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 Mar;9(2):361-368.e3. doi: 10.1016/j.jvsv.2020.04.031. Epub 2020 Jun 24.
Few studies have investigated outcomes after truncal endovenous ablation in patients with combined deep and superficial reflux and no studies have evaluated patient-reported outcomes.
We investigated the short- and long-term clinical and patient-reported outcomes among patients with and without deep venous reflux undergoing truncal endovenous ablation from 2015 to 2019 in the Vascular Quality Initiative. Preprocedural and postprocedural comparisons were performed using the t-test, χ, or their nonparametric counterpart when appropriate. Multivariable logistic regression models were used to assess for confounding.
A total of 4881 patients were included, of which 2254 (46.2%) had combined deep and superficial reflux. The median follow-up was 336.5 days. Patients with deep reflux were less likely to be female (65.9% vs 69.9%; P = .003), more likely to be Caucasian (90.2% vs 86.5%; P = .003) and had no difference in BMI (30.6 ± 7.5 vs 30.6 ± 7.2; P = .904). Additionally, no difference was seen in rates of prior varicose vein treatments, number of pregnancies, or history of deep venous thrombosis; however, patients without deep reflux were more likely to be on anticoagulation at the time of the procedure (10.9% vs 8.1%; P < .001). Patients without deep reflux had slightly higher median preprocedural Venous Clinical Severity Score (VCSS) scores (8 [interquartile range (IQR), 6-10]) vs 7 [IQR, 6-10]; P = .005) as well as postprocedural VCSS scores (5 [IQR, 3-7] vs 4 [IQR, 2-6]; P < .001). The median change in VCSS from before to after the procedure was lower for patients without deep reflux (3 [IQR, 1.0-5.5] vs 3.5 [IQR, 1-6]; P = .006). Total symptom score was higher for patients without deep reflux both before (median, 14 [IQR, 10-19] vs median, 13.5 [IQR, 9.5-18]; P = .005) and postprocedurally (median, 4 [IQR, 1-9] vs median, 3.25 [IQR, 1-7]; P < .001), but no difference was seen in change in symptom score (median, 8 [IQR, 4-13] vs median, 9 [IQR, 4-13]; P = .172). Patients with deep reflux had substantially higher rates of complications (10.4% vs 3.0%; P < .001), with a particular increase in proximal thrombus extension (3.1% vs 1.1%; P < .001). After controlling for confounding, this estimate of effect size for any complication increased (odds ratio, 5.72; 95% confidence interval, 2.21-14.81; P < .001).
No significant difference is seen in total symptom improvement when patients undergo truncal endovenous ablation with concomitant deep venous reflux, although a greater improvement was seen in VCSS score in these patients. Patients with deep venous reflux had a significantly increased rate of complications, independent of confounding variables, and should be counseled appropriately before the decision for treatment.
很少有研究调查伴有深静脉和浅静脉反流的患者行主干静脉内消融术的结果，也没有研究评估患者报告的结局。
我们调查了 2015 年至 2019 年期间在血管质量倡议中接受主干静脉内消融术的深静脉反流患者和无深静脉反流患者的短期和长期临床及患者报告结局。使用 t 检验、χ2 检验或适当的非参数检验进行术前和术后比较。使用多变量逻辑回归模型评估混杂因素。
共纳入 4881 例患者，其中 2254 例（46.2%）合并深静脉和浅静脉反流。中位随访时间为 336.5 天。深静脉反流患者女性比例较低（65.9%比 69.9%；P=.003），白种人比例较高（90.2%比 86.5%；P=.003），BMI 无差异（30.6±7.5 比 30.6±7.2；P=.904）。此外，两组在既往静脉曲张治疗、妊娠次数或深静脉血栓形成史方面无差异；然而，无深静脉反流患者在手术时更可能正在接受抗凝治疗（10.9%比 8.1%；P <.001）。无深静脉反流患者术前静脉临床严重程度评分（VCSS）中位数较高（8 [四分位距（IQR），6-10] 比 7 [IQR，6-10]；P=.005），术后 VCSS 评分中位数也较高（5 [IQR，3-7] 比 4 [IQR，2-6]；P <.001）。无深静脉反流患者术后 VCSS 评分的中位数变化较小（3 [IQR，1.0-5.5] 比 3.5 [IQR，1-6]；P=.006）。无深静脉反流患者术前（中位数，14 [IQR，10-19] 比中位数，13.5 [IQR，9.5-18]；P=.005）和术后（中位数，4 [IQR，1-9] 比中位数，3.25 [IQR，1-7]；P <.001）总症状评分均较高，但症状评分的中位数变化无差异（中位数，8 [IQR，4-13] 比中位数，9 [IQR，4-13]；P=.172）。深静脉反流患者并发症发生率显著较高（10.4%比 3.0%；P <.001），尤其是近端血栓延伸的发生率较高（3.1%比 1.1%；P <.001）。控制混杂因素后，该并发症发生率的估计效应大小增加（比值比，5.72；95%置信区间，2.21-14.81；P <.001）。
当伴有深静脉反流的患者行主干静脉内消融术时，总症状改善程度无显著差异，尽管这些患者的 VCSS 评分有较大改善。深静脉反流患者的并发症发生率显著增加，且不受混杂因素的影响，在决定治疗前应适当进行咨询。
