Higher CEAP Classification Is Associated with Lower Odds of Improvement in Patient-Reported Outcomes After Endovenous Thermal Ablation

Endovenous thermal ablation (EVTA) of superficial lower extremity veins performed with laser or radiofrequency ablation has high rates of technical success. However, it is unknown how improvement in patient-reported outcomes (PROs) after EVTA is related to the pre-operative clinical, etiological, anatomical, and pathophysiological (CEAP) classification. This study investigated whether patients with higher clinical CEAP class have greater perceived symptomatic improvement than patients with lower pre-procedural CEAP classes.

Methods:

A retrospective cohort analysis of Vascular Quality Initiative (VQI) Registry data from 2014-2021 was conducted. Patients who underwent EVTA and followed up within 3 months were included, while those with a CEAP class of C0, inpatient procedure site, or age < 18 were excluded. Patient-reported limb appearance, work impact, and a composite score of heaviness, achiness, swelling, throbbing and itching (HASTI) were analyzed on a per-limb basis. The presence and degree of improvement in PROs were tested with multivariable mixed-effects logistic regression and multivariable mixed-effects linear regression, respectively. The models adjusted for CEAP class, demographics and anatomic variables as fixed effects and clustered by VQI center. Demographic and comorbidity data were compared across CEAP classes with Kruskal-Wallis tests.

Results:

23,819 patients met inclusion criteria, and 34,372 limbs were analyzed for the study period. Patient demographics and comorbid venous pathologies were not evenly distributed among the CEAP classes on Kruskal-Wallis testing. Higher clinical CEAP classification was associated with lower odds of improvement in HASTI score (odds ratio [OR]:0.95, 95% confidence interval [CI]:0.90-1.00; p=0.035), patient-reported appearance (OR:0.89, 95% CI:0.86-0.93; p< 0.001), and impact on work (OR:0.94, 95% CI:0.90-0.97; p=0.001) using mixed-effects logistic regression (Table I). Despite lower odds of improvement as a binary outcome, higher CEAP classes were associated with a greater magnitude of improvement in HASTI score (OR:1.19, 95% CI:1.05-1.34; p=0.005) than lower CEAP classes using mixed-effects linear regression. Post-procedure limb appearance was negatively associated with CEAP class (OR:0.95, 95% CI:0.92-0.98; p< 0.001).

Conclusions:

Higher CEAP classification is associated with lower odds of improvement in HASTI score, appearance, and work impact after EVTA for venous insufficiency. Despite the lower odds of improvement, higher CEAP class was associated with greater magnitude of improvement in HASTI than lower CEAP classes. The degree of improvement in appearance was negatively associated with higher CEAP class. These findings are important for patient counseling regarding what outcomes they can expect with EVTA based on their pre-operative clinical presentation.