrent bilateral ablations. Preprocedural and postprocedural comparisons were performed using t-test, χ test, or their nonparametric counterpart when appropriate. Multivariable ordinal logistic regression was performed on ordinal outcome variables.
A total of 5029 patients were included, of whom 3782 (75.2%) underwent unilateral procedures. Median follow-up was 227 days (interquartile range [IQR], 55-788 days). Unilateral patients were less likely to be female (67.0% vs 70.3%; P = .031) and white (86.3% vs 91.2%; P < .001) and had lower body mass index (30.3 ± 7.3 kg/m vs 31.8 ± 7.6 kg/m; P < .001) compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments (23.0% vs 15.7%; P < .001) and had higher median preprocedural Venous Clinical Severity Score (VCSS; 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). No difference was seen in complications (6.9% vs 8.2%; P = .292), and systemic complications were rare in both groups. No difference was seen in VCSS improvement after treatment (median, 3 [IQR, 1-6] for unilateral; median, 3 [IQR 1-5] for bilateral; P = .055). In comparing staged with concurrent bilateral procedures, there was no difference in overall complications (7.5% vs 12.2%; P = .144). Staged bilateral patients were older (56.9 ± 13.3 years vs 54.2 ± 12.9 years; P = .002), less likely to have had prior varicose vein treatment (14.3% vs 19.8%; P = .020), and more likely to be therapeutically anticoagulated (10.8% vs 6.5%; P = .028) compared with concurrent bilateral patients. Staged patients also have higher preprocedural VCSS compared with concurrent patients (median, 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). In multivariable analysis, there was no difference in the likelihood of VCSS improvement for concurrent compared with staged procedures (odds ratio, 0.70; 95% confidence interval, 0.40-1.24; P = .226).
Concurrent bilateral truncal endovenous ablation can be performed safely without increased morbidity compared with staged bilateral or unilateral ablations.
静脉功能不全通常是双侧的，与分期手术相比，患者通常更喜欢单次治疗。很少有研究调查单侧与双侧静脉消融术或分期与同期双侧手术之间的临床结果。这里，我们报告了血管质量倡议（Vascular Quality Initiative）关于慢性静脉功能不全的主干静脉消融的数据。
使用血管质量倡议的数据，我们调查了 2015 年至 2019 年期间接受单侧与双侧主干静脉内消融术的患者的即刻术后以及长期临床和患者报告的结果。我们进一步调查了分期双侧与同期双侧消融之间的结果。使用 t 检验、χ 检验或适当的非参数对应物进行术前和术后比较。对有序结果变量进行多变量有序逻辑回归。
共纳入 5029 例患者，其中 3782 例（75.2%）接受了单侧手术。中位随访时间为 227 天（四分位距[IQR]，55-788 天）。与接受双侧手术的患者相比，单侧患者更不可能是女性（67.0% vs 70.3%；P =.031）和白人（86.3% vs 91.2%；P <.001），体重指数（BMI）更低（30.3 ± 7.3 kg/m 比 31.8 ± 7.6 kg/m；P <.001）。此外，与接受双侧手术的患者相比，单侧患者先前的静脉曲张治疗次数较少（23.0% vs 15.7%；P <.001），术前静脉临床严重程度评分（VCSS）中位数较高（8 [IQR，6-10] 比 7 [IQR，5.5-9]；P <.001）。并发症无差异（6.9% vs 8.2%；P =.292），且两组均罕见全身性并发症。治疗后 VCSS 改善无差异（单侧中位数为 3 [IQR，1-6]；双侧中位数为 3 [IQR 1-5]；P =.055）。在比较分期与同期双侧手术时，总体并发症无差异（7.5% vs 12.2%；P =.144）。分期双侧患者年龄较大（56.9 ± 13.3 岁 vs 54.2 ± 12.9 岁；P =.002），先前静脉曲张治疗的可能性较小（14.3% vs 19.8%；P =.020），接受治疗性抗凝的可能性较大（10.8% vs 6.5%；P =.028）与同期双侧患者相比。分期患者的术前 VCSS 也高于同期患者（中位数，8 [IQR，6-10] 比 7 [IQR，5.5-9]；P <.001）。多变量分析显示，同期与分期手术相比，VCSS 改善的可能性无差异（优势比，0.70；95%置信区间，0.40-1.24；P =.226）。
与分期双侧或单侧消融术相比，同期双侧主干静脉内消融术可安全进行，且不会增加发病率。
