Satam Keyuree, Aurshina Afsha, Zhuo Haoran, Zhang Yawei, Cardella Jonathan, Aboian Edouard, Tonnessen Britt, Guzman Raul J, Ochoa Chaar Cassius Iyad
Yale School of Medicine, New Haven, CT.
Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
Ann Vasc Surg. 2023 Apr;91:182-190. doi: 10.1016/j.avsg.2022.11.034. Epub 2023 Jan 21.
Venous ablation (VA) of the saphenous vein is the most common procedure performed for venous insufficiency. The incidence of concomitant deep venous reflux (DVR) in patients undergoing VA is unknown. Our hypothesis is that patients undergoing saphenous VA with concomitant DVR exhibit a higher clinical, etiology, anatomy, and pathophysiology (CEAP) stage and less relief after VA compared to patients without DVR.
Electronic medical records of patients treated with saphenous VA at a tertiary care center from March 2012 to June 2016 were reviewed. Patients were divided into 2 groups based on presence or absence of DVR on initial ultrasound (US) before saphenous VA. Patient characteristics and outcomes were compared. A telephone survey was conducted to assess long-term symptomatic relief, compliance with compression, and pain medication use. Subgroup analysis of patients with post-thrombotic versus primary DVR was performed.
362 patients underwent 497 ablations, and the incidence of DVR (>1 sec) was 20% (N = 71). Patients with DVR were significantly more likely to be male (46.4% vs. 32.1%, P = 0.021) and of Black race (21.2% vs. 5.5%, P = 0.0001) compared to patients without DVR. Patients with DVR were more likely to have a history of deep vein thrombosis (DVT) (15.1% vs. 7.9%, P = 0.045), but there was no difference in other comorbidities. There was no significant difference in presenting symptoms, CEAP stage, or symptom severity based on numeric rating scale (NRS) (0-10) for pain and swelling. Clinical success of saphenous VA was comparable between the 2 groups, but patients with DVR were more likely to develop endovenous heat-induced thrombosis (EHIT) II-IV (6% vs. 1%, P = 0.002). After a mean follow-up of 26 months, there was still no difference in pain or swelling scores, but patients with DVR were more likely to use compression stockings and used them more frequently. Only 11 of 71 patients with DVR had a history of DVT. Patients with post-thrombotic DVR were significantly older than patients with primary DVR (67.3 vs. 57.2, P = 0.038) and exhibited a trend toward more advanced venous disease (C4-C6: 45.4% vs. 33.3%, P = 0.439).
In this study, 20% of patients undergoing saphenous VA demonstrated DVR, which was more common in Black men. Presence of DVR is associated with increased risk of EHIT after saphenous VA but does not seem to impact disease severity or clinical relief after ablation. Larger studies are needed to understand outcome differences between post-thrombotic and primary DVR.
大隐静脉消融术（VA）是治疗静脉功能不全最常用的手术。接受VA手术的患者中合并深静脉反流（DVR）的发生率尚不清楚。我们的假设是，与无DVR的患者相比，合并DVR接受大隐静脉VA手术的患者临床、病因、解剖和病理生理（CEAP）分期更高，VA术后缓解程度更低。
回顾了2012年3月至2016年6月在一家三级医疗中心接受大隐静脉VA治疗的患者的电子病历。根据大隐静脉VA术前首次超声（US）检查有无DVR将患者分为两组。比较患者特征和结局。进行电话调查以评估长期症状缓解情况、压迫治疗依从性和止痛药物使用情况。对血栓形成后DVR与原发性DVR患者进行亚组分析。
362例患者接受了497次消融，DVR（>1秒）发生率为20%（N = 71）。与无DVR的患者相比，有DVR的患者男性比例显著更高（46.4%对32.1%，P = 0.021），黑人种族比例更高（21.2%对5.5%，P = 0.0001）。有DVR的患者更可能有深静脉血栓形成（DVT）病史（15.1%对7.9%，P = 0.045），但其他合并症无差异。根据疼痛和肿胀的数字评分量表（NRS）（0 - 10），两组患者的首发症状、CEAP分期或症状严重程度无显著差异。两组大隐静脉VA的临床成功率相当，但有DVR的患者更易发生II - IV级静脉内热诱导血栓形成（EHIT）（6%对1%，P = 0.002）。平均随访26个月后，疼痛或肿胀评分仍无差异，但有DVR的患者更可能使用弹力袜且使用频率更高。71例有DVR的患者中只有11例有DVT病史。血栓形成后DVR患者比原发性DVR患者年龄显著更大（67.3对57.2，P = 0.038），且静脉疾病有更严重趋势（C4 - C6：45.4%对33.3%，P = 0.439）。
在本研究中，20%接受大隐静脉VA手术的患者存在DVR，在黑人男性中更常见。DVR的存在与大隐静脉VA术后EHIT风险增加相关，但似乎不影响疾病严重程度或消融术后的临床缓解情况。需要更大规模的研究来了解血栓形成后DVR与原发性DVR的结局差异。
