Complications of Varicose Vein Interventions in the Vascular Quality Initiative

Treatment of superficial venous disease is generally considered low risk. However, the prevalence of procedural complications and risk factors for adverse events are not well described. This study aims to evaluate patient and procedural factors associated with complications following varicose vein interventions.



Methods:

We performed a retrospective review of the VQI Varicose Vein Registry from 2014 to 2018. We evaluated all procedures performed for venous insufficiency.  Patient demographics and history, procedural details, and outcomes were recorded. Major periprocedural complications were defined as severe allergic reaction, transient ischemic attack, stroke, pulmonary embolism, or death. Major long-term procedural complications were defined as bleeding requiring intervention, deep vein thrombosis (DVT), significant wound infection, or intervention-associated skin ulcers noted during follow up. Univariate and multivariate comparisons were performed as appropriate.



Results:

A total of 12,176 procedures were analyzed. Most procedures (10604, 87.1%) involved treatment of truncal veins while a small percentage involved treatment of perforators (450, 3.7%). Both truncal and perforator veins were treated in 272 (2.2%) procedures. Mean age was 56.0 years and 71.2% were female. Fifty-two (0.4%) procedures had a peri-procedural complication. Major peri-procedural complications occurred in 5 (0.04%) cases. Four percent (489) procedures had a long-term procedural complication noted at follow up.  Major long-term procedural complications occurred in 86 (0.71%) cases.

Major peri-procedural complications were associated with use of general anesthesia (80% versus 18.9%, p=0.004) and interventions performed at an ambulatory surgery center (80% versus 13.3%, p=0.006). BMI was significantly higher in procedures with major periprocedural complications (44.9 vs 30.2 kg/m², p< 0.001).  There was no difference in demographics, disease severity by VCSS and CEAP, venous history, compression or anticoagulation use.  

Major long-term procedural complications were associated with male gender (48.8% male versus 28.7% male, p< 0.001), prior DVT (p=0.04), prior phlebitis (p=0.03), treatment of more veins during the procedure (mean 2.1 versus 1.8, p=0.03), and continued use of compression (p=0.001) and anticoagulation (p< 0.001) at follow-up.  Patients who were treated with radiofrequency ablation (RFA) (0.9% versus 0.5%, p=0.03) and phlebectomy (0.9% versus 0.6%, p=0.03) experience more complications.  After multivariate logistic regression, gender, RFA, phlebectomy, chronic anticoagulation, and continued compression remained independent risk factors for long-term procedural complications.



Conclusions:

This study is the largest VQI based data describing major complications following treatment of venous insufficiency.  Complications associated with varicose vein treatment are rare. Peri-procedural complications stem primarily from surgical environment while long-term complications are associated with patient factors and procedure type.