Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
J Vasc Surg Venous Lymphat Disord. 2024 Jul;12(4):101873. doi: 10.1016/j.jvsv.2024.101873. Epub 2024 Mar 19.
Endovenous thermal ablation (EVTA) is a prevalent treatment option for patients with severe venous disease. However, the decision to intervene for patients with less severe disease (CEAP [clinical, etiology, anatomy, pathophysiology] C2 and C3) is less clear and becomes further complicated for patients with obesity, a pathology known to increase venous disease symptom severity. Therefore, the objective of this study was to use the Society for Vascular Surgery Vascular Quality Initiative database to evaluate outcomes after EVTA in obese patients with CEAP C2 and C3 venous insufficiency.
Using the Society for Vascular Surgery Vascular Quality Initiative database, we retrospectively analyzed the initial procedure of all patients with a CEAP clinical class of C2 or C3 who underwent EVTA from January 2015 to December 2021. Patients were grouped by obesity, defined as a body mass index of ≥30 kg/m. The primary outcome was the change in venous clinical severity score (VCSS) from the procedure to the patient's initial follow-up. The secondary outcomes included the change in patient-reported outcomes at follow-up via the HASTI (heaviness, achiness, swelling, throbbing, itching) score, incidence of follow-up complications, and recanalization of treated veins. The change in the VCSS and HASTI score were analyzed using Student t tests, and complications and recanalization were assessed using the Fisher exact test. Significant outcomes were confirmed by multiple variable logistic regression. The remaining significant variables were then analyzed, with obesity categorized using the World Health Organization classification system to analyze how increasing obesity levels affect outcomes.
There were 8146 limbs that met the inclusion criteria, of which 5183 (63.6%) were classified as nonobese and 2963 (36.4%) as obese. Obesity showed no impact on improvement in the VCSS (-3.29 vs -3.35; P = .408). Obesity was found to be associated with a larger improvement in overall symptoms, as evidence by a greater improvement in the HASTI score (-7.24 vs -6.62; P < .001). Obese limbs showed a higher incidence of superficial phlebitis (1.5% vs 0.7%; P = .001), but no difference was found in recanalization or any other complication.
These data suggest that obese patients with CEAP clinical class C2 or C3 experience greater improvement in their perceived symptoms after EVTA with little difference in clinical improvement and complications compared with nonobese patients. Although obesity has been associated with increased severity of venous disease symptoms, obese patients are able to derive significant relief after treatment during the short term and may experience greater relief of symptoms than nonobese patients when treated at more mild disease presentations.
静脉腔内热消融术（EVTA）是治疗严重静脉疾病患者的一种常见治疗选择。然而，对于临床分期（CEAP）为 C2 和 C3 的疾病程度较轻的患者，干预的决策就不那么明确了，对于肥胖患者来说，这个问题变得更加复杂，因为肥胖是已知会增加静脉疾病症状严重程度的一种病理状态。因此，本研究的目的是利用血管外科学会血管质量倡议数据库评估肥胖患者（体质量指数≥30 kg/m）接受 EVTA 治疗后 CEAP C2 和 C3 静脉功能不全的结局。
利用血管外科学会血管质量倡议数据库，我们回顾性分析了 2015 年 1 月至 2021 年 12 月期间接受 EVTA 的所有 CEAP 临床 C2 或 C3 级别的患者的初始手术情况。根据体质量指数（BMI）是否≥30 kg/m 将患者分为肥胖组和非肥胖组。主要结局是从手术到患者首次随访时静脉临床严重程度评分（VCSS）的变化。次要结局包括通过 HASTI（沉重感、疼痛、肿胀、悸动、瘙痒）评分评估患者在随访时的报告结局变化、随访时的并发症发生率和治疗静脉的再通率。使用学生 t 检验分析 VCSS 和 HASTI 评分的变化，使用 Fisher 确切检验评估并发症和再通情况。通过多变量逻辑回归确认有意义的结果。然后分析其他有意义的变量，使用世界卫生组织（WHO）分类系统对肥胖进行分类，以分析肥胖程度的增加如何影响结局。
共纳入 8146 条肢体，其中 5183 条（63.6%）为非肥胖，2963 条（36.4%）为肥胖。肥胖对 VCSS 的改善没有影响（-3.29 与-3.35；P=0.408）。肥胖与整体症状的更大改善有关，HASTI 评分的改善更大（-7.24 与-6.62；P<0.001）。肥胖肢体更易发生浅表性静脉炎（1.5%与 0.7%；P=0.001），但再通率或任何其他并发症无差异。
这些数据表明，CEAP 临床 C2 或 C3 级别的肥胖患者在接受 EVTA 治疗后，症状感知有更大程度的改善，与非肥胖患者相比，临床改善和并发症无差异。尽管肥胖与静脉疾病症状严重程度增加有关，但肥胖患者在短期内接受治疗后能够获得显著缓解，并且在治疗更轻度疾病表现时，症状缓解可能比非肥胖患者更明显。
