The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation

• Published in: Journal of vascular surgery 2007-05, Vol.45 (5), p.1008-1015.e2
• Main Authors: Vasquez, Michael A., MD, Wang, Jiping, MD, PhD, Mahathanaruk, Marchyan, BS, Buczkowski, Glenn, RPAC, Sprehe, Esther, MS, ANP, Dosluoglu, Hasan H., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Catheter Ablation; Extremities - physiopathology; Female; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Risk Factors; Saphenous Vein - surgery; Severity of Illness Index; Surgery; Treatment Failure; Vascular Surgical Procedures; Venous Insufficiency
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2006.12.061

Objectives The goal of endovenous ablation is to reduce the symptoms associated with chronic venous insufficiency. This prospective study was designed to apply the venous clinical severity score to limbs before and after endovenous saphenous vein radiofrequency ablation and to identify risk factors associated with treatment failure. Methods Between September 2003 and March 2005, 499 patients underwent 682 saphenous vein radiofrequency ablation procedures. Preoperative venous clinical severity scores were documented. Follow-up clinical and duplex examinations were performed at 4 days, 4 weeks, and 4 months after saphenous vein radiofrequency ablation and at ≥6 months thereafter. Venous clinical severity scoring was repeated at follow-up visits, and patients were asked to evaluate their level of satisfaction with the procedure. Results The mean ± standard deviation age of the patients was 53.5 ± 13.3 years (range, 28 to 86 years), and 68% were women. Pretreatment CEAP clinical class C3/C4 comprised 80% of limbs (520/682). Preoperative, 4-day, 4-week, and 4-month venous clinical severity scores were, respectively, 8.8 ± 3.7 in 648 limbs, 5.2 ± 3.0 in 629, 4.1 ± 2.4 in 530, and 3.3 ± 1.6 in 479 limbs. Saphenous vein radiofrequency ablation significantly reduced pain related to lower extremity venous disease from 95.7% to 15.2% ( P < .0001) and edema from 92.4% to 17.0% ( P < .0001). Before treatment, venous stasis ulcers were present in 52 limbs and healed at a rate of 86%. Complications in 633 limbs at last follow-up included superficial thrombophlebitis in 12.0%, paresthesia in 0.3%, and nonocclusive thrombus extension in 0.2%. No skin thermal injury was observed. Fewer than 2% of patients reported dissatisfaction with their procedural outcome. Age (relative risk, 0.98; P = .06), female sex (relative risk, 0.19; P < .0001), and tumescent volume >250 mL (relative risk, 0.59; P = .06) were associated with higher rates of occlusion. The overall occlusion rate was 87.1%. Conclusions As determined by the venous clinical severity score, treatment of saphenous vein reflux with endovenous radiofrequency ablation results in the clinical improvement of symptoms and aids in the healing of venous ulcers. Age, female sex, and tumescent volume are associated with high success rates of occlusion. We found the venous clinical severity score to be an excellent stand-alone tool for assessing outcomes after saphenous vein radiofrequency ablation.