Quickshot: Not Entirely in Vein: Predictors of Progressive Chronic Venous Insufficiency and Mediators of Successful Endovenous Laser Ablation

Venous insufficiency (VI) is a common disorder and can lead to significant limb discomfort and morbidity.  Comorbidities and risk factors that may impact the trajectory of disease progression or responsiveness remain less clear.   The purpose of this study is to evaluate commonly used scores for severity of venous disease including Venous Clinical Severity Score (VCSS) and the CEAP (Clinical, Etiological, Anatomic, Pathophysiologic) score and whether they predict objective data by vascular ultrasound and if they change with successful interventional therapy (Endovenous Laser Ablation, EVLA).

Methods:

A retrospective study of 123 limbs from 106 patients diagnosed and treated with sclerotherapy for VI were conducted. CEAP and VCSS scores were recorded before and after interventional therapy.  Physiological data from venous ultrasound (reflux time, vein size) were evaluated in the context of clinical variables including body mass index (BMI), and whether these data were associated with sex, race, age, and location of vein disease.  Spearman’s Rho examined correlations between relevant clinical variables.

Results:

Patients (mean age 55, 62% female) and  nearly 50% of whom had elevated BMIs, displayed a
moderate correlation between CEAP and baseline VCSS scores  (r = 0.57, p< 0.001) suggesting good concordance.  Baseline VCSS correlated with large vein diameter (r = 0.25, p=0.009).   EVLA did not improve VCSS in a small number of limbs (n=25).  All patients with CEAP scores of 4b or higher showed improvement after sclerotherapy.  For each point increase in baseline VCSS score, the odds of a lack of improvement decreased by 33%. BMI was positively associated with the baseline VCSS and vein diameter.  Finally, patients with higher BMIs experienced larger decreases in VCSS after treatment with EVLA.

Conclusions:

Our major findings suggest that CEAP and baseline VCSS are modestly associated. Baseline VCSS was positively associated with vein diameter and BMI in patients with CVI treated with EVLA.  Higher CEAP scores and prior EVLA were predictors of a more favorable outcome with subsequent EVLA.  Patients with higher BMIs were noted to have larger decreases in VCSS scores after intervention. These findings provide valuable insight into the treatment of patients with venous insufficiency and the importance of tailored care.