Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI.
Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI.
J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1229-1237.e2. doi: 10.1016/j.jvsv.2022.05.013. Epub 2022 Aug 4.
To evaluate the association between gender and long-term clinician-reported and patient-reported outcomes after endovenous ablation procedures.
This retrospective cohort study of prospectively collected data from the Vascular Quality Initiative's Varicose Vein Registry included patients undergoing endovenous ablation procedures on truncal veins with or without treatment of perforating veins between 2015 and 2019. A univariate analysis included comparisons of preprocedural, postprocedural, and periprocedural change in Venous Clinical Severity Score (VCSS) and total symptom score by gender. Rates of complications including deep vein thrombosis, endovenous heat-induced thrombosis, leg pigmentation, blistering, paresthesia, incisional infection, and any postprocedural complications were reported by gender. Multivariable analysis leveraged linear regression to examine how gender affected the relationships between patient characteristics, complication rates, and periprocedural change in VCSS score and total symptom score.
Of 9743 patients who met the inclusion criteria, 3090 (31.7%) were men and 6653 (68.2%) were women. The perioperative change in VCSS score was greater for men than women (average -4.46 for men vs -4.13 for women; P < .0001). Perioperative change in total symptom score was greater for women than for men (average -10.64 for women vs -9.64 for men; P < .0001). Women had lower incidence of any leg complication (6.1% vs 8.6%; P = .001) endovenous heat-induced thrombosis (1.1% vs 2.2%; P = .002), and infection (0.4% vs 0.7%; P = .001). In multivariable analysis, among patients with a body mass index of more than 40, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2, women had a greater periprocedural change in VCSS score than men.
Women benefited from endovenous ablation similarly as men, with a lower incidence of postprocedural complications. Gender may be useful for patient selection and counseling for endovenous ablation, with particular usefulness among patients with a high body mass index, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2.
评估静脉内消融术后长期临床医生报告和患者报告结局与性别之间的关联。
本研究回顾性分析了 2015 年至 2019 年间，前瞻性收集的来自血管质量倡议静脉曲张登记处的患者数据，这些患者在主干静脉中接受静脉内消融治疗，无论是否同时治疗穿通静脉。单变量分析包括比较性别之间静脉临床严重程度评分（VCSS）和总症状评分的术前、术后和围手术期变化。报告了包括深静脉血栓形成、静脉内热诱导血栓形成、腿部色素沉着、水疱、感觉异常、切口感染和任何术后并发症在内的并发症发生率。多变量分析利用线性回归来检查性别如何影响患者特征、并发症发生率以及 VCSS 评分和总症状评分的围手术期变化之间的关系。
在符合纳入标准的 9743 名患者中，3090 名（31.7%）为男性，6653 名（68.2%）为女性。与女性相比，男性的 VCSS 评分围手术期变化更大（男性平均为-4.46，女性平均为-4.13；P<0.0001）。与男性相比，女性的总症状评分围手术期变化更大（女性平均为-10.64，男性平均为-9.64；P<0.0001）。女性下肢并发症发生率较低（6.1%比 8.6%；P=0.001），静脉内热诱导血栓形成发生率较低（1.1%比 2.2%；P=0.002），感染发生率较低（0.4%比 0.7%；P=0.001）。在多变量分析中，对于 BMI 超过 40、存在深反流以及术前临床、病因、解剖和生理分类为 2 的患者，女性 VCSS 评分的围手术期变化大于男性。
女性与男性一样从静脉内消融中获益，术后并发症发生率较低。性别可能对静脉内消融术患者的选择和咨询有用，在 BMI 较高、存在深反流以及术前临床、病因、解剖和生理分类为 2 的患者中尤其有用。
